Papalia Rocco, Franceschi Francesco, Zampogna Biagio, Tecame Andrea, Maffulli Nicola, Denaro Vincenzo
Department of Orthopaedic and Trauma Surgery, Campus Biomedico University of Rome, Via Alvaro del Portillo 200, Rome, Italy,
Knee Surg Sports Traumatol Arthrosc. 2014 Jan;22(1):154-65. doi: 10.1007/s00167-012-2339-1. Epub 2012 Dec 23.
Partial anterior cruciate ligament (ACL) tears involving the posterolateral (PL) bundle can lead to rotatory laxity of the knee, while tears involving the anteromedial (AM) bundle result in abnormal anteroposterior laxity of the knee. In this systematic review, we examine the best evidence on the management of partial tears of the ACL.
A comprehensive search of several databases was performed from the inception of the database to December 2011, using various combinations of keywords focusing on clinical outcomes of human patients who had partial tears of ACL and who had undergone ACL augmentation. We evaluated the methodological quality of each article using the Coleman Methodology Score.
Ten articles published in peer-reviewed journals were identified (392 males and 242 females), with a mean modified Coleman methodology of 66.1 ± 10.2. Only two studies compared standard ACL reconstruction and augmentation techniques. No study has a sample large enough to allow establishing guidelines. Validated and standardized proprioception assessment methods should be used to report outcomes. Imaging outcomes should be compared to functional outcomes, and a control group consisting of traditional complete ACL reconstruction should be present.
There is a need to perform appropriately powered randomized controlled trials presenting clinical outcome with homogeneous score systems to allow accurate statistical analysis. ACL augmentation technique, preserving the intact AM or PL bundle of the ACL, is encouraging but currently available evidences are too weak to support his routine use in clinical practice.
涉及后外侧（PL）束的前交叉韧带（ACL）部分撕裂可导致膝关节旋转松弛，而涉及前内侧（AM）束的撕裂则会导致膝关节前后向松弛异常。在本系统评价中，我们考察了ACL部分撕裂治疗的最佳证据。
从数据库建立至2011年12月，对多个数据库进行全面检索，使用各种关键词组合，重点关注ACL部分撕裂且接受ACL增强术的人类患者的临床结局。我们使用科尔曼方法评分评估每篇文章的方法学质量。
共识别出10篇发表于同行评审期刊的文章（男性392例，女性242例），平均改良科尔曼方法评分为66.1±10.2。仅有两项研究比较了标准ACL重建和增强技术。没有一项研究的样本量足够大到可以制定指南。应使用经过验证和标准化的本体感觉评估方法来报告结局。影像学结局应与功能结局进行比较，并且应设置一个由传统完全ACL重建组成的对照组。
需要开展具有足够效力的随机对照试验，采用统一的评分系统呈现临床结局，以便进行准确的统计分析。保留ACL完整AM或PL束的ACL增强技术令人鼓舞，但目前可得的证据过于薄弱，无法支持其在临床实践中的常规应用。
