Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York.
Weill Cornell Medical College, New York, New York.
Arthroscopy. 2021 Aug;37(8):2677-2703. doi: 10.1016/j.arthro.2021.03.058. Epub 2021 Apr 20.
To perform a systematic review and meta-analysis of the literature on anterolateral ligament (ALL) reconstruction as it relates to techniques, biomechanical properties, and clinical outcomes.
PubMed, OVID/Medline, and Embase were queried in July 2020. Data pertaining to (1) techniques, (2) biomechanical properties, and (3) clinical outcomes of ALL reconstruction were recorded. DerSimonian-Laird random-effects meta-analyses were performed for included randomized controlled trials comparing combined ALL/anterior cruciate ligament (ACL) reconstruction and isolated ACL reconstruction. Data from lower levels of evidence were described qualitatively, and when possible, outcomes were reported as ranges to avoid inappropriate pooling of data.
A total of 46 articles were identified. Sixteen were biomechanical studies, 16 were clinical outcome studies, and 14 were technique studies. Of the 16 biomechanical studies, the majority demonstrated that anterior translation, internal rotation, and pivot shift was restored with combined ACL/ALL reconstruction and superior to ACL reconstruction alone. Ten biomechanical studies reported on constraint: 4 noted overconstraint when the femoral attachment site was proximal and posterior to the lateral femoral condyle, whereas 1 reported laxity. ACL failure rates after combined ACL/ALL reconstruction ranged between 2.7% and 11.1%. The mean postoperative Lysholm score ranged between 58.7 and 98.0; mean postoperative International Knee Documentation Committee score between 57.8 and 96.3; and mean postoperative Tegner score between 4 and 8. Six outcomes were explored through meta-analysis, of which the mean difference in Lysholm scores (2.26, P < .001) and restoration of pivot shift (relative risk 1.1, P = .046) was found to favor combined ACL/ALL reconstruction.
Although indications for ALL reconstruction remain heterogeneous, contemporary evidence suggests that ALL reconstruction improves pivot shift and confers comparable clinical and functional outcomes with isolated ACLR.
IV, systematic review and meta-analysis.
对前外侧韧带（ALL）重建相关技术、生物力学特性和临床结果的文献进行系统回顾和荟萃分析。
2020 年 7 月在 PubMed、OVID/Medline 和 Embase 上进行检索。记录与（1）技术、（2）生物力学特性和（3）ALL 重建的临床结果相关的数据。对比较联合 ALL/前交叉韧带（ACL）重建和单独 ACL 重建的随机对照试验进行了 DerSimonian-Laird 随机效应荟萃分析。对证据水平较低的数据进行了定性描述，并且在可能的情况下，报告结果的范围以避免数据的不当合并。
共确定了 46 篇文章。其中 16 篇为生物力学研究，16 篇为临床结果研究，14 篇为技术研究。在 16 项生物力学研究中，大多数研究表明，联合 ACL/ALL 重建可恢复前向平移、内旋和旋转不稳定，并优于单独 ACL 重建。有 10 项生物力学研究报告了约束情况：4 项研究表明，当股骨附着点位于外侧股骨髁的近端和后方时，存在过约束，而 1 项研究报告了松弛。联合 ACL/ALL 重建后 ACL 失败率为 2.7%至 11.1%。术后 Lysholm 评分的平均值在 58.7 至 98.0 之间；术后国际膝关节文献委员会评分平均值在 57.8 至 96.3 之间；术后 Tegner 评分平均值在 4 至 8 之间。通过荟萃分析探讨了 6 个结果，其中 Lysholm 评分的平均差异（2.26，P<.001）和旋转不稳定的恢复（相对风险 1.1，P=.046）有利于联合 ACL/ALL 重建。
尽管 ALL 重建的适应证仍然存在异质性，但当代证据表明，ALL 重建可改善旋转不稳定，并与单独 ACLR 具有相当的临床和功能结果。
IV，系统评价和荟萃分析。
