Georgoulis Jim D, Savvidou Olga D, Patras Kostas, Melissaridou Dimitra, Hadjimichael Argyris C, Papagelopoulos Panayiotis J, Georgoulis Anastasios D
1st Department of Orthopaedic Surgery, National and Kapodistrian University, Athens, Greece.
Orthopaedic Sports Medicine Center of Ioannina, Orthopaedic Surgery Department, University of Ioannina, Greece.
Orthop J Sports Med. 2024 Oct 24;12(10):23259671241265840. doi: 10.1177/23259671241265840. eCollection 2024 Oct.
Previous systematic reviews have reported the incidence of anterior knee pain (AKP) and extension deficit (ED) after anterior cruciate ligament reconstruction (ACLR); however, both outcomes are estimated separately and thus are assumed to be uncorrelated.
To estimate whether there is a clinically relevant association between the population effects of ED and AKP after ACLR.
Systematic review; Level of evidence, 2.
Under PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic review was conducted by searching PubMed, EMBASE, and the Cochrane Library electronic databases for published articles reporting incidence of both AKP and ED after ACLR with either bone-patellar tendon-bone (BPTB) or hamstring (HS) graft that returned 298 studies after the initial search. A Bayesian hierarchical measurement error model estimated the population effect of ED and AKP.
Twelve publications involving 976 patients (mean follow-up, 77.9 months; range, 24-180 months) were included in the systematic review. There was a clear, moderate correlation between population ED and population AKP for the BPTB ( = 0.40; 95% CI, 0.39-0.42) and the HS grafts ( = 0.35; 95% CI, 0.33-0.36). Model expected estimates for the population effects of AKP and ED were 24.1% (95% CI, 17.4%-31.9%) and 17.5% (95% CI, 10.6%-25.0%), respectively, for the BPTB graft and 16.1% (95% CI, 9.2%-23.9%) and 13.1% ED (95% CI, 6.0%-20.8%) for the HS graft, respectively. The posterior mean difference in AKP between BPTB and HS grafts was clear and substantial (8.3% [95% CI, 0.3% to 16.1%]); there was no substantial difference in the posterior mean difference of ED between BPTB and HS grafts (4.3% [95% CI, -3.8% to 13.0%).
Our systematic review demonstrated a moderate but clear correlation between ED and AKP irrespective of graft type. From a clinical perspective, this association emphasizes the need for intraoperative achievement of full extension and avoidance of situations that may cause ED. The higher incidence of AKP in patients with BPTB graft may also be attributed to factors related to the graft harvest site. Future metaregression analyses could investigate whether additional factors such as follow-up duration or rehabilitation protocols can moderate the association between AKP and ED after ACLR with either BPTB or HS graft.
既往的系统评价报告了前交叉韧带重建（ACLR）术后前膝痛（AKP）和伸直受限（ED）的发生率；然而，这两种结果是分别估算的，因此被认为是不相关的。
评估ACLR术后ED和AKP的总体效应之间是否存在临床相关关联。
系统评价；证据等级，2级。
按照PRISMA（系统评价与Meta分析优先报告条目）指南，通过检索PubMed、EMBASE和Cochrane图书馆电子数据库，对已发表的报道采用骨-髌腱-骨（BPTB）或腘绳肌（HS）移植物进行ACLR术后AKP和ED发生率的文章进行系统评价，初步检索后得到298项研究。采用贝叶斯分层测量误差模型估算ED和AKP的总体效应。
系统评价纳入了12篇涉及976例患者的文献（平均随访77.9个月；范围24 - 180个月）。对于BPTB移植物（r = 0.40；95%CI，0.39 - 0.42）和HS移植物（r = 0.35；95%CI，0.33 - 0.36），总体ED与总体AKP之间存在明显的中度相关性。BPTB移植物的AKP和ED总体效应的模型预期估计值分别为24.1%（95%CI，17.4% - 31.9%）和17.5%（95%CI，10.6% - 25.0%），HS移植物的AKP和ED总体效应的模型预期估计值分别为16.1%（95%CI，9.2% - 23.9%）和13.1%（95%CI，6.0% - 20.8%）。BPTB与HS移植物之间AKP的后验均值差异明显且显著（8.3%[95%CI，0.3%至16.1%]）；BPTB与HS移植物之间ED的后验均值差异无显著差异（4.3%[95%CI， - 3.8%至13.0%]）。
我们的系统评价表明，无论移植物类型如何，ED与AKP之间存在中度但明显的相关性。从临床角度来看，这种关联强调了术中实现完全伸直以及避免可能导致ED情况的必要性。BPTB移植物患者中AKP发生率较高也可能归因于与移植物取材部位相关的因素。未来的Meta回归分析可以研究诸如随访时间或康复方案等其他因素是否能调节采用BPTB或HS移植物进行ACLR术后AKP与ED之间的关联。
