Tripathy Sujit Kumar, Varghese Paulson, Behera Hrudeswar, Balagod Raghavendra, Rao P Bhaskar, Sahoo Alok Kumar, Panda Aparajita
Dept. of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar, India.
Dept. of Anaesthesia and Critical Care, All India Institute of Medical Sciences, Bhubaneswar, India.
J Clin Orthop Trauma. 2022 Mar 26;28:101847. doi: 10.1016/j.jcot.2022.101847. eCollection 2022 May.
Pain, swelling and joint stiffness are the major problems following arthroscopic ACL reconstruction (ACLR) surgery that restrict early return to sports and athletic activities. The patients often receive prolonged analgesic medications to control the inflammatory response and resume the pre-injury activities. This systematic review aims to evaluate the safety and efficacy of intraarticular (IA) hyaluronic acid (HA) injection following ACLR.
A literature search of electronic databases and a manual search of studies reporting clinical effectiveness of IA HA following ACLR was performed on 1 November 2020. The quality of the methodology and risk of bias was assessed using the Cochrane Collaboration Risk of Bias Tool and Newcastle-Ottawa scale for randomized-controlled trial and prospective cohort studies, respectively.
Of 324 studies retrieved, four studies (3 RCTs and one prospective cohort study) were found to be suitable for inclusion in this review. These studies had a low to moderate risk of bias. There were 182 patients in the HA group and 121 patients in the control group. The demographic characteristics of the patients were similar in all studies. The pooled analysis of studies evaluating pain at different follow up periods (2-week, 4-6 weeks, 8-12 weeks) after ACLR revealed no significant difference between the HA and control groups (p > 0.05). The knee swelling was significantly less in the HA group at two weeks (MD -7.85, 95% CI: [-15.03, -0.68], p = 0.03, I2 = 0%), but no such difference was noted after 4-6 weeks and 8-12 weeks. The functional outcome score was not significantly different between the groups (SMD 0.00, 95% CI: 0.38 to 0.38, p = 0.99, I = 0%).
Although the individual study demonstrated a short-term positive response regarding pain control and swelling reduction, the pooled analysis did not find any clinical benefit of IA HA injection following ACLR surgery.
II.
疼痛、肿胀和关节僵硬是关节镜下前交叉韧带重建（ACLR）手术后的主要问题，这些问题限制了患者早期恢复运动和体育活动。患者通常需要长期服用止痛药物来控制炎症反应并恢复伤前活动。本系统评价旨在评估ACLR术后关节内（IA）注射透明质酸（HA）的安全性和有效性。
于2020年11月1日对电子数据库进行文献检索，并手动检索报告ACLR术后IA HA临床疗效的研究。分别使用Cochrane协作偏倚风险工具和纽卡斯尔-渥太华量表对随机对照试验和前瞻性队列研究的方法学质量和偏倚风险进行评估。
在检索到的324项研究中，有4项研究（3项随机对照试验和1项前瞻性队列研究）适合纳入本评价。这些研究的偏倚风险为低到中度。HA组有182例患者，对照组有121例患者。所有研究中患者的人口统计学特征相似。对评估ACLR术后不同随访期（2周、4 - 6周、8 - 12周）疼痛情况的研究进行汇总分析，结果显示HA组和对照组之间无显著差异（p > 0.05）。HA组在术后两周时膝关节肿胀明显减轻（MD -7.85，95% CI：[-15.03, -0.68]，p = 0.03，I2 = 0%），但在4 - 6周和8 - 12周后未观察到此类差异。两组之间的功能结局评分无显著差异（SMD 0.00，95% CI：0.38至0.38，p = 0.99，I = 0%）。
尽管个别研究显示IA HA注射在疼痛控制和肿胀减轻方面有短期积极反应，但汇总分析未发现ACLR手术后IA HA注射有任何临床益处。
II级
