BG Center for Trauma and Reconstructive Surgery, Eberhard-Karls University of Tübingen, Tübingen, Germany.
Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101, Bruderholz, Switzerland.
Knee Surg Sports Traumatol Arthrosc. 2019 Jan;27(1):13-20. doi: 10.1007/s00167-018-5301-z. Epub 2018 Nov 26.
It was the aim to assess all published original research dealing with dynamic repair of the anterior cruciate ligament (ACL) and to provide a semi-quantitative analysis of clinical outcome reports.
Both OVIS and MEDLINE databases were utilized for allocation of articles. All preclinical and clinical studies related to dynamic intraligamentary stabilization (DIS) were identified. Results were tabulated and semi-quantitative analysis performed.
Twenty-three articles related to DIS were identified. The predominant level of evidence ranged between II and IV, with only one level I study. Reported failure rates ranged between 4% and 13.6%. Most clinical studies only reported revision rates without referring to failure of restoring stability. Highest success was achieved with proximal ACL ruptures. Both the level of physical activity and patient age have been found to influence the risk of failure.
There is sufficient evidence to support that DIS repair may be an effective modality for the treatment of acute proximal tears of the ACL. However, comparative studies are lacking. Upcoming studies should compare the technique to ACL reconstruction with failure as an endpoint. Comparison to rigid methods of proximal fixation is also necessary to justify the need for dynamic fixation. Overall, there is evidence to suggest the potential space for ACL repair in the decision tree for individualized treatment planning. The best outcome will be in the hands of the best patient selectors.
IV.
评估所有关于前交叉韧带（ACL）动态修复的已发表原始研究，并对临床结果报告进行半定量分析。
利用 OVIS 和 MEDLINE 数据库分配文章。确定所有与动态韧带内稳定（DIS）相关的临床前和临床研究。对结果进行制表和半定量分析。
确定了 23 篇与 DIS 相关的文章。主要证据水平在 II 级和 IV 级之间，仅有一项 I 级研究。报告的失败率在 4%至 13.6%之间。大多数临床研究仅报告了翻修率，而没有提到恢复稳定性的失败。对于前交叉韧带近端撕裂，成功率最高。运动水平和患者年龄都被发现会影响失败的风险。
有足够的证据支持 DIS 修复可能是治疗急性前交叉韧带近端撕裂的有效方法。然而，缺乏比较性研究。未来的研究应将该技术与以失败为终点的 ACL 重建进行比较。与近端固定的刚性方法进行比较也有必要证明动态固定的必要性。总的来说，有证据表明在个体化治疗计划的决策树中，ACL 修复有一定的空间。最佳结果将掌握在最佳的患者选择者手中。
IV。
