Steadman Philippon Research Institute, Vail, Colorado, U.S.A.
Steadman Philippon Research Institute, Vail, Colorado, U.S.A.; Oslo University Hospital, Oslo, Norway.
Arthroscopy. 2017 Nov;33(11):2066-2080. doi: 10.1016/j.arthro.2017.06.049. Epub 2017 Aug 31.
To perform a systematic review on the techniques and a meta-analysis on the functional and objective outcomes after single-bundle (SB) versus double-bundle (DB) posterior cruciate ligament (PCL) reconstructions.
A systematic review of the techniques, as well as functional and objective outcomes of clinical studies comparing SB versus DB PCL reconstruction with a mean follow-up of at least 24 months and minimum level of evidence of III were performed. After review of the literature, a quality analysis of the studies (Detsky score) and a meta-analysis comparing raw mean differences in data between SB and DB PCL groups were performed. Clinical outcome measures included in the meta-analysis were functional outcomes (Lysholm, Tegner, and objective International Knee Documentation Committee [IKDC] scores) and objective measurements (arthrometer and stress radiographs).
The systematic search identified 11 studies (441 patients). Three studies were prospective randomized controlled trials and the other 8 studies were case-control studies. Two hundred thirty-two patients were treated with SB PCL reconstruction, whereas 209 were treated with DB PCL reconstruction. Only 4 studies satisfied the threshold for a satisfactory level of methodologic quality (>75%). There were no significant differences between SB and DB PCL reconstructions in postoperative Lysholm (P = .6, 95% confidence interval [CI], -0.98, 2.18) or Tegner scores (P = .37, 95% CI, -0.19, 0.92). DB PCL reconstruction provided significantly better objective posterior tibial translation stability than the SB technique using the Telos technique at 90° (P = -.58, 95% CI, -1.06, -0.10).
Improved patient-reported outcomes and knee stability were achieved with both SB and DB PCL reconstruction surgery. DB PCL reconstruction provided significantly improved objective posterior tibial stability and objective IKDC scores when compared with SB PCL reconstruction in randomized clinical trials. No significant difference was found for the other patient-reported outcomes.
Level III, systematic review and meta-analysis of Level II and III studies.
对单束（SB）与双束（DB）后交叉韧带（PCL）重建术后技术进行系统评价，并对功能和客观结果进行荟萃分析。
对至少 24 个月随访且最低证据级别为 III 级的比较 SB 与 DB PCL 重建的临床研究的技术、功能和客观结果进行系统评价。文献复习后，对研究进行质量分析（Detsky 评分）并对 SB 和 DB PCL 组之间原始数据均数差异进行荟萃分析。纳入荟萃分析的临床结果测量包括功能结果（Lysholm、Tegner 和客观国际膝关节文献委员会 [IKDC] 评分）和客观测量（关节活动度计和应力射线照相）。
系统搜索确定了 11 项研究（441 例患者）。其中 3 项为前瞻性随机对照试验，其余 8 项为病例对照研究。232 例患者接受 SB PCL 重建，209 例患者接受 DB PCL 重建。只有 4 项研究满足方法学质量满意水平的阈值（>75%）。SB 和 DB PCL 重建术后 Lysholm 评分（P=.6，95%置信区间 [CI]，-0.98，2.18）或 Tegner 评分（P=.37，95% CI，-0.19，0.92）无显著差异。使用 Telos 技术，DB PCL 重建在 90°时提供了比 SB 技术更好的胫骨后移稳定性的客观结果（P=-.58，95% CI，-1.06，-0.10）。
SB 和 DB PCL 重建术均能改善患者报告的结果和膝关节稳定性。与 SB PCL 重建相比，DB PCL 重建在随机临床试验中提供了更好的胫骨后移稳定性和客观 IKDC 评分，但患者报告的其他结果无显著差异。
III 级，对 II 级和 III 级研究进行系统评价和荟萃分析。
