Lee Tsung-Min, Wu Wei-Ting, Chiu Yi-Hsiang, Chang Ke-Vin, Özçakar Levent
Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei 10051, Taiwan.
Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan.
J Clin Med. 2022 Jul 4;11(13):3876. doi: 10.3390/jcm11133876.
Anterior cruciate ligament (ACL) reconstruction is widely used to restore knee stability after injury, but the risk of revision surgery increases when the autograft size is inadequate. Ultrasound (US) measurements of preoperative target tendons have been applied to predict the intraoperative autograft size, with various outcomes across different studies. This systematic review and meta-analysis aimed to summarize the evidence and investigate the usefulness of US in predicting autograft size. Electronic databases were searched for relevant studies from inception to 19 January 2022. The primary outcome was the correlation between the preoperative US measurements of donor tendons and intraoperative autograft size. The secondary outcomes encompassed the predictive performance of US for autograft size and the comparison between US and magnetic resonance imaging (MRI) for preoperative tendon measurements. Nine studies, comprising 249 patients, were enrolled. The preoperative US measurements of the donor tendons demonstrated a significant positive correlation with their intraoperative autograft diameter, with a pooled correlation coefficient of 0.443 (95% confidence interval [CI], 0.266−0.591, p < 0.001) for the gracilis and semitendinosus autograft, 0.525 (95% CI, 0.114−0.783, p = 0.015) for the semitendinosus autograft, and 0.475 (95% CI, 0.187−0.687, p = 0.002) for the gracilis autograft. The pooled sensitivity and specificity of US imaging in predicting the autograft diameter were 0.83 (95% CI 0.57−0.95) and 0.70 (95% CI, 0.36−0.91), respectively. Moreover, no significant differences were observed between US and MRI measurements in predicting the sizes of the gracilis and semitendinosus autografts. Preoperative US measurements of the target tendons were moderately correlated with the intraoperative autograft size. US imaging has a discriminative performance similar to that of MRI in predicting the autograft size. A standardized US scanning protocol is needed for future studies to minimize the variations in tendon measurements across different investigators and increase the comparability of US imaging with intraoperative findings.
前交叉韧带（ACL）重建术被广泛用于损伤后恢复膝关节稳定性，但当自体移植物尺寸不足时，翻修手术的风险会增加。术前对目标肌腱进行超声（US）测量已被用于预测术中自体移植物尺寸，不同研究的结果各异。本系统评价和荟萃分析旨在总结证据并研究超声在预测自体移植物尺寸方面的有用性。检索电子数据库中从数据库建立至2022年1月19日的相关研究。主要结局是术前对供体肌腱的超声测量与术中自体移植物尺寸之间的相关性。次要结局包括超声对自体移植物尺寸的预测性能以及超声与磁共振成像（MRI）在术前肌腱测量方面的比较。纳入了9项研究，共249例患者。术前对供体肌腱的超声测量显示与术中自体移植物直径呈显著正相关，股薄肌和半腱肌自体移植物的合并相关系数为0.443（95%置信区间[CI]，0.266−0.591，p<0.001），半腱肌自体移植物为0.525（95%CI，0.114−0.783，p = 0.015），股薄肌自体移植物为0.475（95%CI，0.187−0.687，p = 0.002）。超声成像预测自体移植物直径的合并敏感性和特异性分别为0.83（95%CI 0.57−0.95）和0.70（95%CI，0.36−0.91）。此外，在预测股薄肌和半腱肌自体移植物尺寸方面，超声和MRI测量之间未观察到显著差异。术前对目标肌腱的超声测量与术中自体移植物尺寸呈中度相关。超声成像在预测自体移植物尺寸方面具有与MRI相似的判别性能。未来研究需要一个标准化的超声扫描方案，以尽量减少不同研究者之间肌腱测量的差异，并提高超声成像与术中结果的可比性。
