Smith + Nephew, Hull, UK.
Department of Orthopedics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
Knee Surg Sports Traumatol Arthrosc. 2021 Oct;29(10):3458-3466. doi: 10.1007/s00167-020-06292-y. Epub 2020 Sep 30.
Bi-cruciate retaining total knee arthroplasty (BCR TKA) is thought to result in more natural knee kinematics compared to conventional TKA designs. This may lead to a reduction in dissatisfied patients after TKA. An intact anterior cruciate ligament (ACL) is a prerequisite for implantation of a BCR TKA but the frequency of an intact ACL in patients indicated for TKA is not well known. The objective of this systematic literature review was to determine the presence of an intact ACL in patients undergoing TKA by intraoperative macroscopic or MRI assessment. A systematic literature review was conducted using PubMed™ and EMBASE™ in June 2020. The ACL of patients with knee osteoarthritis (OA) undergoing TKA was classified as present (including intact and degenerated) vs. absent, and as intact vs. not fully intact. Proportional meta-analyses were performed. 2840 articles were identified and screened. 135 full texts were analyzed and 18 studies met the inclusion criteria for subsequent qualitative and quantitative meta-analysis. Analysis of the status of the ACL when assessed intraoperatively during TKA showed that the ligament was present in 79.4% of patients (CI: 73.5-84.3%), from 14 studies with 2067 cases studied. The ACL was determined to be intact in 55.0% of patients (CI: 45.3-64.4%), from 14 studies with 1916 cases. Preoperative ACL assessment using MRI (2 studies) revealed it was present in 82.9% of 193 cases (CI: 76.9-87.6%), and intact in 56.8% of 176 cases (CI: 8.2-94.7%). This systematic literature review shows that the ACL is macroscopically intact in more than half of patients with knee OA undergoing TKA, based on intraoperative assessment of the ligament. The results suggest BCR TKA may be considered as an alternative to traditional TKA in a large number of TKA patients. More high-quality studies are needed to better understand the functional status of the ACL in TKA patients.Level of evidence III.
双髁保留型全膝关节置换术（BCR TKA）被认为可以比传统 TKA 设计更能模拟自然膝关节运动学，这可能会降低 TKA 后患者的不满率。完整的前交叉韧带（ACL）是植入 BCR TKA 的前提条件，但需要 TKA 的患者中 ACL 完整的频率尚不清楚。本系统文献复习的目的是通过术中宏观或 MRI 评估来确定接受 TKA 的患者 ACL 的存在情况。于 2020 年 6 月使用 PubMed 和 EMBASE 进行了系统文献复习。将膝关节骨关节炎（OA）患者的 ACL 分为存在（包括完整和退变）和不存在，并分为完整和不完全完整。进行了比例荟萃分析。确定了 2840 篇文章并进行了筛选。分析了 135 篇全文，18 项研究符合随后进行定性和定量荟萃分析的纳入标准。分析 TKA 术中评估时 ACL 的状态表明，韧带存在于 79.4%的患者（CI：73.5-84.3%）中，涉及 14 项研究共 2067 例。14 项研究共 1916 例患者的 ACL 被确定为完整，占 55.0%（CI：45.3-64.4%）。使用 MRI 进行术前 ACL 评估（2 项研究）显示，193 例（CI：76.9-87.6%）中 82.9%的 ACL 存在，176 例（CI：8.2-94.7%）中有 56.8%的 ACL 完整。本系统文献复习显示，根据术中对韧带的评估，超过一半的膝关节 OA 患者的 ACL 在宏观上是完整的。这表明 BCR TKA 可以作为传统 TKA 的替代方法，用于大量的 TKA 患者。需要更多高质量的研究来更好地了解 TKA 患者 ACL 的功能状态。证据等级 III。
