Lamsam Chanin, Kaewpornsawan Kamolporn, Luangsa-Ard Jaran, Thephamongkhol Kullathorn, Vanadurongwan Bavornrat, Soparat Krabkaew
Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
J Med Assoc Thai. 2012 Sep;95 Suppl 9:S114-21.
This meta-analysis study compares the treatment outcomes between single bundle (SB) and double bundle (DB) anterior cruciate ligament reconstructions (ACLR) including manual laxity tests, KT-1000 measurements and functional knee scores including International Knee Documentation Committee (IKDC) and Lysholm scores.
Medline, Scopus, Web of Science and Cochrane Central Register of Controlled Trials (January 1985 to March 2008).
All randomized controlled trials reporting one or more outcomes related to single bundle versus double bundle ACLR were recruited in the present study. Random effect models were used to pool the data. Heterogeneity in the effect of treatment was tested on the basis of study quality, randomization status and type of ACLR.
There were 2,119 studies initially identified, 7 studies met our inclusion criteria. Four hundred and eighty two patients (238 in SB group and 244 in DB group) were included in the present study. The results of KT 1,000 arthrometry in 7 studies favor DB-ACLR with statistical significance (p < 0.05). Pivot shift test were available for 374 patients from 6 studies, 183 and 191 patients in SB group and DB group respectively. The results favor DB-ACLR with statistical significance (p < 0.001). IKDC scores were available for 257 patients from 4 studies. The results trend to favor DB-ACLR but not statistically significant (p = 0.17). Lysholm scores were available for 174 patients from 3 studies. The results trend to favor DB-ACLR without statistical significance (p = 0.10).
The present study shows that DB-ACLR provides better AP and rotational stability than SB-ACLR. There is no difference in the results of functional scores. DB-ACLR should be considered in patients who particularly require rotational stability of the knee. In the future, the interesting issue is to develop the functional knee score that is more specific to rotational stability evaluation.
本荟萃分析研究比较单束（SB）和双束（DB）前交叉韧带重建术（ACLR）的治疗效果，包括手法松弛试验、KT-1000测量以及膝关节功能评分，如国际膝关节文献委员会（IKDC）评分和Lysholm评分。
医学文献数据库（Medline）、Scopus数据库、科学引文索引（Web of Science）以及Cochrane对照试验中心注册库（1985年1月至2008年3月）。
本研究纳入了所有报告一项或多项与单束与双束ACLR相关结果的随机对照试验。采用随机效应模型汇总数据。根据研究质量、随机化状态和ACLR类型对治疗效果的异质性进行检验。
最初识别出2119项研究，7项研究符合我们的纳入标准。本研究纳入了482例患者（SB组238例，DB组244例）。7项研究中KT 1000关节测量结果显示DB-ACLR具有统计学意义（p < 0.05）。6项研究中的374例患者可进行轴移试验，SB组和DB组分别有183例和191例患者。结果显示DB-ACLR具有统计学意义（p < 0.001）。4项研究中的257例患者可获得IKDC评分。结果倾向于DB-ACLR，但无统计学意义（p = 0.17）。3项研究中的174例患者可获得Lysholm评分。结果倾向于DB-ACLR，但无统计学意义（p = 0.10）。
本研究表明，DB-ACLR比SB-ACLR提供更好的前后向和旋转稳定性。功能评分结果无差异。对于特别需要膝关节旋转稳定性的患者，应考虑采用DB-ACLR。未来，有趣的问题是开发更特异于旋转稳定性评估的膝关节功能评分。
