Department of Orthopaedic Surgery, Hospital de Sant'Ana, Rua de Benguela 501, 2775-028, Parede, Portugal.
Department of Bioengineering, iBB - Institute for Bioengineering and Biosciences, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001, Lisboa, Portugal.
Knee Surg Sports Traumatol Arthrosc. 2023 May;31(5):1644-1657. doi: 10.1007/s00167-021-06613-9. Epub 2021 Jun 5.
Current treatment recommendations emphasize early loading, with preservation of tendon length and physiologic tension. The objective of this systematic review and network meta-analysis was to compare failure load and elongation after cyclic loading of Achilles tendon repair techniques at time-zero.
The databases PubMed, CENTRAL and Web of Science were searched for all published in-vitro studies comparing Achilles tendon repair techniques, or augmentation with autografts/biomaterials, and reports of failure load or elongation after cyclic loading. Only studies using human cadaveric Achilles tendons and matched pairs, or randomized specimen allocation, were selected for quantitative synthesis. A network meta-analysis per primary outcome was performed. Results were summarized as P score rankings and their validity was assessed using statistical methods.
Sixteen studies, comprising 367 tendon repairs, were included. The following repair techniques were used (n = number of studies): Krackow (n = 8), Achillon (n = 4), double Krackow (n = 3), Bunnell (n = 3), Percutaneous Achilles Repair System (n = 3), Percutaneous Achilles Repair System Midsubstance (n = 2), Kessler (n = 3), double Kessler (n = 1), modified triple Kessler (n = 1), triple bundle (n = 1), a multifilament stainless steel cable-crimp technique (n = 1) and a double loop knot stitch (n = 1). Five studies assessed augmentation with autografts/biomaterials. Regarding the failure load, biomaterial augmented Krackow repairs occupied the first four positions in the ranking, followed by the multifilament stainless steel cable-crimp and Percutaneous Achilles Repair System Midsubstance techniques. Concerning elongation after cyclic loading, the triple Kessler was ranked first, followed by the Achillon and Percutaneous Achilles Repair System Midsubstance techniques. A negligible correlation between ranks was found (r = 0.11; p = 0.75n.s.), meaning that a higher repair tensile strength is not necessarily related to improved performance in regard to avoidance of elongation.
In the failure load network meta-analysis, biomaterial augmented Krackow repairs ranked highest, but noticeable statistical heterogeneity was found. Regarding elongation with cyclic loading, the modified triple Kessler stitch showed the highest probability of ranking first.
Level IV.
目前的治疗建议强调早期负重，同时保持肌腱长度和生理张力。本系统评价和网络荟萃分析的目的是比较跟腱修复技术在零时刻的循环加载后的失效负荷和伸长率。
在 PubMed、CENTRAL 和 Web of Science 数据库中检索所有比较跟腱修复技术或使用自体移植物/生物材料增强的体外研究，并报告循环加载后的失效负荷或伸长率。仅选择使用人尸体跟腱和配对或随机标本分配的研究进行定量综合。对主要结果进行网络荟萃分析。结果总结为 P 评分排名，并使用统计方法评估其有效性。
纳入了 16 项研究，共 367 例跟腱修复。使用了以下修复技术（n=研究数量）：Krackow（n=8）、Achillon（n=4）、双 Krackow（n=3）、Bunnell（n=3）、经皮跟腱修复系统（n=3）、经皮跟腱修复系统中间部分（n=2）、Kessler（n=3）、双 Kessler（n=1）、改良三联 Kessler（n=1）、三束（n=1）、多丝不锈钢缆线卷曲技术（n=1）和双环结缝线（n=1）。有 5 项研究评估了自体移植物/生物材料的增强作用。关于失效负荷，生物材料增强的 Krackow 修复在排名中占据前四的位置，其次是多丝不锈钢缆线卷曲和经皮跟腱修复系统中间部分技术。关于循环加载后的伸长率，三联 Kessler 排名第一，其次是 Achillon 和经皮跟腱修复系统中间部分技术。发现等级之间的相关性很小（r=0.11；p=0.75n.s.），这意味着修复的拉伸强度越高，不一定与避免伸长的性能提高有关。
在失效负荷网络荟萃分析中，生物材料增强的 Krackow 修复排名最高，但存在明显的统计异质性。关于循环加载后的伸长率，改良三联 Kessler 缝线表现出排名第一的最高概率。
IV 级。
