EBM Analytics, Crows Nest, NSW, Australia.
Orthopaedics Department, Queen Elizabeth II Jubilee Hospital, Coopers Plains, QLD, Australia.
Knee Surg Sports Traumatol Arthrosc. 2023 Aug;31(8):3172-3185. doi: 10.1007/s00167-022-07299-3. Epub 2023 Jan 27.
Knee extension deficits complicate recovery from ACL injury and reconstruction; however, the incidence of knee extension loss is not well defined. The aim of this review was to identify the incidence of loss of extension (LOE) following ACL rupture and reconstruction, explore the definitions of knee extension deficits reported and identify prognostic factors affecting LOE incidence.
A systematic search was conducted in Medline, Cochrane Library and PEDro for studies in publication up to November 2021, with no restrictions on publication year. References were screened and assessed for inclusion using predetermined eligibility criteria. Randomised controlled trials (RCTs) that quantified knee angle, loss of extension or incidence of extension deficit were included for quality assessment and data extraction. Statistical summaries were generated and meta-analyses performed in two parts to examine: (i) the probability of a datapoint being zero incidence compared to a nonzero incidence and (ii) the relationship between the predictors and nonzero LOE incidence.
A sample of 15,494 studies were retrieved using the search criteria, with 53 studies meeting eligibility criteria. The pooled results from 4991 participants were included for analysis, with 4891 participants who had undergone ACLR. The proportion of included studies judged at an overall low risk of bias was small (7.8%). The observed group and study were the most important predictors for whether a datapoint reported an incidence of extension deficit. Time to follow-up (P < 0.001) and graft type (P = 0.02) were found to have a significant influence on nonzero LOE incidence (%). Covariate adjusted estimates of average LOE indicated 1 in 3 patients presenting with LOE at 12 month follow-up, reducing to 1 in 4 at 2 years.
This review examined the definitions for the measurement and interpretation of postoperative knee extension and established the trajectory of knee extension deficit after ACL injury and reconstruction. While factors associated with loss of extension were identified, the exact trajectory of knee extension deficits was difficult to infer due to discrepancies in measurement techniques and patient variation. On average, 1 in 3 patients may present with loss of extension of at least 3 degrees at 12-month follow-up, decreasing to 1 in 4 at 2 years. These results may be used by clinicians as an upper threshold for acceptable complication rates following ACLR. Future work should focus on LOE as a clinically relevant complication of ACL injury and treatment with appropriate attention to standardisation of definitions, measurements and better understanding of natural history.
CRD42018092295.
Level I.
膝关节伸展不足会影响 ACL 损伤和重建后的恢复；然而，膝关节伸展丧失的发生率尚不清楚。本综述的目的是确定 ACL 断裂和重建后伸展丧失（LOE）的发生率，探讨报告的膝关节伸展不足的定义，并确定影响 LOE 发生率的预测因素。
在 Medline、Cochrane 图书馆和 PEDro 中进行了系统搜索，检索截至 2021 年 11 月的出版物，对出版年份没有限制。使用预定的入选标准筛选参考文献并进行评估。纳入了量化膝关节角度、伸展损失或伸展缺陷发生率的随机对照试验（RCT）进行质量评估和数据提取。在两部分中生成统计摘要并进行荟萃分析，以检查：（i）数据点为零发生率与非零发生率的概率，以及（ii）预测因子与非零 LOE 发生率之间的关系。
使用搜索标准检索到 15494 项研究，其中 53 项符合入选标准。对 4991 名参与者进行了分析，其中 4891 名参与者接受了 ACLR。总体认为低偏倚风险的研究比例较小（7.8%）。观察到的组和研究是报告伸展缺陷发生率的数据点的最重要预测因素。随访时间（P<0.001）和移植物类型（P=0.02）被发现对非零 LOE 发生率（%）有显著影响。协变量调整后的平均 LOE 估计值表明，13 的患者在 12 个月随访时出现 LOE，2 年后减少到 14。
本综述检查了术后膝关节伸展的测量和解释的定义，并确定了 ACL 损伤和重建后膝关节伸展不足的轨迹。虽然确定了与伸展丧失相关的因素，但由于测量技术和患者差异的差异，很难推断膝关节伸展不足的确切轨迹。平均而言，13 的患者可能在 12 个月随访时出现至少 3 度的伸展丧失，2 年后减少到 14。这些结果可被临床医生用作 ACLR 后可接受并发症发生率的上限。未来的工作应重点关注 LOE 作为 ACL 损伤和治疗的临床相关并发症，并适当关注定义、测量的标准化以及对自然史的更好理解。
PROSPERO 注册号：CRD42018092295。
一级。
