Wen Yixin, Huang Wei, Li Minghui, Jiang Yong, Tong Yibo, Mei Hongjun, Tan Junfeng
Department of Orthopaedic Surgery, The Fifth Hospital of Wuhan, Wuhan, Hubei, 430000, China.
Department of Gynecologic and Oncology, Tongji Medical College, Hubei Cancer Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, 430000, China.
J Orthop Surg Res. 2025 Jan 7;20(1):19. doi: 10.1186/s13018-025-05451-6.
Graft rupture is a significant cause of graft failure in anterior cruciate ligament reconstruction (ACLR). To address this issue, clinicians have combined the internal tension relieving technique (ITRT) with ACLR to improve graft stiffness, aiming to reduce the risk of graft failure. The purpose of this study is to compare the graft failure rates and clinical functional outcomes between ITRT-assisted ACLR and conventional ACLR.
Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a search was conducted in databases including Ovid, PubMed, Web of Science, Embase, Cochrane Library, Wanfang Data, CNKI, and VIP Medical Database for clinical controlled trials comparing the ITRT combined with ACLR to conventional ACLR. The search period spanned from the establishment of the databases to September 2024. Studies meeting the inclusion and exclusion criteria were selected, with two independent reviewers conducting literature screening, quality assessment, and data extraction. Data analysis was performed using RevMan 5.4 software. The evaluated outcomes included graft failure rate, Lysholm Knee Scoring Scale, Tegner activity score, Knee injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC) score, Visual Analog Scale (VAS) score, Single Assessment Numeric Evaluation (SANE), return to sport (RTS) rate, and knee joint laxity.
A total of 11 studies were included in the final analysis, with 1,339 patients (592 patients with ITRT-assisted ACLR and 747 patients with conventional ACLR). The combined analysis results indicated that, compared to conventional ACLR, ITRT-assisted ACLR showed significant advantages in reducing graft failure rates (RR = 0.44; 95% CI: 0.23, 0.83; P = 0.01), increasing return-to-sport rates (MD = 1.75; 95% CI: 1.05, 2.91; P = 0.03), and improving knee scores (including KOOS score and Tegner activity score) (all P values < 0.05). However, no significant differences were observed between the two approaches in terms of Lysholm knee score, VAS score, IKDC score, and knee joint laxity.
This meta-analysis highlighted the significance and superiority of combining ITRT with ACLR compared to conventional ACLR, particularly in reducing graft failure rate and improving knee function outcomes. The ITRT-assisted ACLR procedure may represent the optimal approach for minimizing graft failure. However, given the limitations of short-term follow-up and reliance on retrospective studies, more randomized controlled trials and longer follow-up periods are needed to further evaluate the long-term graft failure rates and functional outcomes.
移植物破裂是前交叉韧带重建术（ACLR）中移植物失败的一个重要原因。为解决这一问题，临床医生将内部张力缓解技术（ITRT）与ACLR相结合，以提高移植物的刚度，旨在降低移植物失败的风险。本研究的目的是比较ITRT辅助的ACLR与传统ACLR之间的移植物失败率和临床功能结局。
按照PRISMA（系统评价和Meta分析的首选报告项目）指南，在包括Ovid、PubMed、Web of Science、Embase、Cochrane图书馆、万方数据、中国知网和维普医学数据库在内的数据库中进行检索，以查找比较ITRT联合ACLR与传统ACLR的临床对照试验。检索期从数据库建立至2024年9月。选择符合纳入和排除标准的研究，由两名独立的审阅者进行文献筛选、质量评估和数据提取。使用RevMan 5.4软件进行数据分析。评估的结局包括移植物失败率、Lysholm膝关节评分量表、Tegner活动评分、膝关节损伤和骨关节炎结局评分（KOOS）、国际膝关节文献委员会（IKDC）评分、视觉模拟量表（VAS）评分、单项评估数字评价（SANE）、恢复运动（RTS）率和膝关节松弛度。
最终分析共纳入11项研究，1339例患者（592例接受ITRT辅助的ACLR，747例接受传统ACLR）。合并分析结果表明，与传统ACLR相比，ITRT辅助的ACLR在降低移植物失败率（RR = 0.44；95%CI：0.23，0.83；P = 0.01）、提高恢复运动率（MD = 1.75；95%CI：1.05，2.91；P = 0.03）和改善膝关节评分（包括KOOS评分和Tegner活动评分）方面均显示出显著优势（所有P值均<0.05）。然而，在Lysholm膝关节评分、VAS评分、IKDC评分和膝关节松弛度方面，两种方法之间未观察到显著差异。
这项Meta分析强调了与传统ACLR相比，将ITRT与ACLR相结合的重要性和优越性，特别是在降低移植物失败率和改善膝关节功能结局方面。ITRT辅助的ACLR手术可能是将移植物失败降至最低的最佳方法。然而，鉴于短期随访的局限性以及对回顾性研究的依赖，需要更多的随机对照试验和更长的随访期来进一步评估长期移植物失败率和功能结局。
