前内侧入路与胫骨隧道技术在单束前交叉韧带重建后股骨隧道增宽相似：系统评价和荟萃分析。
Femoral tunnel widening is similar between anteromedial portal and transtibial techniques following single-bundle anterior cruciate ligament reconstruction: a systematic review and meta-analysis.
机构信息
Department of Orthopaedic Surgery, College of Medicine, Gangneung Asan Hospital, Ulsan University, Gangneung, Republic of Korea.
Department of Orthopaedic Surgery, Umraniye Training and Research Hospital, Istanbul, Turkey.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2019 Feb;27(2):626-635. doi: 10.1007/s00167-018-5204-z. Epub 2018 Oct 10.
PURPOSE
In anterior cruciate ligament (ACL) reconstruction, there is concern regarding the potential risk of femoral tunnel widening in the anteromedial portal (AMP) technique due to the acute graft-bending angle at the aperture and the more elliptical aperture shape of the femoral tunnel compared to the transtibial (TT) techniques. Therefore, the aim of the current systematic review and meta-analysis was to compare the femoral tunnel widening between the AMP and TT techniques in patients who underwent ACL reconstruction.
METHODS
It should be included the studies that reported on femoral tunnel widening in patients who underwent single-bundle ACL reconstruction, using soft-tissue tendon graft, with AMP and/or TT techniques. Two reviewers independently recorded data from each study, including the sample size and magnitude of tunnel widening after ACL reconstruction.
RESULTS
Twenty-one studies were finally included in this meta-analysis. The pooled changes of absolute millimeters of tunnel widening from the immediate postoperative status to the last follow-up did not differ significantly between the AMP and TT techniques at both the aperture [3.31 mm, 95% confidence interval (CI) 1.7-5.0. mm versus 2.9 mm, 95% CI 2.4-3.4 mm, P = n.s.] and the midportion (3.5 mm, 95% CI 0.8-6.3 mm versus 3.0 mm, 95% CI 2.2-3.9 mm, P = n.s.) of the femoral tunnel. No significant difference was observed between the two techniques in the relative percentage of femoral tunnel widening (AMP; 28.8%, 95% CI 14.8-42.9% vs. TT; 29.7%, 95% CI 15.6-43.7%, P = n.s.).
CONCLUSION
No significant difference in femoral tunnel widening was observed between the AMP and TT techniques, both in absolute millimeter and relative percentage, in patients who underwent single-bundle ACL reconstruction. This finding could alleviate the potential concerns associated with femoral tunnels being wider for the AMP than for the TT technique.
LEVEL OF EVIDENCE
III.
目的
在前交叉韧带（ACL）重建中，由于移植物在入孔处的急性弯曲角度以及与经胫骨（TT）技术相比股骨隧道的椭圆形孔径形状，人们担心前内侧入孔（AMP）技术会导致股骨隧道增宽。因此，本系统评价和荟萃分析的目的是比较 ACL 重建患者中 AMP 和 TT 技术之间的股骨隧道增宽。
方法
应包括报告使用软组织肌腱移植物进行单束 ACL 重建患者的股骨隧道增宽的研究，包括 AMP 和/或 TT 技术。两位评审员独立记录每项研究的数据，包括样本量和 ACL 重建后隧道增宽的程度。
结果
最终有 21 项研究纳入本荟萃分析。从术后即刻到最后随访时，绝对毫米数的隧道增宽变化在 AMP 和 TT 技术之间在孔径[3.31 毫米，95%置信区间（CI）1.7-5.0 毫米与 2.9 毫米，95%CI 2.4-3.4 毫米，P=n.s.]和股骨隧道中段（3.5 毫米，95%CI 0.8-6.3 毫米与 3.0 毫米，95%CI 2.2-3.9 毫米，P=n.s.）处没有显著差异。两种技术在股骨隧道增宽的相对百分比（AMP；28.8%，95%CI 14.8-42.9%与 TT；29.7%，95%CI 15.6-43.7%，P=n.s.）方面也没有显著差异。
结论
在接受单束 ACL 重建的患者中，在绝对毫米数和相对百分比方面，AMP 和 TT 技术之间的股骨隧道增宽没有显著差异。这一发现可能减轻了 AMP 比 TT 技术的股骨隧道更宽的潜在担忧。
证据水平
III。
Zotero 插件