Guo Weiming, Wan Teng, Tan Haifeng, Fan Gang, Gao Xiaoyu, Liu Pan, Jiang Changqing
Department of Sports Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital, The 6th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China.
Hengyang Medical College, University of South China, Hengyang, Hunan, China.
Front Bioeng Biotechnol. 2022 Aug 23;10:890118. doi: 10.3389/fbioe.2022.890118. eCollection 2022.
The unicondylar knee arthroplasty (UKA) procedure is primarily indicated for osteoarthritis of the knee. Anterior cruciate ligament (ACL) defects have long been considered a contraindication to UKA. However, recent clinical studies have found that ACL defects do not affect postoperative outcomes in UKA. To elucidate whether ACL defects affect postoperative outcomes in UKA, we performed a systematic review and Meta-analysis of observational cohort studies comparing the effects of ACL defects and intactness on surgical outcomes in UKA. In this study, we used "Anterior Cruciate Ligament", "Anterior Cruciate Ligament Injuries" and "Arthroplasty, Replacement, Knee" as the subject terms according to PICOS principles. These subject terms and the corresponding free texts were used to conduct a systematic search in the three major databases PubMed, Embase and Cochrane on December 9, 2021. The main study variables included age, gender, region, definition of ACL defect and diagnosed diseases. The study used a random effect model to pool the effect of 95% CIs. To explore the sources of heterogeneity and to test the stability of the results, a sensitivity analysis was performed. The systematic review found no significant differences in postoperative clinical outcomes in the elderly population when unicondylar replacement was performed in the setting of multiple factors such as injury, defects, longitudinal tear, and synovial bursa injury defined as ACL deficiency. The primary clinical outcomes included postoperative revision, Tegner activity score, and Oxford Knee Score (OKS). After statistical meta-analysis, postoperative outcomes such as postoperative revision (OR, 1.174; 95% CIs, 0.758-1.817) and Tegner activity score (OR, -0.084; 95% CIs, -0.320-0.151) were not statistically different. There was no difference in postoperative revision rates and functional outcomes such as Tegner activity score between the ACL-deficient group compared with the ACL-intact group. For the present results, it is not advisable to consider ACL deficiency as a contraindication of UKA.
单髁膝关节置换术（UKA）主要适用于膝关节骨关节炎。长期以来，前交叉韧带（ACL）缺损一直被视为UKA的禁忌证。然而，最近的临床研究发现，ACL缺损并不影响UKA的术后效果。为了阐明ACL缺损是否会影响UKA的术后效果，我们对观察性队列研究进行了系统评价和Meta分析，比较了ACL缺损与完整对UKA手术效果的影响。在本研究中，我们根据PICOS原则，使用“前交叉韧带”“前交叉韧带损伤”和“关节成形术，置换，膝”作为主题词。2021年12月9日，使用这些主题词及相应的自由文本在三大数据库PubMed、Embase和Cochrane中进行系统检索。主要研究变量包括年龄、性别、地区、ACL缺损的定义和诊断疾病。该研究采用随机效应模型汇总95%可信区间的效应。为了探索异质性来源并检验结果的稳定性，进行了敏感性分析。系统评价发现，在多种因素（如损伤、缺损、纵向撕裂和滑膜囊损伤，定义为ACL缺陷）情况下进行单髁置换时，老年人群术后临床效果无显著差异。主要临床结果包括术后翻修、Tegner活动评分和牛津膝关节评分（OKS）。经统计学Meta分析，术后翻修（OR，1.174；95%可信区间，0.758 - 1.817）和Tegner活动评分（OR， - 0.084；95%可信区间， - 0.320 - 0.151）等术后结果无统计学差异。ACL缺陷组与ACL完整组相比，术后翻修率和Tegner活动评分等功能结果无差异。就目前结果而言，不宜将ACL缺陷视为UKA的禁忌证。
