Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water St., Pittsburgh, PA, 15203, USA.
Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.
Knee Surg Sports Traumatol Arthrosc. 2021 Apr;29(4):1238-1250. doi: 10.1007/s00167-020-06171-6. Epub 2020 Jul 23.
In single-stage ACL-PCL reconstruction, there is uncertainty regarding the order of graft tensioning and fixation, as well as the optimal knee flexion angle(s) for graft fixation. A systematic review of clinical studies of single-stage combined ACL-PCL reconstruction was performed to determine whether a particular fixation sequence and/or knee flexion angle is associated with superior outcomes.
A systematic review was performed according to PRISMA guidelines. All levels of evidence were included. All outcome measures were extracted, including physical examination values, radiographic measurements, and objective and subjective outcomes.
Of the 19 included studies, 17 tensioned and fixed the PCL before the ACL. Only four studies reported the methods/forces used for graft tensioning. Across studies, the ACL was fixed at variable knee flexion angles, from full extension to 70°. Conversely, 3 studies fixed the PCL at a knee flexion angle < 45°, while the remaining 16 studies fixed the PCL at a flexion angle > 70°. Patient-reported outcomes were qualitatively similar between groups.
This systematic review found considerable variability in graft tension, fixation sequence, and knee flexion angle at the time of fixation, with insufficient evidence to support specific surgical practices. Most commonly, the PCL is fixed before the ACL graft, with fixation occurring at a knee flexion angle between 70° and 90° and near full extension, respectively. The methodology for quantifying the forces applied for graft tensioning is rarely described. Given this clinical equipoise, future studies should consistently report these surgical details. Furthermore, prospective, randomized studies on the treatment of multiligament knee injuries are needed to improve outcomes in patients.
IV.
在单阶段 ACL-PCL 重建中，对于移植物的拉紧和固定顺序以及移植物固定的最佳膝关节弯曲角度（s）存在不确定性。对单阶段联合 ACL-PCL 重建的临床研究进行了系统评价，以确定特定的固定顺序和/或膝关节弯曲角度是否与更好的结果相关。
根据 PRISMA 指南进行系统评价。纳入所有证据水平的研究。提取所有的结果指标，包括体格检查值、影像学测量值以及客观和主观结果。
在纳入的 19 项研究中，有 17 项研究先拉紧并固定了 PCL，然后再拉紧 ACL。只有 4 项研究报告了用于移植物拉紧的方法/力。在不同的研究中，ACL 是在从完全伸展到 70°的不同膝关节弯曲角度下固定的。相反，有 3 项研究将 PCL 固定在小于 45°的膝关节弯曲角度下，而其余 16 项研究则将 PCL 固定在大于 70°的膝关节弯曲角度下。两组患者报告的结果在定性上相似。
这项系统评价发现，在移植物拉紧、固定顺序和固定时的膝关节弯曲角度方面存在相当大的差异，缺乏支持特定手术实践的证据。最常见的是，PCL 在 ACL 移植物之前固定，固定发生在 70°至 90°之间的膝关节弯曲角度和接近完全伸展的位置。很少有研究描述用于量化移植物拉紧力的方法。鉴于这种临床平衡，未来的研究应该一致报告这些手术细节。此外，需要对多韧带膝关节损伤的治疗进行前瞻性、随机研究，以改善患者的预后。
IV。
