Ren Yunong, Wang Jia, Ji Junjie, Zhang Chao, Meng Qingyang
Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China.
Medical College of Qingdao University, Qingdao, Shandong, China.
Orthop J Sports Med. 2024 Jan 25;12(1):23259671231223743. doi: 10.1177/23259671231223743. eCollection 2024 Jan.
Anterior cruciate ligament (ACL) reconstruction has been the gold standard for primary ACL rupture since the 1990s. In the past decade, ACL repair has received renewed attention and increased research.
To compare the clinical outcomes of modern augmented ACL repair versus autograft reconstruction for ACL ruptures.
Systematic review; Level of evidence, 3.
A search of the PubMed, EMBASE, Scopus, Web of Science, and the Cochrane Library databases was conducted for prospective or retrospective comparative studies published between January 1, 2010, and January 3, 2023, with a minimum 2-year follow-up. Two independent reviewers performed data extraction and methodological quality assessment. Sensitivity analysis was performed to maintain the stability of results.
Nine studies were included (minimum follow-up period, 24-60 months). The total sample size was 833 patients (augmented repair group: 358 patients; autograft ACL reconstruction group: 475 patients). There were 4 randomized controlled trials (level 1), 1 prospective comparative study (level 2), 2 retrospective comparative studies (level 3), and 2 case-control studies (level 3). The augmented ACL repair group attained significantly higher Lysholm score (weighted mean difference [WMD] = 1.57; 95% confidence interval [CI], 0.14-3.01; = .03) and hamstring strength (WMD = 36.69; 95% CI, 29.07-44.31; < .01) but had higher rates of hardware removal (odds ratio [OR] = 6.30; 95% CI, 2.44-16.23; = .0001), reoperation (OR = 1.87; 95% CI, 1.33-2.62; = .0003), and failure (OR = 1.58; 95% CI, 1.03-2.43; = .0003) compared with the autograft ACL reconstruction group. No significant differences were observed between the repair and reconstruction groups regarding postoperative International Knee Documentation Committee scores, Tegner scores, knee laxity, satisfaction, ACL revisions, complications, and reoperation rather than revision.
Augmented ACL repair was associated with higher rates of reoperation, hardware removal, and failure compared with autograft ACL reconstruction in studies with minimum 2-year follow-up data. However, augmented ACL repair had higher Lysholm scores and hamstring strength versus autograft ACL reconstruction.
自20世纪90年代以来，前交叉韧带（ACL）重建一直是原发性ACL断裂的金标准。在过去十年中，ACL修复受到了新的关注并增加了研究。
比较现代增强型ACL修复与自体移植重建治疗ACL断裂的临床结果。
系统评价；证据等级，3级。
检索PubMed、EMBASE、Scopus、Web of Science和Cochrane图书馆数据库，查找2010年1月1日至2023年1月3日发表的前瞻性或回顾性比较研究，随访期至少2年。两名独立 reviewers 进行数据提取和方法学质量评估。进行敏感性分析以维持结果的稳定性。
纳入9项研究（最短随访期24 - 60个月）。总样本量为833例患者（增强修复组：358例患者；自体移植ACL重建组：475例患者）。有4项随机对照试验（1级）、1项前瞻性比较研究（2级）、2项回顾性比较研究（3级）和2项病例对照研究（3级）。与自体移植ACL重建组相比，增强型ACL修复组的Lysholm评分显著更高（加权平均差[WMD]=1.57；95%置信区间[CI]，0.14 - 3.01；P = 0.03）和腘绳肌力量（WMD = 36.69；95% CI，29.07 - 44.31；P < .01），但硬件取出率更高（优势比[OR]=6.30；95% CI，2.44 - 16.23；P = .0001）、再次手术率更高（OR = 1.87；95% CI，1.33 - 2.62；P = .0003）和失败率更高（OR = 1.58；95% CI，1.03 - 2.43；P = .0003）。在术后国际膝关节文献委员会评分、Tegner评分、膝关节松弛度、满意度、ACL翻修、并发症以及再次手术而非翻修方面，修复组和重建组之间未观察到显著差异。
在有至少2年随访数据的研究中，与自体移植ACL重建相比，增强型ACL修复的再次手术率、硬件取出率和失败率更高。然而，与自体移植ACL重建相比，增强型ACL修复的Lysholm评分和腘绳肌力量更高。
