Conde Rodrigo Arruda, Richard da Silva Oliveira Filho André, Machinski Elcio, Furtado da Cruz Vinícius, Varone Bruno Butturi, Gobbi Riccardo Gomes, Helito Camilo Partezani, Leal Daniel Peixoto
Fundación H.A. Barceló, Av. Gral. Las Heras 1907, Buenos Aires, BsAs, Argentina.
Universidade Federal da Paraíba (UFPB), João Pessoa, PB, Brazil.
J Orthop. 2024 Nov 19;64:130-138. doi: 10.1016/j.jor.2024.11.013. eCollection 2025 Jun.
Interest in repairing ruptured anterior cruciate ligaments (ACL) has resurged, with suture tape augmentation (internal brace, ACL-IB) emerging as a prominent technique. However, the efficacy of ACL-IB compared to ACL reconstruction (ACL-R) remains unclear. We conducted a meta-analysis to address this gap.
Adhering to PRISMA guidelines, a search to PubMed, EMBASE and Cochrane Central for studies comparing ACL-IB to ACL-R was performed. The main endpoints were patient-reported outcomes (PROs) and failure rate. Muscle and joint function and surgery time were also assessed. Statistical analysis was performed by Review Manager 5.1.7.
Nine studies comprising 1049 patients were included; 381 (36.3 %) underwent ACL-IB. Hamstring autografts were used for ACL-R in 421 patients (63.0 %). Most studies (6 of 8) reported follow-up longer than two years. The failure rate was higher in the ACL-IB group (risk ratio 3.62; 95 % CI 1.16 to 11.33; p = 0.03; I: 52 %). No significant difference was found between groups for PROs, except KOOS Symptoms, which was significantly improved with ACL-IB (mean difference 2.49; 95 % CI 0.05 to 4.92; p = 0.05; I: 0 %). ACL-IB resulted in stronger hamstrings (mean difference 11.99 %; 95 % CI 4.47 %-19.51 %; p = 0.002; I: 73 %). No significant difference was found in anterior tibial translation and quadriceps strength.
ACL-IB had a higher failure rate compared to ACL-R. However, ACL-IB showed better hamstring strength and KOOS symptom score. No significant differences were seen in other PROs, time to return to sports, or quadriceps strength.
修复断裂前交叉韧带（ACL）的关注度再度兴起，缝线带增强术（内置支撑，ACL-IB）成为一项突出的技术。然而，与ACL重建术（ACL-R）相比，ACL-IB的疗效仍不明确。我们进行了一项荟萃分析以填补这一空白。
遵循PRISMA指南，在PubMed、EMBASE和Cochrane Central中检索比较ACL-IB与ACL-R的研究。主要终点是患者报告结局（PROs）和失败率。还评估了肌肉和关节功能以及手术时间。使用Review Manager 5.1.7进行统计分析。
纳入9项研究，共1049例患者；381例（36.3%）接受了ACL-IB。421例患者（63.0%）的ACL-R使用了腘绳肌自体移植物。大多数研究（8项中的6项）报告随访时间超过两年。ACL-IB组的失败率更高（风险比3.62；95%置信区间1.16至11.33；p = 0.03；I²：52%）。除了KOOS症状，两组之间的PROs没有显著差异，ACL-IB显著改善了KOOS症状（平均差异2.49；95%置信区间0.05至4.92；p = 0.05；I²：0%）。ACL-IB使腘绳肌更强壮（平均差异11.99%；95%置信区间4.47% - 19.51%；p = 0.002；I²：73%）。在前交叉韧带胫骨前移和股四头肌力量方面未发现显著差异。
与ACL-R相比，ACL-IB的失败率更高。然而，ACL-IB显示出更好的腘绳肌力量和KOOS症状评分。在其他PROs、恢复运动时间或股四头肌力量方面未发现显著差异。
