Kunming Medical University, Kunming, 650032, Yunnan, People's Republic of China.
Department of Orthopedic Surgery, 920th Hospital of Joint Logistics Support Force, 212 Daguan Road, Kunming, 650100, Yunnan, People's Republic of China.
J Orthop Surg Res. 2023 Feb 21;18(1):127. doi: 10.1186/s13018-023-03613-y.
All-inside anterior cruciate ligament reconstruction (ACLR) is a novel technique that has gained attention due to its minimally invasive. However, evidence surrounding the efficacy and safety between all-inside and complete tibial tunnel ACLR are lacking. Present work was aimed to compare clinical outcome for ACLR performed with an all-inside versus a complete tibial tunnel technique.
Systematic searches were conducted of published literature on PubMed, Embase, and Cochrane for studies according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines up to May 10, 2022. The outcomes included KT-1000 arthrometer ligament laxity test, International Knee Documentation Committee (IKDC) subjective score, Lysholm score, Tegner activity scale, and Knee Society Score (KSS) Scale, and tibial tunnel widening. Complications of interest extracted were graft re-ruptures and evaluated the graft re-rupture rate. Data from published RCTs meeting inclusion criteria were extracted and analyzed, and all the extracted data are pooled and analyzed by RevMan 5.3.
A total of 8 randomized controlled trials involving 544 patients (consisting of 272 all-inside and 272 complete tibial tunnel patients) were included in the meta-analysis. We found clinical outcomes (International Knee Documentation Committee [IKDC] subjective score: mean difference [MD], 2.22; 95% CI, 0.23-4.22; p = 0.03; Lysholm score: MD, 1.09; 95% CI, 0.25-1.93; p = 0.01; Tegner activity scale: MD, 0.41; 95% CI, 0.11-0.71; p < 0.01; Tibial Tunnel Widening: MD = - 1.92; 95% CI, - 3.58 to - 0.25; p = 0.02; knee laxity: MD = 0.66; 95% CI, 0.12-1.20; p = 0.02; and graft re-rupture rate: RR, 1.97;95% CI, 0.50-7.74; P = 0.33) in the all-inside and complete tibial tunnel group. The findings also indicated that all-inside may be more advantageous in tibial tunnel healing.
Our meta-analysis indicated that the all-inside ACLR was superior to complete tibial tunnel ACLR in functional outcomes and tibial tunnel widening. However, the all-inside ACLR was not entirely superior to complete tibial tunnel ACLR in knee laxity measured, and graft re-rupture rate.
全内视镜前十字韧带重建（ACLR）是一种新型技术，因其微创而备受关注。然而，关于全内视镜和完整胫骨隧道 ACLR 之间的疗效和安全性的证据仍然缺乏。本研究旨在比较全内视镜与完整胫骨隧道技术行 ACLR 的临床结果。
根据系统评价和荟萃分析的首选报告项目，对截至 2022 年 5 月 10 日在 PubMed、Embase 和 Cochrane 上发表的文献进行系统搜索。结果包括 KT-1000 关节测径仪韧带松弛试验、国际膝关节文献委员会（IKDC）主观评分、Lysholm 评分、Tegner 活动量表和膝关节协会评分（KSS）量表以及胫骨隧道增宽。提取的感兴趣的并发症包括移植物再断裂，并评估移植物再断裂率。提取符合纳入标准的已发表 RCT 的数据并进行分析，所有提取的数据均通过 RevMan 5.3 进行汇总和分析。
共有 8 项随机对照试验纳入了 544 名患者（包括 272 名全内视镜和 272 名完整胫骨隧道患者）进行荟萃分析。我们发现临床结果（国际膝关节文献委员会[IKDC]主观评分：平均差值[MD]，2.22；95%置信区间，0.23-4.22；p=0.03；Lysholm 评分：MD，1.09；95%置信区间，0.25-1.93；p=0.01；Tegner 活动量表：MD，0.41；95%置信区间，0.11-0.71；p<0.01；胫骨隧道增宽：MD=-1.92；95%置信区间，-3.58 至-0.25；p=0.02；膝关节松弛度：MD=0.66；95%置信区间，0.12-1.20；p=0.02；以及移植物再断裂率：RR，1.97；95%置信区间，0.50-7.74；P=0.33）在全内视镜和完整胫骨隧道组之间存在差异。研究结果还表明，全内视镜可能在胫骨隧道愈合方面更有优势。
我们的荟萃分析表明，全内视镜 ACLR 在功能结果和胫骨隧道增宽方面优于完整胫骨隧道 ACLR。然而，在测量的膝关节松弛度和移植物再断裂率方面，全内视镜 ACLR 并非完全优于完整胫骨隧道 ACLR。
