Devitt Brian M, Dissanayake Ruchith, Clair Joseph, Napier Richard J, Porter Tabitha J, Feller Julian A, Webster Kate E
OrthoSport Victoria, Epworth Healthcare, Melbourne, Australia.
School of Allied Health, La Trobe University, Melbourne, Australia.
Orthop J Sports Med. 2018 Oct 26;6(10):2325967118804478. doi: 10.1177/2325967118804478. eCollection 2018 Oct.
Although isolated posterior cruciate ligament reconstruction (PCLR) has become a more frequently performed procedure, reports of functional outcomes and return-to-sport (RTS) rates to support its use are still limited.
To systematically review the literature to determine the rates of RTS and the functional outcomes of patients after isolated PCLR.
Systematic review: Level of evidence, 4.
Two reviewers independently searched 5 databases for patient-based clinical studies with a minimum 2-year follow-up that analyzed functional outcome and RTS following isolated PCLR. Studies with multiligament knee reconstruction were excluded. Risk of bias was performed with a modified Downs and Black checklist. The primary outcomes were Tegner and Lysholm scores, rates of RTS, and International Knee Documentation Committee (IKDC) subjective scores. Secondary outcomes were IKDC objective scores, instrumented knee laxity assessment, and Telos radiographic analysis. Where feasible, these data were pooled via a random effects meta-analysis model.
Of the 240 titles identified, 14 studies were included. The median time from injury to surgery was 10.6 months (range, 6 weeks-21 years). The pooled mean postoperative Tegner and Lysholm scores were 5.7 (95% CI, 5.4-6.0) and 87.8 (95% CI, 85.6-90.0), respectively, following isolated PCLR; the pooled effect size between pre- and postoperative values was 2.8 (95% CI, 1.6-4.0) and 3.7 (95% CI, 2.6-4.9), respectively. An RTS rate of 44% (95% CI, 23%-66%) was identified. IKDC subjective scores improved to a pooled mean of 73.5 (95% CI, 62.8-84.1), with an effect size of 3.0 (95% CI, 0.4-5.6). The proportion of patients with postoperative IKDC objective scores of grade A/B was 82%. The pooled postoperative KT-1000/KT-2000 side-to-side difference was 3.4 mm (95% CI, 2.5-4.3 mm), with an effect size of 2.8 (95% CI, 1.1-4.5). The pooled postoperative Telos side-to-side difference measurement was 3.5 mm (95% CI, 2.8-4.3 mm), with an effect size of 3.9 (95% CI, 3.3-4.5).
The results of this review demonstrate that while isolated PCLR results in a significant improvement in functional outcome scores and improved knee laxity, there is a low rate of return to preinjury level of sport. The prolonged period from injury to surgery might reduce functional improvement and RTS following reconstruction. Therefore, comparison of the outcomes of isolated PCLR and nonoperative treatment is impracticable owing to the potential for selection bias.
尽管单纯后交叉韧带重建术（PCLR）已成为一种更常施行的手术，但支持其应用的功能预后和重返运动（RTS）率的报告仍然有限。
系统回顾文献，以确定单纯PCLR术后患者的RTS率和功能预后。
系统评价：证据等级，4级。
两名研究者独立检索5个数据库，查找以患者为基础的临床研究，这些研究至少随访2年，分析单纯PCLR后的功能预后和RTS情况。排除多韧带膝关节重建的研究。采用改良的唐斯和布莱克清单进行偏倚风险评估。主要结局指标为特格纳（Tegner）和莱霍尔姆（Lysholm）评分、RTS率以及国际膝关节文献委员会（IKDC）主观评分。次要结局指标为IKDC客观评分、仪器测量的膝关节松弛度评估以及Telos影像学分析。在可行的情况下，通过随机效应荟萃分析模型汇总这些数据。
在检索到的240篇文献标题中，纳入了14项研究。受伤至手术的中位时间为10.6个月（范围为6周 - 21年）。单纯PCLR术后，汇总的术后平均特格纳和莱霍尔姆评分分别为5.7（95%可信区间，5.4 - 6.0）和87.8（95%可信区间，85.6 - 90.0）；术前和术后值之间的汇总效应量分别为2.8（95%可信区间，1.6 - 4.0）和3.7（95%可信区间，2.6 - 4.9）。确定的RTS率为44%（95%可信区间，23% - 66%）。IKDC主观评分提高到汇总平均分为73.5（95%可信区间，62.8 - 84.1），效应量为3.0（95%可信区间，0.4 - 5.6）。术后IKDC客观评分为A/B级的患者比例为82%。汇总的术后KT - 1000/KT - 2000两侧差值为3.4 mm（95%可信区间，2.5 - 4.3 mm），效应量为2.8（95%可信区间，1.1 - 4.5）。汇总的术后Telos两侧差值测量值为3.5 mm（95%可信区间，2.8 - 4.3 mm），效应量为3.9（95%可信区间，3.3 - 4.5）。
本综述结果表明，虽然单纯PCLR可使功能预后评分显著改善且膝关节松弛度得到改善，但恢复到伤前运动水平的比例较低。受伤至手术的时间延长可能会降低重建后的功能改善和RTS率。因此，由于存在选择偏倚的可能性，比较单纯PCLR与非手术治疗的结果是不可行的。
