Ramelli Luca, Docter Shgufta, Kim Christopher, Sheth Ujash, Park Sam Si-Hyeong
School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada.
Division of Orthopaedic Surgery, Women's College Hospital, Toronto, Ontario, Canada.
Orthop J Sports Med. 2024 Aug 12;12(8):23259671241262772. doi: 10.1177/23259671241262772. eCollection 2024 Aug.
Approximately 6% of people will report Achilles tendon pain during their lifetime, and one-third of these individuals will have Achilles insertional tendinopathy (AIT). For patients who have failed conservative treatment, surgical repair is performed. Achilles tendon repair can occur through various techniques, including a single-row or double-row repair.
To determine if there are significant advantages to double-row repair over single-row repair with respect to biomechanical and clinical outcomes.
Systematic review; Level of evidence, 3.
A systematic review of the literature was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. An electronic search of the EMBASE and PubMed databases was performed for all studies related to surgical treatment of AIT, which yielded 1431 unique results. These included both biomechanical and clinical studies. Clinical studies in which patients were not diagnosed with AIT, underwent surgery for repair of acute Achilles tendon rupture, or studies that included additional procedures such as a concomitant flexor hallucis longus transfer were excluded. Eligible studies were independently screened by 2 reviewers. A risk-of-bias assessment was conducted using the Cochrane Risk Of Bias In Non-randomized Studies-of Interventions and risk-of-bias tool for randomized trials tools.
A total of 23 studies were included, 4 of which were biomechanical studies and 19 were clinical studies. Biomechanical comparison found that there was a significant advantage to using double-row versus single-row fixation with respect to load at yield (354.7 N vs 198.7 N; = .01) and mean peak load (433.9 N vs 212 N; = .042). There was no significant difference between double-row and single-row repair with respect to load to failure. Significant heterogeneity of the studies did not allow for a statistical comparison of the clinical outcomes between double-row and single-row repairs.
Although biomechanical studies favor double-row repair for AIT, the current data available on the clinical outcomes are not sufficient to determine if there is a clinical advantage of double-row repair. Larger, prospective randomized controlled trials utilizing validated outcome measures are needed to further elucidate whether the biomechanical advantages associated with double-row repair also translate into improved patient-reported outcomes.
约6%的人在一生中会出现跟腱疼痛，其中三分之一的人会患有跟腱止点性肌腱病（AIT）。对于保守治疗失败的患者，需进行手术修复。跟腱修复可通过多种技术进行，包括单排或双排修复。
确定双排修复相对于单排修复在生物力学和临床结果方面是否具有显著优势。
系统评价；证据等级，3级。
按照PRISMA（系统评价和Meta分析的首选报告项目）指南对文献进行系统评价。对EMBASE和PubMed数据库进行电子检索，查找所有与AIT手术治疗相关的研究，共获得1431条独特结果。这些研究包括生物力学和临床研究。排除未诊断为AIT的患者、接受急性跟腱断裂修复手术的患者或包括其他手术（如同时进行拇长屈肌转移）的研究。符合条件的研究由2名审阅者独立筛选。使用Cochrane非随机干预研究中的偏倚风险评估和随机试验的偏倚风险工具进行偏倚风险评估。
共纳入23项研究，其中4项为生物力学研究，19项为临床研究。生物力学比较发现，在屈服载荷（354.7 N对198.7 N；P = 0.01）和平均峰值载荷（433.9 N对212 N；P = 0.042）方面，双排固定相对于单排固定具有显著优势。双排修复和单排修复在失效载荷方面无显著差异。研究的显著异质性使得无法对双排修复和单排修复的临床结果进行统计学比较。
虽然生物力学研究支持AIT采用双排修复，但目前关于临床结果的现有数据不足以确定双排修复是否具有临床优势。需要进行更大规模、采用经过验证的结局指标的前瞻性随机对照试验，以进一步阐明与双排修复相关的生物力学优势是否也能转化为患者报告结局的改善。
