Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, U.S.A..
Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, New Jersey, U.S.A.
Arthroscopy. 2019 Mar;35(3):996-1003. doi: 10.1016/j.arthro.2018.10.127. Epub 2019 Feb 4.
To systematically review high-quality studies in the literature to compare the postoperative radiographic incidence of knee osteoarthritis (OA) after anterior cruciate ligament reconstruction (ACLR) with a single-bundle (SB) versus double-bundle (DB) graft.
A systematic review was performed by searching PubMed, the Cochrane Library, and Embase to locate randomized controlled trials that compared the postoperative progression of knee OA in SB versus DB ACLR patients. The search terms used were "anterior cruciate ligament reconstruction," "single-bundle," "double-bundle," "randomized," and "osteoarthritis." Patients were assessed based on radiographic evaluation (Kellgren-Lawrence [K-L] and objective International Knee Documentation Committee scales) and graft failure.
A total of 7 studies (5 Level I and 2 Level II) met the inclusion criteria, including 375 SB and 477 DB ACLR patients with a mean follow-up period of 5.3 years. Graft failure occurred in 3.2% of patients overall (27 of 852), with no significant difference between groups (P = .10). No significant difference in overall K-L grade distribution was found between groups (P = .90). Overall, 15.1% of patients (58 of 383) were given a K-L grade of 2 or greater, including 14.4% in the SB group (31 of 215) and 16.1% in the DB group (27 of 168) (P = .65). Using other, unconventional grading schemes, 2 studies found DB ACLR patients to have significantly fewer signs of radiographic knee OA at follow-up compared with SB ACLR patients (P < .05).
Patients undergoing ACLR with either an SB or DB graft can be expected to experience a similar incidence of postoperative knee OA at midterm follow-up according to the K-L grading system.
Level II, systematic review of Level I and II studies.
系统回顾文献中的高质量研究，比较前交叉韧带重建（ACLR）中使用单束（SB）与双束（DB）移植物后膝关节骨关节炎（OA）的术后放射学发生率。
通过搜索 PubMed、Cochrane 图书馆和 Embase，查找比较 SB 与 DB ACLR 患者术后膝关节 OA 进展的随机对照试验，进行系统综述。使用的检索词为“前交叉韧带重建”、“单束”、“双束”、“随机”和“骨关节炎”。根据放射学评估（Kellgren-Lawrence [K-L] 和客观国际膝关节文献委员会评分）和移植物失败情况对患者进行评估。
共有 7 项研究（5 项 I 级和 2 项 II 级）符合纳入标准，包括 375 例 SB 和 477 例 DB ACLR 患者，平均随访时间为 5.3 年。总的移植物失败率为 3.2%（852 例中有 27 例），两组间无显著差异（P =.10）。两组间总体 K-L 分级分布无显著差异（P =.90）。总体而言，383 例患者中有 15.1%（58 例）的 K-L 分级为 2 或更高，其中 SB 组为 14.4%（215 例中有 31 例），DB 组为 16.1%（168 例中有 27 例）（P =.65）。使用其他非传统的分级方案，有 2 项研究发现 DB ACLR 患者在随访时的放射学膝关节 OA 迹象明显少于 SB ACLR 患者（P <.05）。
根据 K-L 分级系统，接受 SB 或 DB 移植物 ACLR 的患者在中期随访时可预期出现类似的术后膝关节 OA 发生率。
II 级，I 级和 II 级研究的系统评价。
