Steadman Clinic, Vail, Colorado, U.S.A.; Steadman Philippon Research Institute, Vail, Colorado, U.S.A.
Steadman Philippon Research Institute, Vail, Colorado, U.S.A.
Arthroscopy. 2017 Aug;33(8):1575-1583. doi: 10.1016/j.arthro.2017.03.009. Epub 2017 May 11.
To perform a systematic review of the described anterolateral ligament (ALL) reconstruction techniques, biomechanical performance, and clinical outcomes of ALL reconstruction in the setting of concurrent anterior cruciate ligament (ACL) reconstruction.
A systematic review was performed according to PRISMA guidelines using the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed, MEDLINE, and Embase, from 1980 to present. Inclusion criteria were as follows: ALL reconstruction techniques, ALL reconstruction biomechanical studies, ALL surgical outcomes, English language, human studies with at least 2 years of follow-up, and cadaveric studies. Exclusion criteria were lateral extra-articular tenodesis, ALL anatomic studies, ALL radiographic studies, animal studies, clinical studies with <2 years of follow-up, editorial articles, and surveys.
The systematic review identified 12 articles that met the inclusion criteria: 6 techniques, 5 biomechanical studies, and 1 outcome study were available. Five studies described ALL reconstruction in the setting of ACL reconstruction, whereas 1 study described isolated ALL reconstruction. Femoral tunnel location was most commonly placed posterior and proximal to the lateral epicondyle, whereas 2 studies reported a distal tunnel location. There was little variability in tibial tunnel location. The most common ALL reconstruction graft used was the gracilis tendon. Review of the biomechanical studies revealed internal rotation overconstraint with the posterior/proximal femoral tunnel position but not anterior/distal, although fixation angle and graft tension were inconsistent. Only 1 clinical study with 2 years' follow-up was available and reported improvement in the majority of cases. Complications occurred in 15 patients, including a residual pivot shift in 8% of patients at 2 years after a combined ACL and ALL reconstruction.
There is inconsistency in the selection of ALL graft femoral attachment location as well as in the biomechanical performance of ALL reconstruction techniques.
Level IV, systematic review of Level IV studies.
对前外侧韧带 (ALL) 重建技术进行系统评价，分析在同期前交叉韧带 (ACL) 重建背景下 ALL 重建的生物力学性能和临床效果。
根据 PRISMA 指南，使用 Cochrane 系统评价数据库、Cochrane 对照试验中心注册库、PubMed、MEDLINE 和 Embase 进行系统评价，检索时间从 1980 年至今。纳入标准如下：ALL 重建技术、ALL 重建生物力学研究、ALL 手术结果、英语语言、至少随访 2 年的人体研究和尸体研究。排除标准包括外侧关节外肌腱固定术、ALL 解剖研究、ALL 影像学研究、动物研究、随访时间<2 年的临床研究、社论文章和调查。
系统评价共纳入 12 篇符合纳入标准的文章：5 项技术、5 项生物力学研究和 1 项结果研究。有 5 项研究描述了 ACL 重建背景下的 ALL 重建，1 项研究描述了单纯 ALL 重建。股骨隧道的位置最常位于外上髁后和近端，而 2 项研究报告了远端隧道位置。胫骨隧道的位置差异不大。最常用的 ALL 重建移植物是股薄肌肌腱。生物力学研究的综述显示，当股骨隧道位置偏后和偏上时会出现内旋过度约束，但偏前和偏下时不会，尽管固定角度和移植物张力不一致。只有 1 项具有 2 年随访的临床研究，结果显示大多数病例均有改善。15 例患者发生并发症，包括联合 ACL 和 ALL 重建后 2 年时 8%的患者仍存在残余旋转不稳定。
ALL 移植物股骨附着位置的选择以及 ALL 重建技术的生物力学性能不一致。
IV 级，对 IV 级研究的系统评价。
