单纯前交叉韧带重建与外侧关节外肌腱固定术的最低 2 年随访结果的比较：一项随机对照试验的荟萃分析和系统评价。
Anterior Cruciate Ligament Reconstruction Alone Versus With Lateral Extra-articular Tenodesis With Minimum 2-Year Follow-up: A Meta-analysis and Systematic Review of Randomized Controlled Trials.
机构信息
Department of Orthopaedic Surgery, Box Hill Hospital, Melbourne, Victoria, Australia.
Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.
出版信息
Am J Sports Med. 2022 Mar;50(4):1137-1145. doi: 10.1177/03635465211004946. Epub 2021 Apr 22.
BACKGROUND
Lateral extra-articular tenodesis (LEAT) aims to improve anterolateral stability of the injured knee during anterior cruciate ligament reconstruction (ACLR) surgery. Inconclusive evidence surrounding the efficacy and safety of LEAT has propelled clinical interest and ongoing discussions.
PURPOSE
To establish level 1 evidence by assessing randomized controlled trials (RCTs) with minimum 2-year follow-up that directly compared ACLR with LEAT (LEAT group) and ACLR alone (non-LEAT group) in terms of clinical outcomes and complications.
STUDY DESIGN
Meta-analysis and systematic review; Level of evidence, 1.
METHODS
Meta-analysis was performed with a multidatabase search (Cochrane, EMBASE, OVID Medline, PubMed, and Web of Science) according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines on September 9, 2020. Data from published RCTs meeting inclusion criteria were extracted and analyzed with an inverse variance statistical model.
RESULTS
A total of 7 RCTs were included, consisting of 517 LEAT and 589 non-LEAT patients. Only autografts were used for ACLR and LEAT. A variety of LEAT techniques and autograft fixation methods were used. We found improved stability (residual positive pivot shift: risk ratio [RR], 0.59; 95% CI, 0.39-0.88; = .01) and better clinical outcomes (International Knee Documentation Committee [IKDC] score: mean difference [MD], 2.31; 95% CI, 0.54-4.09; = .01; and Lysholm score: MD, 2.71; 95% CI, 0.68-4.75; = .009) in the LEAT than non-LEAT group. Graft rerupture rate was 3 times less likely (RR, 0.31; 95% CI, 0.17-0.58; < .001) in the LEAT group than the non-LEAT group.
CONCLUSION
Good-quality evidence is available to support the efficacy of LEAT in improving anterolateral knee stability and reducing graft reruptures in primary ACLR. LEAT should be considered in patients with high risk factors. Although Lysholm and IKDC scores were statistically better in the LEAT group, these are unlikely to be clinically significant. Future studies should aim to identify patient populations that would best benefit from LEAT with ACLR.
背景
外侧关节外腱固定术（LEAT）旨在改善前交叉韧带重建（ACLR）手术中受伤膝关节的前外侧稳定性。LEAT 的疗效和安全性证据尚不明确，这引发了临床关注和持续讨论。
目的
通过评估至少 2 年随访的随机对照试验（RCT），采用荟萃分析和系统评价方法，根据 PRISMA（系统评价和荟萃分析的首选报告项目）指南，建立 1 级证据，直接比较 ACLR 联合 LEAT（LEAT 组）与 ACLR 单独治疗（非 LEAT 组）在临床结果和并发症方面的差异。
研究设计
荟萃分析和系统评价；证据水平，1 级。
方法
根据 PRISMA 指南，于 2020 年 9 月 9 日进行多数据库检索（Cochrane、EMBASE、OVID Medline、PubMed 和 Web of Science）。提取并分析符合纳入标准的已发表 RCT 数据，采用逆方差统计模型进行分析。
结果
共纳入 7 项 RCT，包括 517 例 LEAT 患者和 589 例非 LEAT 患者。ACLR 和 LEAT 均仅使用自体移植物。使用了各种 LEAT 技术和自体移植物固定方法。我们发现 LEAT 组的稳定性（残余阳性髌股关节旋转试验：风险比 [RR]，0.59；95%CI，0.39-0.88； =.01）和临床结局（国际膝关节文献委员会 [IKDC] 评分：均数差 [MD]，2.31；95%CI，0.54-4.09； =.01；和 Lysholm 评分：MD，2.71；95%CI，0.68-4.75； =.009）均优于非 LEAT 组。LEAT 组的移植物再断裂率降低了 3 倍（RR，0.31；95%CI，0.17-0.58； <.001）。
结论
有高质量证据支持 LEAT 在改善 ACLR 后膝关节前外侧稳定性和降低移植物再断裂方面的疗效。LEAT 应考虑用于高危患者。虽然 LEAT 组的 Lysholm 和 IKDC 评分在统计学上更好，但这些评分不太可能具有临床意义。未来的研究应旨在确定从 LEAT 联合 ACLR 中获益最大的患者人群。
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