一项比较单前交叉韧带损伤和多韧带膝关节损伤中早期与延迟韧带手术结果的系统评价。
A systematic review comparing the results of early vs delayed ligament surgeries in single anterior cruciate ligament and multiligament knee injuries.
作者信息
Kim Seong Hwan, Han Sang-Jin, Park Yong-Beom, Kim Dong-Hyun, Lee Han-Jun, Pujol Nicolas
机构信息
Department of Orthopedic Surgery, Hyundae General Hospital, Chung-Ang University College of Medicine, Jinjeop-eup, Namyangju-si, Gyunggi-do, Republic of Korea.
Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, Republic of Korea.
出版信息
Knee Surg Relat Res. 2021 Jan 7;33(1):1. doi: 10.1186/s43019-020-00086-9.
PURPOSE
The purpose of this study was to compare clinical outcomes and incidence of concomitant injuries in patients undergoing early vs delayed surgical treatment of single anterior cruciate ligament (ACL) injury and multiligament knee injury (MLKI).
METHODS
A literature search using PubMed, Embase, the Cochrane Library, the Cumulative Index to Nursing and Allied Health, and Scopus from their inception to April 30, 2020 was conducted. Studies with levels I to IV evidence reporting the incidence of meniscus or cartilage injury according to early vs delayed surgery in single ACL injuries and MLKIs were included. In the meta-analysis, data based on the number of meniscus and cartilage injuries were extracted and pooled. Lysholm and Tegner scores were analyzed using two-sample Z-tests to calculate the non-weighted mean difference (NMD). A meta-regression analysis was also performed to determine the effect of single ACL injury and MLKI/study design.
RESULTS
Sixteen studies on single ACL injury and 14 studies on MLKI were included in this analysis. In the analysis, there were significant decreases in Lysholm score (NMD - 5.3 [95% confidence interval (CI) - 7.37 to - 3.23]) and Tegner score (NMD - 0.25 [95% CI - 0.45 to - 0.05]) and increases in risk of meniscus tear (odds ratio [OR] 1.73 [95% CI 1.1-2.73], p = 0.01) and cartilage injury (OR 2.48 [95% CI 1.46-4.2], p = 0.0007) in the delayed surgery group regardless of single ACL injury or MLKI. The result of the meta-regression analysis indicated that single ACL injury and MLKI/study design were not significant moderators of overall heterogeneity (p > 0.05).
CONCLUSIONS
Our study suggests that delayed ACL surgery significantly resulted in a higher risk of meniscus tear and cartilage injury and decreased Lysholm and Tegner scores compared to early ACL surgery. The Lysholm scores in the delayed MLKI surgery group were significantly decreased, but the risks of meniscus tear and cartilage injury in the delayed MLKI surgery group remained unclear.
LEVEL OF EVIDENCE
Level III, meta-analysis.
目的
本研究旨在比较单纯前交叉韧带（ACL）损伤和膝关节多韧带损伤（MLKI）患者接受早期与延迟手术治疗的临床结局及合并伤发生率。
方法
利用PubMed、Embase、Cochrane图书馆、护理及相关健康累积索引和Scopus进行文献检索，检索时间范围从各数据库建库至2020年4月30日。纳入证据等级为I至IV级、报告单纯ACL损伤和MLKI患者早期与延迟手术半月板或软骨损伤发生率的研究。在荟萃分析中，提取并汇总基于半月板和软骨损伤数量的数据。使用双样本Z检验分析Lysholm和Tegner评分，以计算非加权平均差（NMD）。还进行了荟萃回归分析，以确定单纯ACL损伤和MLKI/研究设计的影响。
结果
本分析纳入了16项关于单纯ACL损伤的研究和14项关于MLKI的研究。分析结果显示，无论单纯ACL损伤还是MLKI，延迟手术组的Lysholm评分（NMD -5.3[95%置信区间（CI）-7.37至-3.23]）和Tegner评分（NMD -0.25[95%CI -0.45至-0.05]）显著降低，半月板撕裂风险（优势比[OR]1.73[95%CI 1.1 - 2.73]，p = 0.01）和软骨损伤风险（OR 2.48[95%CI 1.46 - 4.2]，p = 0.0007）增加。荟萃回归分析结果表明，单纯ACL损伤和MLKI/研究设计不是总体异质性的显著调节因素（p>0.05）。
结论
我们的研究表明，与早期ACL手术相比，延迟ACL手术显著增加半月板撕裂和软骨损伤风险，并降低Lysholm和Tegner评分。延迟MLKI手术组的Lysholm评分显著降低，但延迟MLKI手术组的半月板撕裂和软骨损伤风险仍不明确。
证据等级
III级，荟萃分析。
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