Pang Long, Li Pengcheng, Li Tao, Li Yinghao, Zhu Jing, Tang Xin
Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China.
Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China.
Front Surg. 2022 Apr 20;9:887522. doi: 10.3389/fsurg.2022.887522. eCollection 2022.
To compare the clinical outcomes of arthroscopic anterior cruciate ligament (ACL) repair and autograft ACL reconstruction for ACL ruptures.
PubMed, EMBASE, Scopus, Web of Science and The Cochrane Library were searched for relevant studies from 1 January 1990 to 21 March 2022. Two evaluators independently screened the literature, extracted data and assessed the methodological quality of the enrolled studies. Meta-analysis was conducted using RevMan 5.4 software.
Ten studies with mean follow-up periods from 12 to 36 months were included. For 638 patients with ACL ruptures, arthroscopic ACL repair showed statistically comparable outcomes of failure ( = 0.18), complications ( = 0.29), reoperation other than revision ( = 0.78), Lysholm score ( = 0.78), Tegner score ( = 0.70), and satisfaction ( = 0.45) when compared with autograft ACL reconstruction. A significantly higher rate of hardware removal ( = 0.0008) but greater International Knee Documentation Committee (IKDC) score ( = 0.009) were found in the ACL repair group. The heterogeneity of the side-to-side difference of anterior tibial translation (ΔATT) was high ( = 80%). After the sensitivity analysis, the decreased dramatically ( = 32%), and the knees with ACL repair showed significantly greater ΔATT ( = 0.04).
For proximal ACL ruptures, arthroscopic ACL repair showed similar clinical outcomes, and even better functional performance when compared to autograft ACL reconstruction. ACL repair has a higher rate of hardware removal, and might be related to greater asymptomatic knee laxity. More high-quality prospective trials are needed to confirm our findings.
比较关节镜下前交叉韧带（ACL）修复术与自体移植ACL重建术治疗ACL断裂的临床疗效。
检索PubMed、EMBASE、Scopus、Web of Science和Cochrane图书馆，查找1990年1月1日至2022年3月21日的相关研究。两名评估人员独立筛选文献、提取数据并评估纳入研究的方法学质量。使用RevMan 5.4软件进行荟萃分析。
纳入10项平均随访时间为12至36个月的研究。对于638例ACL断裂患者，与自体移植ACL重建术相比，关节镜下ACL修复术在失败率（=0.18）、并发症发生率（=0.29）、翻修以外的再次手术率（=0.78）、Lysholm评分（=0.78）、Tegner评分（=0.70）和满意度（=0.45）方面显示出统计学上相当的结果。ACL修复组的取出内植物率显著更高（=0.0008），但国际膝关节文献委员会（IKDC）评分更高（=0.009）。胫骨前移（ΔATT）的左右侧差异异质性较高（=80%）。敏感性分析后，异质性显著降低（=32%），ACL修复的膝关节显示出显著更大的ΔATT（=0.04）。
对于近端ACL断裂，关节镜下ACL修复术显示出相似的临床疗效，与自体移植ACL重建术相比，功能表现甚至更好。ACL修复术的取出内植物率更高，可能与膝关节无症状性松弛程度更高有关。需要更多高质量的前瞻性试验来证实我们的发现。
