Zhang Ling, Xu Junjie, Luo Ye, Guo Luqi, Wang Shaobai
School of Exercise and Health, Shanghai University of Sport, 200th. Hengren Road, Yangpu District, 200438, Shanghai, China.
Department of Sport Medicine, Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, 600th. Yishan Road, Xuhui District, 201306, Shanghai, China.
Heliyon. 2024 Aug 6;10(16):e35824. doi: 10.1016/j.heliyon.2024.e35824. eCollection 2024 Aug 30.
Anatomic anterior cruciate ligament (ACL) reconstruction is considered the gold standard treatment for ACL injuries because it aims to restore the knee's normal anatomy and stability, while also protecting long-term knee health. Long-term clinical and radiological outcomes after ACL reconstruction using the modified TT technique are unclear.
To assess the clinical and radiological outcomes following ACL reconstruction using modified transtibial (TT) techniques at a minimum 12-month follow-up.
A systematic review with meta-analysis.
PubMed, EMBASE, Web of Science, the Cochrane Library, and MEDLINE databases were searched from the inception to December 1, 2022. PICO search strategy was used to identify studies applying modified TT techniques on patients with ACL reconstruction and a minimum follow-up of 12 months. Eligible studies were identified independently by two reviewers. We extracted data on patient demographics, surgical characteristics, patient reported outcomes including subjective evaluations and clinical outcomes. Radiological data including femoral and tibial tunnel position, femoral and tibial tunnel length, and femoral tunnel angle were also extracted. The tunnel position was evaluated using the quadrant method based on three-dimensional computed tomography (3D CT) images. The standardized mean difference (SMD) and 95 % confidence interval (CI) were calculated for clinical and radiological outcomes.
Sixteen studies involving 628 patients were finally included. The SMD of Lysholm (90.39; 95 % CI 83.41-97.38), IKDC (86.07; 95 % CI 79.84-92.31), and Tegner (6.15; 95 % CI 3.96-8.33) scores were considered satisfactory. The depth of the femoral tunnel showed a pooled SMD of 30.08 % (95 % CI 28.25-31.91 %), and the height showed a pooled SMD of 37.72 % (95 % CI 35.75-39.70 %). The pooled SMD for the femoral tunnel angle in the coronal plane was 48.27°(95 % CI 43.14-53.40°), and the pooled SMD for the femoral tunnel length was 33.98 mm (95 % CI 29.03-38.93 mm).
This investigation has shown that modified TT technique can create an anatomic femoral tunnel and maintain optimal tunnel length and angulation. Most patients had satisfactory subjective outcomes and physical examinations after ACL reconstruction using modified TT technique. This information may assist in guiding expectations of clinicians and patients following ACL reconstruction with modified TT technique.
解剖学前交叉韧带（ACL）重建被认为是ACL损伤的金标准治疗方法，因为它旨在恢复膝关节的正常解剖结构和稳定性，同时保护膝关节的长期健康。使用改良经胫骨（TT）技术进行ACL重建后的长期临床和放射学结果尚不清楚。
评估使用改良经胫骨（TT）技术进行ACL重建后至少12个月随访的临床和放射学结果。
一项系统评价并进行荟萃分析。
检索了PubMed、EMBASE、Web of Science、Cochrane图书馆和MEDLINE数据库，检索时间从建库至2022年12月1日。采用PICO检索策略，以确定对ACL重建患者应用改良TT技术且随访至少12个月的研究。两名评价者独立识别符合条件的研究。我们提取了患者人口统计学、手术特征、患者报告的结果（包括主观评价和临床结果）的数据。还提取了放射学数据，包括股骨和胫骨隧道位置、股骨和胫骨隧道长度以及股骨隧道角度。基于三维计算机断层扫描（3D CT）图像，使用象限法评估隧道位置。计算临床和放射学结果的标准化均数差（SMD）和95%置信区间（CI）。
最终纳入16项研究，共628例患者。Lysholm评分（90.39；95%CI 83.41 - 97.38）、IKDC评分（86.07；95%CI 79.84 - 92.31）和Tegner评分（6.15；95%CI 3.96 - 8.33）的SMD被认为是令人满意的。股骨隧道深度的合并SMD为30.08%（95%CI 28.25 - 31.91%），高度的合并SMD为37.72%（95%CI 35.75 - 39.70%）。冠状面股骨隧道角度的合并SMD为48.27°（95%CI 43.14 - 53.40°），股骨隧道长度的合并SMD为33.98 mm（95%CI 29.03 - 38.93 mm）。
本研究表明，改良TT技术可以创建解剖学股骨隧道，并保持最佳的隧道长度和角度。大多数患者在使用改良TT技术进行ACL重建后主观结果和体格检查令人满意。这些信息可能有助于指导临床医生和患者对改良TT技术进行ACL重建后的预期。
