前交叉韧带重建时机对临床和稳定性结果的影响：系统评价和荟萃分析。
Effect of the Timing of Anterior Cruciate Ligament Reconstruction on Clinical and Stability Outcomes: A Systematic Review and Meta-analysis.
机构信息
Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Hospital Seongnam-si, Gyeonggi-do, Republic of Korea.
Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Hospital Seongnam-si, Gyeonggi-do, Republic of Korea.
出版信息
Arthroscopy. 2018 Feb;34(2):592-602. doi: 10.1016/j.arthro.2017.07.023. Epub 2017 Sep 30.
PURPOSE
The purpose of this systematic review and meta-analysis was to evaluate the effect of the timing of anterior cruciate ligament (ACL) reconstruction on clinical and stability outcomes by analyzing high-quality studies that assessed timing as a primary objective.
METHODS
The MEDLINE, EMBASE, and Cochrane database were systematically searched. The inclusion criteria were as follows: (1) English articles, (2) noncomparative study or relevant study reporting clinical and/or stability results, and (3) timing of the ACL reconstruction as a primary objective. Study type, level of evidence, randomization method, exclusion criteria, number of cases, age, sex, timing of ACL reconstruction, follow-up, clinical outcomes, stability outcomes, and other relevant findings were recorded. Statistical analysis of the Lysholm scores and KT-1000 arthrometer measurements after early and delayed ACL reconstruction was performed using R version 3.3.1.
RESULTS
Seven articles were included in the final analysis. There were 6 randomized controlled trials and 1 Level II study. Pooled analysis was performed using only Level I studies. All studies assessed the timing of ACL reconstruction as a primary objective. The definition of early ranged broadly from 9 days to 5 months and delayed ranged from 10 weeks to >24 months, and there was an overlap of the time intervals between some studies. The standard timing of the delayed reconstruction was around 10 weeks from injury in the pooled analysis. After pooling of data, clinical result was not statistically different between groups (I: 47%, moderate level of heterogeneity). No statistically significant difference was observed in the KT-1000 arthrometer measurements between groups (I: 76.2%, high level of heterogeneity) either.
CONCLUSION
This systematic review and meta-analysis performed using currently available high-quality literature provides relatively strong evidence that early ACL reconstruction results in good clinical and stability outcomes. Early ACL reconstruction results in comparable clinical and stability outcomes compared with delayed ACL reconstruction.
LEVEL OF EVIDENCE
Level II, a systematic review and meta-analysis of Level I and II studies.
目的
本系统评价和荟萃分析的目的是通过分析将时间作为主要目标进行评估的高质量研究，评估前交叉韧带（ACL）重建时机对临床和稳定性结果的影响。
方法
系统检索了 MEDLINE、EMBASE 和 Cochrane 数据库。纳入标准为：（1）英文文章，（2）非对照研究或相关研究报告临床和/或稳定性结果，（3）以时间作为主要目标。记录研究类型、证据水平、随机分组方法、排除标准、病例数、年龄、性别、ACL 重建时间、随访时间、临床结果、稳定性结果和其他相关发现。使用 R 版本 3.3.1 对早期和延迟 ACL 重建后的 Lysholm 评分和 KT-1000 关节测量仪测量值进行统计学分析。
结果
最终分析纳入了 7 篇文章。其中 6 项为随机对照试验，1 项为 II 级研究。仅对 I 级研究进行了汇总分析。所有研究均将 ACL 重建时机作为主要目标进行评估。早期重建的时间范围从受伤后 9 天到 5 个月不等，延迟重建的时间范围从受伤后 10 周到>24 个月不等，一些研究的时间间隔存在重叠。汇总分析中，延迟重建的标准时间约为受伤后 10 周。汇总数据后，组间临床结果无统计学差异（I：47%，中度异质性）。组间 KT-1000 关节测量仪测量值也无统计学差异（I：76.2%，高度异质性）。
结论
本系统评价和荟萃分析使用目前高质量文献提供了相对较强的证据，表明早期 ACL 重建可获得良好的临床和稳定性结果。早期 ACL 重建与延迟 ACL 重建相比，具有相似的临床和稳定性结果。
证据水平
II 级，对 I 级和 II 级研究的系统评价和荟萃分析。
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