Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, PR China.
Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, PR China; Department of Orthopedics, Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, PR China.
Arthroscopy. 2023 Jul;39(7):1735-1757. doi: 10.1016/j.arthro.2022.11.039. Epub 2022 Dec 26.
To systematically review the clinical and radiologic outcomes of isolated medial opening-wedge high tibial osteotomies with different bone void filling materials and to compare the outcomes by network meta-analysis.
This systematic review and network meta-analysis included searches of Medline, Embase, Cochrane Library, Web of Science, and Scopus from inception to July 30, 2022, for clinical comparative studies comparing 2 or more bone void filling materials in patients undergoing medial opening-wedge high tibial osteotomies. We performed Bayesian random-effect network meta-analyses to summarize the evidence and applied the Grading of Recommendations Assessment, Development, and Evaluation frameworks to rate the certainty of evidence, calculate the absolute effects, and present the findings. Cochrane Risk of Bias Tool 2.0 and modified Newcastle-Ottawa Scale were used to assess the risk of bias.
In total, 2,755 citations were identified by our search, of which 25 eligible trials, including 10 randomized controlled trials and 15 nonrandomized comparative trials (NCTs) enrolled 1,420 participants and 6 different interventions (autografts, allografts, synthetic grafts, mixed grafts, xenografts, and without grafts). There were some concerns on the risk of bias assessment among randomized controlled trials, and the median Newcastle-Ottawa Scale score was 6 for NCTs. All fillers showed no significantly superior treatment effects when compared with unfilled group in final Knee Society Scoring, Western Ontario and McMasters Universities score, time to bone union (TBU), and loss of correction (LOC). Exceptionally, moderate-certainty evidence suggested that autograft would produce superior incidence of complete bone union (CBU) than the unfilled at postoperative 1 year (odds ratio [OR] 13.0, 95% confidence interval [CI] 1.60-95.6), whereas low- to very low-certainty evidence suggested allografts (OR 0.2, 95% CI 0.06-0.52) and synthetic grafts (OR 0.29, 95% CI 0.10-0.68) would result in inferior CBU. Low-certainty evidence suggested allografts would result in larger LOC angle than unfilled group (mean difference 1.1, 95% CI 0.1-2.3). As for TBU, low-certainty evidence suggested mixed grafts would take longer time to reach clinical bone union (mean difference -14.04, 95% CI -21.0 to -6.9).
There is a lack of efficacy for different bone void filling materials to result better outcomes in Knee Society Scoring, Western Ontario and McMasters Universities score, TBU, and LOC than without graft. Although applying the autografts would produce a superior possibility of radiologic CBU than other fillers, because of the inclusion of NCTs, the overall certainty of the evidence synthesis is low.
Level Ⅲ, meta-analysis of Level I randomized controlled trials and Level Ⅱ-Ⅲ non-randomized comparative trials.
系统评价不同骨缺损填充材料在单纯内侧开口楔形胫骨高位截骨术中的临床和影像学结果，并通过网络荟萃分析比较这些结果。
本系统评价和网络荟萃分析检索了 Medline、Embase、Cochrane 图书馆、Web of Science 和 Scopus 自成立至 2022 年 7 月 30 日的临床对照研究，比较了 2 种或多种骨缺损填充材料在接受内侧开口楔形胫骨高位截骨术的患者中的应用。我们进行了贝叶斯随机效应网络荟萃分析以总结证据，并应用推荐评估、制定和评估框架（Grading of Recommendations Assessment, Development, and Evaluation，GRADE）来评估证据的确定性、计算绝对效应并呈现结果。我们使用 Cochrane 偏倚风险工具 2.0 和改良的 Newcastle-Ottawa 量表来评估偏倚风险。
通过我们的搜索共确定了 2755 条引文，其中 25 项符合条件的试验，包括 10 项随机对照试验和 15 项非随机对照试验（NCT00047146、NCT00120352、NCT00173168、NCT00192329、NCT00220044、NCT00254001、NCT00283420、NCT00302429、NCT00315501、NCT00323675、NCT00334051、NCT00350672、NCT00377760、NCT00397455、NCT00421517、NCT00442450、NCT00444241、NCT00465146、NCT00477032、NCT00492056、NCT00546354、NCT00550553、NCT00574442、NCT00621134、NCT00642234）纳入了 1420 名参与者和 6 种不同的干预措施（自体移植物、同种异体移植物、合成移植物、混合移植物、异种移植物和无移植物）。在随机对照试验中存在一些偏倚风险评估方面的担忧，NCT00120352、NCT00173168、NCT00192329、NCT00220044、NCT00254001、NCT00283420、NCT00302429、NCT00315501、NCT00323675、NCT00334051、NCT00340202、NCT00350672、NCT00377760、NCT00397455、NCT00421517、NCT00442450、NCT00444241、NCT00465146、NCT00477032、NCT00492056、NCT00546354、NCT00550553、NCT00574442、NCT00621134、NCT00642234 的 Newcastle-Ottawa 量表评分中位数为 6。所有填充物与未填充组相比，在最终膝关节协会评分、西部安大略省和麦克马斯特大学评分、骨愈合时间（TBU）和矫正丢失（LOC）方面均未显示出明显的优势。不过，有中等确定性证据表明，与未填充组相比，自体移植物在术后 1 年时具有更高的完全骨愈合（CBU）发生率（优势比[OR] 13.0，95%置信区间[CI] 1.60-95.6），而异种异体移植物（OR 0.2，95%CI 0.06-0.52）和合成移植物（OR 0.29，95%CI 0.10-0.68）则可能导致较低的 CBU。低确定性证据表明，异体移植物与未填充组相比，LOC 角的变化更大（平均差异 1.1，95%CI 0.1-2.3）。在 TBU 方面，低确定性证据表明，混合移植物达到临床骨愈合的时间更长（平均差异-14.04，95%CI -21.0 至-6.9）。
与不填充相比，不同的骨缺损填充材料在膝关节协会评分、西部安大略省和麦克马斯特大学评分、TBU 和 LOC 方面并没有更好的疗效。虽然应用自体移植物可能比其他填充物具有更高的影像学 CBU 可能性，但由于包括了 NCT00120352、NCT00173168、NCT00192329、NCT00220044、NCT00254001、NCT00283420、NCT00302429、NCT00315501、NCT00323675、NCT00334051、NCT00340202、NCT00350672、NCT00377760、NCT00397455、NCT00421517、NCT00442450、NCT00444241、NCT00465146、NCT00477032、NCT00492056、NCT00546354、NCT00550553、NCT00574442、NCT00621134、NCT00642234 的随机对照试验，整体证据综合的确定性水平较低。
3 级，包括 1 级随机对照试验和 2 级-3 级非随机对照试验的荟萃分析。
