Michael G. DeGroote School of Medicine, 1280 Main St W, Hamilton, ON, L8S 4K1, Canada.
UPMC Center for Sports Medicine, 3200 S. Water St, Pittsburgh, PA, 15203, USA.
Knee Surg Sports Traumatol Arthrosc. 2018 Dec;26(12):3690-3698. doi: 10.1007/s00167-018-4951-1. Epub 2018 Apr 23.
To describe (1) the current graft tensioning practices in ACL reconstruction (ACLR) and, (2) the failure rates with the use of manual tensioning, or device-assisted tensioning at the time of graft fixation.
The electronic databases MEDLINE, EMBASE, and PubMed were searched independently by two reviewers from database inception to search date on January 21, 2017. Inclusion criteria were studies reporting graft tensioning method and rate of graft failure. The definition of graft failure used was: (1) side-to-side instrumented laxity > 5 mm, (2) Lachman 2 +, (3) positive pivot-shift testing, (4) MRI-confirmed graft rupture or, (5) need for revision surgery.
A total of 3379 patients and 3380 knees were treated with ACL reconstruction and followed for an average of 41.7 months (range 4-145 months). ACLR with manual tensioning was performed on 1518 (51.9%) patients and device-assisted tensioning was performed on 1802 (48.1%) patients. The average knee position reported was 29.2° in single-bundle ACLR and 22.9° in double-bundle ACLR. The median amount of tension used in manual tensioning was 'maximum manual tension' and 50 N in device-assisted tensioning. Overall, the failure rate in studies reporting manual tensioning was 8.9% compared to 4.3% in device-assisted tensioning.
Both manual tensioning and device-assisted tensioning are associated with low overall failure rates (< 10%) in ACLR; however, there is a higher rate of reported failure with manual tensioning compared to device-assisted tensioning. These findings highlight the need to investigate variations in graft tensioning practice, such as specific tension devices and their parameters, with high-quality, randomized controlled trials to elucidate details of their clinical impact.
Level IV, systematic review of level I-IV studies.
描述（1）目前在 ACL 重建（ACLR）中使用的移植物张力技术，以及（2）在移植物固定时使用手动或器械辅助张力的失败率。
两位审稿人从数据库建立之初到 2017 年 1 月 21 日，分别在 MEDLINE、EMBASE 和 PubMed 电子数据库中进行了独立搜索。纳入标准为报告移植物张力方法和移植物失败率的研究。使用的移植物失败定义为：（1）侧向仪器松弛度>5mm，（2）Lachman 2+，（3）阳性枢轴转移试验，（4）MRI 证实的移植物破裂，或（5）需要进行翻修手术。
共有 3379 名患者和 3380 个膝关节接受 ACLR 治疗，平均随访 41.7 个月（范围 4-145 个月）。1518 名（51.9%）患者接受手动张力技术，1802 名（48.1%）患者接受器械辅助张力技术。报道的平均膝关节位置为单束 ACLR 时 29.2°，双束 ACLR 时 22.9°。手动张力技术中使用的平均张力中位数为“最大手动张力”和 50N 的器械辅助张力。总体而言，报告手动张力的研究中失败率为 8.9%，而器械辅助张力的失败率为 4.3%。
手动和器械辅助张力在 ACLR 中都与较低的总体失败率（<10%）相关；然而，与器械辅助张力相比，手动张力的报告失败率更高。这些发现强调需要调查移植物张力技术的变化，例如特定的张力设备及其参数，并进行高质量的随机对照试验，以阐明其临床影响的细节。
IV 级，对 I-IV 级研究的系统评价。
