关节镜下保留残端与不保留残端重建前交叉韧带:前瞻性、随机、对照研究的Meta分析

目的:关节镜下重建前交叉韧带已经成为当前前交叉韧带损伤的首选治疗方法,但对于是否保留前交叉韧带胫骨残端重建存在较大争议.文章系统评价关节镜下保留残端与不保留残端重建前交叉韧带的临床效果.方法:通过计算机检索PubMed、EMbase、The Cochrane Library、CBM、WanFang Data、CNKI和...

Arthroscopic reconstruction of anterior cruciate ligament with and without remnant preservation:a Meta-analysis of prospective,randomized,and controlled studies

OBJECTIVE:Arthroscopic reconstruction of the anterior cruciate ligament has become the preferred choice for anterior cruciate ligament injuries,but there is still a big controversy about whether to preserve the tibial remnant of the anterior cruciate ligament.Here,we attempt to systematically evaluate the clinical effect of anterior cruciate ligament reconstruction with and without remnant preservation under arthroscopy.METHODS:PubMed,EMbase,the Cochrane Library,CBM,WanFang Data,CNKI and VIP databases were searched for clinical controlled studies regarding arthroscopic anterior cruciate ligament reconstruction with or without remnant preservation.The retrieval time was from inception of the databases to September 2019.Two researchers independently screened the literature,extracted data and evaluated the risk of bias in the included studies.Revman 5.3 software was then used for Meta-analysis.RESULTS:Compared with the reconstruction without remnant preservation,there was higher Lysholm score[mean difference(MD)=2.20,95%confidence interval(CI)(0.82,3.58),P=0.001],higher International Knee Documentation Committee score(MD=2.28,95%CI(1.20,3.37),P<0.001),lower KT1000/KT2000 score[MD=-0.29,95%CI(-0.52,-0.06),P=0.01]after remnant-preserved reconstruction.There were no significant differences in the axial displacement test,Lachman test and the diameter of the tibial tunnel between the reconstruction with or without remnant preservation.Compared with the reconstruction without remnant preservation,the reconstruction with remnant preservation led to a better proprioception[MD=0.41,95%CI(0.13,0.69),P=0.004].CONCLUSION:Existing evidence has shown that remnant-preserved reconstruction of the anterior cruciate ligament can improve the functional score,proprioception and objective stability of the knee joint after surgery,but there is no evidence that it is beneficial to subjective stability and to protecting the tibial tunnel.