Cho Eunshinae, Chen Jiebo, Xu Caiqi, Zhao Jinzhong
Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China.
J Orthop Traumatol. 2022 Apr 27;23(1):22. doi: 10.1186/s10195-022-00641-y.
Our aim was to evaluate the literature investigating proprioception improvement after anterior cruciate ligament reconstruction (ACLR) and test the hypothesis that ACL tibial remnant-preserving reconstruction (ACLR-R) is more beneficial than standard technique (ACLR-S) in terms of postoperative proprioceptive function with various reported tests, including joint position sense (JPS) and threshold to detect passive motion (TTDPM).
An online search was performed in Embase, MEDLINE/PubMed, Cochrane, SPORTDiscus, and Web of Science databases before 5 October 2020, on the basis of the guidelines of the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. Key terms [('ACLR' or 'ACL-R' or 'anterior cruciate ligament reconstruction') AND ('remnant' or 'stump') AND ('proprioception' or 'proprioceptive')] were used. The Oxford Centre for Evidence-Based Medicine and The McMaster Critical Review Form for Quantitative Studies were used for quality assessment. In total, four articles comparing proprioceptive functions between ACLR-R and ACLR-S were included, two of which were randomized clinical trials rated as level of evidence II, and two were retrospective cohort studies rated as level of evidence III. The outcomes were then compared. Evaluation of proprioception involved joint position sense (JPS) [reproduction of active positioning (RAP) and reproduction of passive positioning (RPP)] and threshold to detect passive motion (TTDPM) tests.
Only four studies were included, with a total of 234 patients (119 ACLR-R patients and 115 ACLR-S patients). High heterogeneity in characteristics and outcome measurements was observed among the studies. Three studies performed sparing technique, and one performed tensioning technique. One study tested RAP and reported better results at an average of 7 months follow-up in ACLR-R (P < 0.05). Three studies tested RPP, one of which measured RPP within 12 months after surgery and reported better results in ACLR-R than in ACLR-S (P < 0.05). The other two studies reported similar results; however, the findings of one study were statistically insignificant. TTDPM was tested in one study, with no statistically significant difference found.
The current literature, although limited, reported proprioception improvement after ACLR-R (compared with ACLR-S) in terms of JPS. However, owing to the heterogeneity of the relevant studies, further research is required to determine remnant preservation effect on knee proprioceptive restoration.
Level III, systematic review of Level II and III studies.
我们旨在评估有关前交叉韧带重建（ACLR）后本体感觉改善情况的文献，并验证以下假设：在术后本体感觉功能方面，采用保留ACL胫骨残端的重建术（ACLR-R）比标准技术（ACLR-S）更具优势，评估方法包括关节位置觉（JPS）和被动运动检测阈值（TTDPM）等多种已报道的测试。
根据系统评价和Meta分析的首选报告项目（PRISMA）声明的指南，于2020年10月5日前在Embase、MEDLINE/PubMed、Cochrane、SPORTDiscus和Web of Science数据库中进行了在线搜索。使用的关键词为[（“ACLR”或“ACL-R”或“前交叉韧带重建”）AND（“残端”或“残株”）AND（“本体感觉”或“本体感受性”）]。采用牛津循证医学中心和麦克马斯特定量研究批判性评价表进行质量评估。总共纳入了4篇比较ACLR-R和ACLR-S本体感觉功能的文章，其中2篇为随机临床试验，证据等级为II级，2篇为回顾性队列研究，证据等级为III级。然后对结果进行比较。本体感觉评估包括关节位置觉（JPS）[主动定位再现（RAP）和被动定位再现（RPP）]以及被动运动检测阈值（TTDPM）测试。
仅纳入了4项研究，共234例患者（119例ACLR-R患者和115例ACLR-S患者）。研究之间在特征和结果测量方面存在高度异质性。3项研究采用了保留技术，1项研究采用了张力技术。1项研究测试了RAP，并报告在ACLR-R组平均随访7个月时结果更好（P < 0.05）。3项研究测试了RPP，其中1项在术后12个月内测量RPP，报告ACLR-R组的结果优于ACLR-S组（P < 0.05）。另外2项研究报告了相似的结果；然而，其中1项研究的结果无统计学意义。1项研究测试了TTDPM，未发现统计学显著差异。
尽管目前的文献有限，但报告了ACLR-R（与ACLR-S相比）在JPS方面本体感觉有所改善。然而，由于相关研究的异质性，需要进一步研究以确定保留残端对膝关节本体感觉恢复的影响。
III级，对II级和III级研究的系统评价。
