对于接受前交叉韧带重建术的胫骨后倾角较高的患者，前侧闭合楔形胫骨高位截骨术是否可行？系统评价和荟萃分析。
Could anterior closed-wedge high tibial osteotomy be a viable option in patients with high posterior tibial slope who undergo anterior cruciate ligament reconstruction? A systematic review and meta-analysis.
机构信息
Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy.
Department of Economics, Boston College, Boston, MA, USA.
出版信息
Eur J Orthop Surg Traumatol. 2023 Aug;33(6):2201-2214. doi: 10.1007/s00590-022-03419-4. Epub 2022 Oct 29.
PURPOSE
This study aims to examine the clinical and radiological outcomes of patients who underwent ACL reconstruction (ACLR) combined with anterior closed-wedge high tibial osteotomy (ACW-HTO) for posterior tibial slope (PTS) reduction to investigate the efficacy of this procedure in improving anterior knee stability and preventing graft failure in primary and revision ACLR.
METHODS
A literature search was conducted in six databases (PubMed, Embase, Medline, Web of Science, Cochrane, and Scopus). The study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. The initial screening identified 1246 studies. Each eligible clinical article was screened according to the Oxford Centre for Evidence-Based Medicine 2011 levels of evidence (LoE), excluding clinical studies of LoE V. Quality assessment of the articles was performed using the ROBINS-I methodological evaluation. This systematic review and meta-analysis was registered on the International Prospective Register of Systematic Reviews (PROSPERO). For the outcomes that were possible to perform a meta-analysis, a p < 0.05 was considered statistically significant.
RESULTS
Five clinical studies were included in the final analysis. A total of 110 patients were examined. Pre- and post-operative clinical and objective tests that assess anteroposterior knee stability, PTS, clinical scores, and data on surgical characteristics, complications, return to sports activity, and graft failure after ACLR were investigated. A meta-analysis was conducted using R software, version 4.1.3 (2022, R Core Team), for Lysholm score and PTS outcomes. A statistically significant improvement for both these clinical and radiological outcomes (p < 0.05) after the ACW-HTO surgical procedure was found.
CONCLUSION
ACLR combined with ACW-HTO restores knee stability and function with satisfactory clinical and radiological outcomes in patients with an anterior cruciate ligament injury associated with a high PTS and seems to have a protective effect from further ruptures on the reconstructed ACL.
LEVEL OF EVIDENCE
Level IV.
目的
本研究旨在探讨接受前交叉韧带重建（ACLR）联合前闭楔形胫骨高位截骨术（ACW-HTO）以降低胫骨后倾角（PTS）的患者的临床和影像学结果，以研究该手术在改善前膝稳定性和预防原发性和复发性 ACLR 中移植物失败方面的疗效。
方法
在六个数据库（PubMed、Embase、Medline、Web of Science、Cochrane 和 Scopus）中进行文献检索。该研究根据系统评价和荟萃分析的首选报告项目（PRISMA）指南进行。初始筛选确定了 1246 项研究。根据牛津循证医学中心 2011 年证据水平（LoE），对每项合格的临床文章进行筛选，排除 LoE V 的临床研究。使用 ROBINS-I 方法学评估对文章进行质量评估。本系统评价和荟萃分析已在国际前瞻性系统评价登记处（PROSPERO）注册。对于可能进行荟萃分析的结果，p<0.05 被认为具有统计学意义。
结果
最终分析纳入了 5 项临床研究。共检查了 110 名患者。检查了术前和术后评估前-后膝关节稳定性、PTS、临床评分以及手术特征、并发症、重返运动活动和 ACLR 后移植物失败的数据。使用 R 软件（版本 4.1.3，2022，R Core Team）对 Lysholm 评分和 PTS 结果进行了荟萃分析。发现 ACW-HTO 手术后这些临床和影像学结果均有统计学显著改善（p<0.05）。
结论
ACL 联合 ACW-HTO 可恢复前交叉韧带损伤伴高 PTS 患者的膝关节稳定性和功能，具有令人满意的临床和影像学结果，并且似乎对重建的 ACL 进一步破裂具有保护作用。
证据水平
四级。
Zotero 插件