Department of Orthopaedic Surgery, Spaarne Gasthuis Hospital, Hoofddorp, The Netherlands.
Amsterdam UMC, Department of Orthopaedic Surgery, University of Amsterdam, Amsterdam, The Netherlands.
Knee Surg Sports Traumatol Arthrosc. 2020 Jun;28(6):1946-1957. doi: 10.1007/s00167-019-05697-8. Epub 2019 Sep 5.
To assess the outcomes of the various techniques of primary repair of proximal anterior cruciate ligament (ACL) tears in the recent literature using a systematic review with meta-analysis.
PRISMA guidelines were followed. All studies reporting outcomes of arthroscopic primary repair of proximal ACL tears using primary repair, repair with static (suture) augmentation and dynamic augmentation between January 2014 and July 2019 in PubMed, Embase and Cochrane were identified and included. Primary outcomes were failure rates and reoperation rates, and secondary outcomes were patient-reported outcome scores.
A total of 13 studies and 1,101 patients (mean age 31 years, mean follow-up 2.1 years, 60% male) were included. Nearly all studies were retrospective studies without a control group and only one randomized study was identified. Grade of recommendation for primary repair was weak. There were 9 out of 74 failures following primary repair (10%), 6 out of 69 following repair with static augmentation (7%) and 106 out of 958 following dynamic augmentation (11%). Repair with dynamic augmentation had more reoperations (99; 10%), and more hardware removal (255; 29%) compared to the other procedures. All functional outcome scores were > 85% of maximum scores.
This systematic review with meta-analysis found that the different techniques of primary repair are safe with failure rates of 7-11%, no complications and functional outcome scores of > 85% of maximum scores. There was a high risk of bias and follow-up was short with 2.1 years. Prospective studies comparing the outcomes to ACL reconstruction with sufficient follow-up are needed prior to widespread implementation.
IV.
通过系统评价和荟萃分析，评估近期文献中前交叉韧带（ACL）近端撕裂的各种初次修复技术的结果。
遵循 PRISMA 指南。检索 PubMed、Embase 和 Cochrane 中 2014 年 1 月至 2019 年 7 月期间报道的使用初次修复、静态（缝线）增强修复和动态增强修复对 ACL 近端撕裂进行关节镜初次修复的结果的所有研究，并进行纳入。主要结局是失败率和再次手术率，次要结局是患者报告的结局评分。
共纳入 13 项研究和 1101 例患者（平均年龄 31 岁，平均随访 2.1 年，60%为男性）。几乎所有研究均为无对照组的回顾性研究，仅确定了 1 项随机研究。初次修复的推荐等级为弱。初次修复后有 9 例（10%）失败，静态增强修复后有 6 例（7%）失败，动态增强修复后有 106 例（11%）失败。与其他手术相比，动态增强修复的再次手术（99 例；10%）和硬件移除（255 例；29%）更多。所有功能结局评分均高于最大评分的 85%。
这项系统评价和荟萃分析发现，不同的初次修复技术是安全的，失败率为 7%-11%，无并发症，功能结局评分高于最大评分的 85%。存在高偏倚风险，随访时间仅为 2.1 年。在广泛实施之前，需要进行前瞻性研究，比较这些结果与 ACL 重建的结果，并进行充分的随访。
IV 级。
