Taylor Samuel A, Khair M Michael, Roberts Timothy R, DiFelice Gregory S
Orthopaedic Trauma and Sports Medicine Services, Hospital for Special Surgery, New York, New York, U.S.A.
Orthopaedic Trauma and Sports Medicine Services, Hospital for Special Surgery, New York, New York, U.S.A..
Arthroscopy. 2015 Nov;31(11):2233-47. doi: 10.1016/j.arthro.2015.05.007. Epub 2015 Jul 10.
To describe the clinical and preclinical research conducted on primary repair of the anterior cruciate ligament (ACL) during the past 10 years.
A systematic search of PubMed, the Cochrane Central Register of Controlled Trials, and Embase was performed for all English-language studies published between 2003 and April 2014 on primary repair of the ACL.
Twenty-six studies met the inclusion and exclusion criteria. In the clinical research group, 8 studies (166 patients; age range, 10 to 71 years) met the inclusion and exclusion criteria and were largely long-term clinical outcome studies, based on the original cohorts from the 1970s and 1980s, and suggested high failure rates, additional surgery, and revision for instability. A subset of patients, however, achieved good to excellent subjective and objective long-term outcomes. In the preclinical research group, 18 studies met the inclusion and exclusion criteria and were based on an ACL transection model; they suggested that (1) stabilization of the knee with an internal suture strut improved the healing and biomechanical properties of the repaired ACL, (2) "enhancing" the repair with biological collagen-platelet composite augmentation improved healing and mechanical strength, (3) younger age and skeletal immaturity seem to correlate with improved histologic healing and biomechanical properties, (4) enhanced primary repair of the ACL may reduce post-traumatic osteoarthritis, and (5) the native ACL biomechanically outperformed the repaired ACL.
Although long-term human studies suggest collectively unacceptable outcomes for open primary repair of the ACL, a subset of patients achieved acceptable long-term results. ACL transection model animal studies showed improved healing and biomechanics with primary suture repair stabilization, early intervention, biological augmentation techniques, and younger age. Primary repair of the ACL may be an effective treatment modality for an appropriately selected subset of patients.
Level IV, systematic review of preclinical and clinical Level IV studies.
描述过去10年中关于前交叉韧带（ACL）一期修复的临床及临床前研究。
对2003年至2014年4月间发表的所有关于ACL一期修复的英文研究，在PubMed、Cochrane对照试验中心注册库和Embase中进行系统检索。
26项研究符合纳入和排除标准。在临床研究组中，8项研究（166例患者；年龄范围10至71岁）符合纳入和排除标准，且大多为长期临床结局研究，基于20世纪70年代和80年代的原始队列，提示失败率高、需再次手术及因不稳定而翻修。然而，一部分患者获得了良好至优秀的主观和客观长期结局。在临床前研究组中，18项研究符合纳入和排除标准，基于ACL横断模型；这些研究提示：（1）用内部缝线支撑稳定膝关节可改善修复的ACL的愈合和生物力学性能；（2）用生物胶原蛋白-血小板复合材料增强“强化”修复可改善愈合和机械强度；（3）年龄较小和骨骼未成熟似乎与更好的组织学愈合和生物力学性能相关；（4）强化ACL一期修复可能减少创伤后骨关节炎；（5）天然ACL在生物力学上优于修复后的ACL。
尽管长期人体研究总体提示ACL开放一期修复的结局不可接受，但一部分患者获得了可接受的长期结果。ACL横断模型动物研究显示，通过一期缝线修复稳定、早期干预、生物增强技术和年龄较小可改善愈合和生物力学性能。ACL一期修复可能是对适当选择的一部分患者有效的治疗方式。
IV级，临床前和临床IV级研究的系统评价。
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