Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
Arthroscopy. 2021 Feb;37(2):694-705. doi: 10.1016/j.arthro.2020.10.017. Epub 2020 Oct 21.
To determine whether combined anterior cruciate ligament reconstruction (ACLR) and anterolateral ligament reconstruction (ALLR) result in better knee rotatory stability and postoperative clinical outcomes than ACLR alone.
A computer literature search was conducted of Medline (1982 to April 2020), Embase (1982 to April 2020), OVID (1982 to April 2020), and the Cochrane Library (1982 to April 2020) to screen all therapeutic trials on combined ACLR and ALLR versus isolated ACLR. Only level of evidence I and II clinical studies were included. The outcome measures included (1) objective knee stability examination such as anterior drawer test, Lachman test, KT-arthrometer measurement, and pivot shift test; (2) patient-reported outcomes such as International Knee Documentation Committee (IKDC), Tegner activity score, and Lysholm score; (3) return to play; and (4) graft rupture rate. Data were extracted, pooled, and analyzed to compare the 2 groups.
A total of 890 studies were screened, and 884 were excluded. Six clinical trials with 828 subjects were included in the final meta-analysis. In comparison to patients received combined ACLR and ALLR, patients who received isolated ACLR had a significantly lower negative pivot shift test rate (odds ratio [OR] 0.46, 95% confidence interval [CI] 0.23 to 0.92, I = 0%, P = .03, 95% prediction interval [PrI] 1.00 to 2.26), Lysholm score (mean difference -2.79, 95 % CI -4.68 to -0.91, I = 77 %, P = .004, 95% PrI -10.81 to 5.42), Tegner score (mean difference -0.57, 95% CI -1.12 to -0.02, I = 90 %, P = .04, 95% PrI -3.12 to 1.93).
Combined ALLR and ACLR could effectively augment knee rotatory stability by reducing pivot shift rate and moderately improve patients' clinical outcomes. However, the effect of ALLR on overall graft rupture rate cannot be confirmed.
II, meta-analysis of level I and II studies.
确定前交叉韧带重建（ACLR）联合前外侧韧带重建（ALLR）是否比单纯 ACLR 更能改善膝关节旋转稳定性和术后临床结果。
计算机检索 Medline（1982 年至 2020 年 4 月）、Embase（1982 年至 2020 年 4 月）、OVID（1982 年至 2020 年 4 月）和 Cochrane 图书馆（1982 年至 2020 年 4 月），以筛选所有关于 ACLR 联合 ALLR 与单纯 ACLR 的治疗性试验。仅纳入证据水平 I 和 II 的临床研究。观察指标包括：（1）客观膝关节稳定性检查，如前抽屉试验、lachman 试验、KT-关节测量仪测量和髌股关节试验；（2）患者报告的结果，如国际膝关节文献委员会（IKDC）、Tegner 活动评分和 Lysholm 评分；（3）重返运动；（4）移植物断裂率。提取、汇总和分析数据以比较两组。
共筛选出 890 项研究，其中 884 项被排除。最终的荟萃分析纳入了 6 项临床试验共 828 例患者。与接受单纯 ACLR 的患者相比，接受 ACLR 联合 ALLR 的患者阴性髌股关节试验率显著降低（比值比 [OR] 0.46，95%置信区间 [CI] 0.23 至 0.92，I = 0%，P =.03，95%预测区间 [PrI] 1.00 至 2.26），Lysholm 评分（均数差 -2.79，95% CI -4.68 至 -0.91，I = 77%，P =.004，95% PrI -10.81 至 5.42），Tegner 评分（均数差 -0.57，95% CI -1.12 至 -0.02，I = 90%，P =.04，95% PrI -3.12 至 1.93）。
ACL 联合 ALLR 可通过降低髌股关节试验率有效增强膝关节旋转稳定性，并适度改善患者的临床结果。然而，不能确定 ALLR 对总体移植物断裂率的影响。
II，I 和 II 级研究的荟萃分析。
