Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, gangnam-gu, Seoul, 06351, Korea.
Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea.
Knee Surg Sports Traumatol Arthrosc. 2018 Aug;26(8):2371-2380. doi: 10.1007/s00167-017-4786-1. Epub 2017 Nov 30.
Although anatomical and independent drilling techniques, such as transportal (TP) technique, have become more popular in anterior cruciate ligament (ACL) reconstruction, the TP technique has not been shown to yield superior clinical or functional outcomes compared to the transtibial (TT) technique. The aim of the current meta-analysis was to compare clinical outcomes of the TP and TT techniques, as determined by patient-reported outcome scores and knee joint laxity tests. It was hypothesized that the TP and TT techniques of ACL reconstruction would yield similar patient-reported functional outcomes and similar results on knee joint laxity tests.
Studies were included if they reported at least one of the following clinical outcomes: IKDC score, IKDC examination, Lysholm knee score, and Tegner activity score. Knee stability was evaluated by single or multiple parameters of the following knee laxity examinations: the Lachman test, the pivot shift test, and side-to-side difference on the instrumented knee laxity test.
Sixteen studies were finally included in this meta-analysis. The proportions of patients with normal grade on the IKDC examination [odds ratio (OR) 2.23; 95% confidence interval (CI) 1.41-3.53; P = 0.0006] and Lysholm score (mean difference 1.27; 95% CI 0.23-2.31; P = 0.02) after surgery were higher with the TP than with the TT technique, but there were no differences in IKDC and Tegner scores. The postoperative proportion of normal knee joint stability was significantly higher with the TP than the TT technique, on both Lachman (OR 2.29; 95% CI 1.35-3.92; P = 0.002) and pivot shift (OR 2.13; 95% CI 1.12-4.05; P = 0.02) tests. The pooled mean side-to-side difference was 0.73 mm lower with the TP than the TT technique (95% CI - 1.14 to - 0.32 mm; P = 0.0005).
This meta-analysis showed that the clinical outcomes of ACL reconstruction were better with the TP than the TT technique, both on knee functional outcome scales and knee laxity tests. The findings thus suggest that the TP technique would be a better option for single-bundle ACL reconstruction compared to the TT technique.
III.
尽管解剖学和独立钻孔技术（如经皮隧道技术[TP]）在前交叉韧带（ACL）重建中越来越受欢迎，但与经胫骨隧道技术（TT）相比，TP 技术并未显示出更优越的临床或功能结果。本荟萃分析的目的是比较经皮隧道技术和经胫骨隧道技术的临床结果，这些结果通过患者报告的结果评分和膝关节松弛度测试来确定。假设 ACL 重建的 TP 和 TT 技术将产生相似的患者报告的功能结果，并且在膝关节松弛度测试中也将产生相似的结果。
如果研究报告了以下至少一种临床结果，则将其纳入本研究：IKDC 评分、IKDC 检查、Lysholm 膝关节评分和 Tegner 活动评分。通过以下膝关节松弛度检查的单一或多个参数评估膝关节稳定性：Lachman 试验、前抽屉试验和关节内松弛度试验的侧间差异。
最终有 16 项研究纳入本荟萃分析。术后 IKDC 检查正常分级的患者比例[优势比（OR）2.23；95%置信区间（CI）1.41-3.53；P=0.0006]和 Lysholm 评分（平均差值 1.27；95%CI 0.23-2.31；P=0.02）更高，而 IKDC 和 Tegner 评分则没有差异。术后，与 TT 技术相比，TP 技术的膝关节稳定性正常比例显著更高，在 Lachman（OR 2.29；95%CI 1.35-3.92；P=0.002）和前抽屉试验（OR 2.13；95%CI 1.12-4.05；P=0.02）中均如此。TP 技术的平均侧间差异比 TT 技术低 0.73mm（95%CI -1.14 至 -0.32mm；P=0.0005）。
本荟萃分析表明，与 TT 技术相比，ACL 重建的临床结果在膝关节功能评分和膝关节松弛度测试中，TP 技术均更好。因此，与 TT 技术相比，TP 技术可能是单束 ACL 重建的更好选择。
III 级。
