May Jedediah H, Gillette Blake P, Morgan Joseph A, Krych Aaron J, Stuart Michael J, Levy Bruce A
Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
J Knee Surg. 2010 Jun;23(2):73-9. doi: 10.1055/s-0030-1267468.
Optimal surgical technique for posterior cruciate ligament (PCL) reconstruction remains controversial. Authors have reported satisfactory outcomes with both transtibial and inlay techniques. Although biomechanical data has failed to demonstrate a difference between the two, there is little clinical data directly comparing transtibial versus inlay PCL reconstruction. Evidence-based treatment recommendations are therefore lacking. The purpose of this study was to perform an evidence-based systematic review comparing the clinical results of transtibial and inlay PCL reconstruction. A comprehensive search of MEDLINE and the Cochrane databases for all relevant articles published from 1980 to 2010 on the clinical outcomes of transtibial and inlay PCL reconstruction was performed. Inclusion criteria included articles published in (1) English, (2) human subjects, (3) between the years 1980 and 2010, (4) minimum of 24-month follow-up, (5) measures of clinical and functional outcomes, and (6) isolated grade III PCL injuries. Exclusion criteria included (1) technique description only, (2) case reports, (3) multiligament knee injuries, (4) PCL bony avulsion, and (5) revision PCL surgery. Our review identified 26 relevant clinical studies. Twenty articles focused on transtibial PCL reconstruction, 3 articles focused on inlay PCL reconstruction, and 3 articles compared the two techniques. No prospective studies directly compared transtibial PCL reconstruction with inlay PCL reconstruction. Currently, there is a paucity of objective data comparing the outcomes of transtibial versus inlay PCL reconstruction. This systematic review demonstrated satisfactory clinical and functional results for both surgical techniques. Prospective randomized clinical trials are needed to evaluate the best treatment strategy. At the present time, surgeon preference appears to be a reasonable option.
后交叉韧带（PCL）重建的最佳手术技术仍存在争议。作者报告经胫骨技术和镶嵌技术均取得了满意的结果。尽管生物力学数据未能显示出两者之间的差异，但几乎没有临床数据直接比较经胫骨与镶嵌式PCL重建。因此缺乏基于证据的治疗建议。本研究的目的是进行一项基于证据的系统评价，比较经胫骨和镶嵌式PCL重建的临床结果。对MEDLINE和Cochrane数据库进行全面检索，以查找1980年至2010年发表的所有关于经胫骨和镶嵌式PCL重建临床结果的相关文章。纳入标准包括发表于（1）英文、（2）人体研究对象、（3）1980年至2010年之间、（4）至少24个月的随访、（5）临床和功能结果的测量，以及（6）单纯III级PCL损伤。排除标准包括（1）仅技术描述、（2）病例报告、（3）多韧带膝关节损伤、（4）PCL骨撕脱，以及（5）PCL翻修手术。我们的综述确定了26项相关临床研究。20篇文章聚焦于经胫骨PCL重建，3篇文章聚焦于镶嵌式PCL重建，3篇文章比较了这两种技术。没有前瞻性研究直接比较经胫骨PCL重建与镶嵌式PCL重建。目前，比较经胫骨与镶嵌式PCL重建结果的客观数据很少。这项系统评价表明两种手术技术均取得了满意的临床和功能结果。需要进行前瞻性随机临床试验来评估最佳治疗策略。目前，术者偏好似乎是一个合理的选择。
