Department of Orthopaedic Surgery, The Armed Forces Daegu Hospital, Gyeongsan, Republic of Korea.
Department of Orthopaedic Surgery and Institute of Health Science, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea.
Am J Sports Med. 2018 Sep;46(11):2789-2797. doi: 10.1177/0363546517725070. Epub 2018 Jan 12.
Transtibial (TT) or tibial inlay (TI) techniques are commonly used for posterior cruciate ligament reconstruction (PCLR). However, the optimum method for PCLR after PCL injury remains debatable. Hypothesis/Purpose: The hypothesis was that TT and TI techniques would not show significant differences for all outcome measures. The purpose was to determine the biomechanical and clinical outcomes of TT and TI surgical techniques for PCLR.
Meta-analysis; Level of evidence, 3.
MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and SCOPUS electronic databases for articles published up until August 2016 were searched to find relevant articles comparing outcomes of TT versus TI techniques for PCLR. Data searching, extraction, analysis, and quality assessment were performed according to Cochrane Collaboration guidelines. Biomechanical outcomes and clinical outcomes of both techniques were compared. Results are presented as risk ratio (RR) for binary outcomes and weighted mean difference (WMD) for continuous outcomes with 95% confidence intervals (CI).
Five biomechanical and 5 clinical studies were included. No significant biomechanical differences were found regarding posterior tibial translation (PTT) at a knee flexion angle of 90° or PTT after cyclic loading between the 2 groups. However, a stronger in situ force in the graft was detected in the TT group (WMD = 15.58; 95% CI, 0.22-30.95; I = 10%). Although no significant differences were found in clinical outcomes such as Lysholm knee function score, Tegner activity score, side-to-side difference, or posterior drawer test at final follow-up between the 2 groups, the TT technique tended to entail fewer perioperative complications than the TI technique (RR = 0.60; 95% CI, 0.35-1.00; I = 0%).
TT and TI techniques for PCLR can both restore normal knee kinematics and improve knee function. However, the issue of which yields better improvement in stability and functional recovery of the knee remains unclear. More high-quality trials and randomized controlled trials are needed. Although PCLR via the TT technique resulted in higher graft forces, determining whether this is clinically significant will require further studies. When performing the TI technique, surgeons should inform patients of the risk of complications.
经胫骨（TT）或胫骨嵌体（TI）技术常用于后交叉韧带重建（PCLR）。然而，PCLR 后最佳的 PCL 损伤治疗方法仍存在争议。假说/目的：该假说为 TT 和 TI 技术在所有结果测量上均不会表现出显著差异。目的是确定 TT 和 TI 手术技术用于 PCLR 的生物力学和临床结果。
荟萃分析；证据水平，3 级。
检索 MEDLINE、EMBASE、Cochrane 中心对照试验注册库（CENTRAL）、Web of Science 和 SCOPUS 电子数据库，以查找截至 2016 年 8 月发表的比较 TT 与 TI 技术用于 PCLR 结果的相关文章。根据 Cochrane 协作组指南进行数据检索、提取、分析和质量评估。比较两种技术的生物力学和临床结果。结果以二项结局的风险比（RR）和连续结局的加权均数差（WMD）呈现，置信区间（CI）为 95%。
纳入 5 项生物力学研究和 5 项临床研究。两组在膝关节 90°屈曲时的胫骨后移（PTT）或循环加载后的 PTT 无显著生物力学差异。然而，TT 组检测到移植物内的原位力更强（WMD=15.58；95%CI，0.22-30.95；I=10%）。虽然两组在最终随访时的临床结局如 Lysholm 膝关节功能评分、Tegner 活动评分、侧间差异或后抽屉试验无显著差异，但 TT 技术较 TI 技术发生围手术期并发症的可能性更小（RR=0.60；95%CI，0.35-1.00；I=0%）。
TT 和 TI 技术均可恢复正常膝关节运动学并改善膝关节功能。然而，哪种方法能更好地改善膝关节的稳定性和功能恢复仍不清楚。需要更多高质量的试验和随机对照试验。虽然 TT 技术行 PCLR 时移植物内的力更高，但确定这是否具有临床意义还需要进一步研究。行 TI 技术时，外科医生应告知患者并发症的风险。
