Singh Sarvpreet, Shaunak Shalin, Shaw Sebastian C K, Anderson John L, Mandalia Vipul
Department of Trauma and Orthopaedics, North West Anglia NHS Foundation Trust, Cambridgeshire, UK.
East Sussex Healthcare NHS Trust, East Sussex, UK.
Indian J Orthop. 2020 Jan 13;54(4):426-443. doi: 10.1007/s43465-019-00022-4. eCollection 2020 Jul.
Anterior cruciate ligament (ACL) injury is a common sports injury. Symptomatic knee instability after this injury is usually treated operatively through ACL reconstruction. The surgery involves a tendon graft being fixed in bony tunnels drilled through femur and tibia. The fixation of the graft is of critical importance to achieving good results. One of the commonest devices used to fix the graft in the femoral bony tunnel is a fixed loop cortical suspensory device. More recently, adjustable loop cortical suspension devices have been introduced, and have gained popularity for ACL reconstruction. These allow for adjusting the length of the suspension loop after insertion. There is currently much debate concerning whether the adjustable loop devices are superior or inferior to the fixed loop devices.
To critique and review the current biomechanical and clinical evidence on the use of adjustable loop devices in hamstring ACL reconstruction. To our knowledge, there have been no previous reviews of this topic.
Systematic review.
This systematic review was conducted in accordance with PRISMA. Five databases were searched using multiple search terms and MeSH terms where possible. The following limits were applied: papers published in English and papers published in the last 21 years.
Eleven laboratory and six clinical studies were reviewed. The laboratory-based studies have frequently shown elongation of adjustable loop devices to more than 3 mm under loading protocols, whereas the clinical studies have not shown any significant differences between the patients with fixed loop and the ones with adjustable loop devices.
This review shows a discrepancy between laboratory-based and clinical studies. The review of clinical studies in our paper would give future researchers confidence and act as a prompt to construct randomised clinical trials to investigate these devices further.
We feel that more robust clinical randomised studies and trials are needed to evaluate these new devices.
前交叉韧带（ACL）损伤是一种常见的运动损伤。该损伤后出现症状性膝关节不稳通常通过ACL重建手术治疗。手术包括将肌腱移植物固定在钻入股骨和胫骨的骨隧道中。移植物的固定对于取得良好效果至关重要。用于在股骨骨隧道中固定移植物的最常见装置之一是固定环皮质悬吊装置。最近，可调环皮质悬吊装置已被引入，并在ACL重建中受到欢迎。这些装置允许在插入后调整悬吊环的长度。目前关于可调环装置优于还是劣于固定环装置存在很多争论。
对腘绳肌ACL重建中使用可调环装置的当前生物力学和临床证据进行评论和综述。据我们所知，此前没有对该主题的综述。
系统评价。
本系统评价按照PRISMA进行。使用多个检索词和尽可能多的医学主题词（MeSH）检索了五个数据库。应用了以下限制条件：英文发表的论文以及过去21年内发表的论文。
对11项实验室研究和6项临床研究进行了综述。基于实验室的研究经常表明，在加载方案下可调环装置的伸长超过3毫米，而临床研究并未显示使用固定环装置的患者与使用可调环装置的患者之间存在任何显著差异。
本综述显示了基于实验室的研究和临床研究之间的差异。我们论文中的临床研究综述将为未来的研究人员提供信心，并促使他们开展随机临床试验以进一步研究这些装置。
我们认为需要更有力的临床随机研究和试验来评估这些新装置。
