Browning William M, Kluczynski Melissa A, Curatolo Christian, Marzo John M
Charleston Area Medical Center, Charleston, West Virginia, USA.
Department of Orthopaedics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.
Am J Sports Med. 2017 Aug;45(10):2418-2427. doi: 10.1177/0363546516680995. Epub 2017 Jan 9.
Hamstring grafts have become a popular choice for anterior cruciate ligament (ACL) reconstruction; however, the most effective means of fixation of these soft tissue grafts is unknown.
To determine whether suspensory or aperture fixation of hamstring tendon autografts provides better stability and clinical outcomes in ACL reconstruction.
Meta-analysis.
A literature search of studies reporting single-bundle ACL reconstructions using 4-stranded hamstring tendon autografts with aperture or suspensory fixation with a minimum 24-month follow-up was conducted. Stability and clinical outcomes were compared for aperture versus suspensory fixation. Knee stability was measured with the Lachman or pivot-shift test or KT-1000 arthrometer side-to-side difference (SSD), and outcomes were determined with the International Knee Documentation Committee (IKDC), Tegner, and Lysholm scores as well as graft failures. A random-effects model with a pooled estimate for the between-study variance was used to estimate proportions or means for each outcome and its corresponding 95% CI.
Forty-one studies were included, of which 20 utilized suspensory fixation techniques and 21 utilized aperture fixation techniques. A >3-mm SSD was seen more often in the aperture group than the suspensory group, which was statistically significant ( P < .0001), but there was no significant difference between groups for a >5-mm SSD ( P = .53). The aperture group demonstrated significantly more graft ruptures than did the suspensory group ( P = .03). There were no statistically significant differences in Lachman grade 0 ( P = .76), grade 1 ( P = .89), and grade 2 ( P = .55) or pivot-shift grade 0 ( P = .72), grade 1 ( P = .97), and grade 2 ( P = .28). There was no statistically significant difference in mean continuous IKDC ( P = .80), Tegner ( P = .34), or Lysholm ( P = .84) scores.
This meta-analysis demonstrated improved overall arthrometric stability and fewer graft ruptures using suspensory fixation compared with aperture fixation of a quadrupled hamstring tendon autograft in ACL reconstruction. There were no differences in IKDC, Lysholm, Lachman, and pivot-shift outcomes between suspensory and aperture fixation.
腘绳肌移植物已成为前交叉韧带（ACL）重建的常用选择；然而，这些软组织移植物最有效的固定方法尚不清楚。
确定在ACL重建中，腘绳肌腱自体移植物的悬吊固定或骨隧道固定是否能提供更好的稳定性和临床效果。
荟萃分析。
检索文献，纳入报告使用4股腘绳肌腱自体移植物进行单束ACL重建且采用骨隧道或悬吊固定并至少随访24个月的研究。比较骨隧道固定与悬吊固定的稳定性和临床效果。通过Lachman试验、轴移试验或KT-1000关节测量仪测量膝关节两侧差值（SSD）来评估膝关节稳定性，并用国际膝关节文献委员会（IKDC）、Tegner和Lysholm评分以及移植物失败情况来确定临床效果。采用随机效应模型，对研究间方差进行合并估计，以估计每个结果的比例或均值及其相应的95%置信区间。
共纳入41项研究，其中20项采用悬吊固定技术，21项采用骨隧道固定技术。骨隧道组出现大于3mm的SSD比悬吊组更常见，差异有统计学意义（P <.0001），但大于5mm的SSD在两组间无显著差异（P =.53）。骨隧道组的移植物断裂明显多于悬吊组（P =.03）。Lachman分级0级（P =.76）、1级（P =.89）和2级（P =.55）或轴移分级0级（P =.72）、1级（P =.97）和2级（P =.28）在两组间无统计学显著差异。连续平均IKDC评分（P =.80）、Tegner评分（P =.34）或Lysholm评分（P =.84）在两组间无统计学显著差异。
这项荟萃分析表明，在ACL重建中，与腘绳肌腱自体移植物的骨隧道固定相比，悬吊固定可提高整体关节测量稳定性并减少移植物断裂。悬吊固定和骨隧道固定在IKDC、Lysholm、Lachman和轴移结果方面无差异。
