Department of Orthopaedic and Trauma Surgery, Campus Biomedico University of Rome, Via Alvaro del Portillo, Rome, Italy.
Knee Surg Sports Traumatol Arthrosc. 2013 May;21(5):1050-63. doi: 10.1007/s00167-013-2418-y. Epub 2013 Feb 2.
The purpose of this quantitative review is to document effectiveness and complications of posterior cruciate ligament (PCL) surgery and compare outcomes, advantages and disadvantages of reconstructive and augmentation procedures.
A systematic literature search was performed in PubMed, Medline, Ovid, Google Scholar and Embase databases using the combined keywords "PCL reconstruction," "PCL augmentation," "clinical outcomes" and "functional outcomes" with no limit for year of publication. Articles were included if they reported data on clinical, functional and imaging outcomes who had undergone reconstruction or augmentation of the PCL for management of PCL injuries. Two authors screened the selected articles for title, abstract and full text in accordance with predefined inclusion and exclusion criteria. The methodological quality of all articles was assessed by two authors according to the Coleman methodology score. The critical appraisal was made using the Physiotherapy Evidence Database (PEDro) scale.
A total of 34 studies, 22 retrospective, 9 prospective and 5 were randomized control trials were included by full text. The modified Coleman methodology score averaged 70.8 (SD 6.5), median 73 (range from 60 to 82). At IKDC assessment, the average rate of normal (A) and nearly normal (B) outcomes was 89.8% (SD 4.2) (from 85 to 93%; median 91.4) after PCL augmentation and 80.1% (SD 12.4) after PCL reconstruction (from 57.2 to 100%; median 81.8 %) were rated as normal (A) and nearly normal (B). The average Lysholm Knee Scores after PCL augmentation were 93.1 points (SD 1.9) and ranged from 82.1 to 94.2 (median 90.5) after PCL reconstruction. The KT 1000 difference improved from an average preoperative difference of 8.8 mm (SD 0.9) to an average postoperative of 2.1 mm (SD 0.6) after PCL augmentation (average improvement of 6.7 mm (SD 4.7)) and from 8.2 (SD 3.6) to 2.3 mm (SD 2.0) (average improvement of 5.9 mm SD 4.2) after PCL reconstruction. Postoperatively, the Telos stress radiographic side to side difference averagely improved by 8.6 mm (SD 6.1) after PCL augmentation, from 11.1 mm (SD 1.4) to 2.5 mm (SD 0.4), and by 8.0 mm (SD 5.7) after PCL reconstruction, from 11.5 mm (SD 2.2) to 3.5 mm (SD 1.3).
Augmentation and reconstruction procedures are grossly equivalent, but more data examining the long-term functional status, recovery to preinjury daily and sport activities and occurrence of degenerative changes are needed.
IV.
本定量综述的目的是记录后交叉韧带（PCL）手术的效果和并发症，并比较重建和增强手术的结果、优缺点。
在 PubMed、Medline、Ovid、Google Scholar 和 Embase 数据库中，使用“PCL 重建”、“PCL 增强”、“临床结果”和“功能结果”的组合关键词进行了系统的文献检索，对出版物年份没有限制。如果文章报告了有关 PCL 损伤管理的 PCL 重建或增强的临床、功能和影像学结果的数据，则将其纳入。两位作者根据预先设定的纳入和排除标准，对选定的文章进行标题、摘要和全文筛选。根据 Coleman 方法评分，两位作者对所有文章的方法学质量进行了评估。使用物理治疗证据数据库（PEDro）量表进行批判性评价。
通过全文阅读，共纳入 34 项研究，其中 22 项为回顾性研究，9 项为前瞻性研究，5 项为随机对照试验。改良 Coleman 方法评分平均为 70.8（SD 6.5），中位数为 73（范围为 60 至 82）。在 IKDC 评估中，PCL 增强后的正常（A）和接近正常（B）结果的平均率为 89.8%（SD 4.2）（范围为 85%至 93%；中位数 91.4%），PCL 重建后的正常（A）和接近正常（B）结果的平均率为 80.1%（SD 12.4）（范围为 57.2%至 100%；中位数 81.8%）。PCL 增强后的平均 Lysholm 膝关节评分（LKS）为 93.1 分（SD 1.9），范围为 82.1 至 94.2（中位数 90.5），PCL 重建后的平均 Lysholm 膝关节评分（LKS）为 93.1 分（SD 1.9）。KT1000 差值从 PCL 增强前的平均术前差值 8.8mm（SD 0.9）改善至平均术后差值 2.1mm（SD 0.6）（平均改善 6.7mm（SD 4.7）），从 PCL 重建前的 8.2mm（SD 3.6）改善至平均术后差值 2.3mm（SD 2.0）（平均改善 5.9mm SD 4.2）。术后，PCL 增强后的 Telos 应力放射侧间差值平均改善 8.6mm（SD 6.1），从 11.1mm（SD 1.4）改善至 2.5mm（SD 0.4），PCL 重建后的 Telos 应力放射侧间差值平均改善 8.0mm（SD 5.7），从 11.5mm（SD 2.2）改善至 3.5mm（SD 1.3）。
增强和重建手术大致相当，但需要更多的数据来检查长期的功能状态、恢复到受伤前的日常和运动活动以及退行性变化的发生。
IV。
