LeDuc Ryan C, Upadhyay Drashti, Brown Nicholas M
Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, 2160 S First Ave. Maguire Bldg. Ste 1300, Maywood, IL 60153 USA.
Loyola University Chicago Stritch School of Medicine, Maywood, IL USA.
Indian J Orthop. 2023 Jun 9;57(8):1188-1195. doi: 10.1007/s43465-023-00914-6. eCollection 2023 Aug.
Primary total knee arthroplasty (TKA) can be performed using cruciate-retaining (CR), cruciate-substituting (CS), or posterior-stabilized (PS) total knee arthroplasty designs. While there have been many studies comparing the outcomes of CR versus PS TKA, the current literature is lacking in systematic reviews and meta-analyses that compare outcomes of CR knees versus CS TKAs.
This study is a systematic review and meta-analysis of the literature comparing CR and CS knees with regard to survivorship, functional, and patient-reported outcomes, range of motion (ROM), biomechanics, and revision rate. PubMed, Cochrane, and Embase were used for the literature search, and the Modified Coleman Methodology Score was used to assess the quality of the studies.
Seven studies met the inclusion criteria. This systematic review and meta-analysis suggests that there are no significant differences in survivorship, ROM, or clinical knee scores between the CR and CS knees. Postoperative complications did not vary greatly between the CR and CS groups. Among the seven studies, three CR designs needed revision for either patellar crepitus, joint stiffness, or aseptic loosening of the tibial component. One CS design needed arthrotomy due to patellar clunk syndrome.
CR and CS knees are both reasonable options for primary TKA.
初次全膝关节置换术（TKA）可采用保留交叉韧带（CR）、替代交叉韧带（CS）或后稳定型（PS）全膝关节置换设计。虽然已有许多研究比较了CR与PS TKA的疗效，但目前的文献中缺乏比较CR膝关节与CS TKA疗效的系统评价和荟萃分析。
本研究是一项对文献的系统评价和荟萃分析，比较了CR和CS膝关节在生存率、功能、患者报告结局、活动范围（ROM）、生物力学和翻修率方面的差异。使用PubMed、Cochrane和Embase进行文献检索，并使用改良的科尔曼方法评分来评估研究质量。
七项研究符合纳入标准。这项系统评价和荟萃分析表明，CR和CS膝关节在生存率、ROM或临床膝关节评分方面没有显著差异。CR组和CS组术后并发症差异不大。在这七项研究中，三种CR设计因髌股关节摩擦音、关节僵硬或胫骨部件无菌性松动需要翻修。一种CS设计因髌股关节撞击综合征需要进行关节切开术。
CR和CS膝关节都是初次TKA的合理选择。
