Synthetic augmentation in ACL reconstruction may reduce re-rupture rates and increase return-to-sport rates: A systematic review and meta-analysis.

IF 3.3 2区医学 Q1 ORTHOPEDICS

Knee Surgery, Sports Traumatology, Arthroscopy Pub Date : 2025-04-18 DOI:10.1002/ksa.12680

Yufei Jiang, Seyran Naghdi, Nick Smith, Toby Smith, Andrew Metcalfe, Hema Mistry

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引用次数: 0

Abstract

Purpose: Synthetic augmentation (SA) in anterior cruciate ligament reconstruction (ACLR) aims to enhance graft durability, but its benefits remain unclear. To evaluate whether SA in ACLR improves return-to-sport (RTS) rates, reduces graft failure, enhances patient-reported outcomes (PROs) and varies in effectiveness across materials and techniques.

Methods: A systematic search of five databases was conducted until February 2025. Comparative studies were pooled using Hedges' random-effects meta-analysis with subgroup analysis based on materials and publication year. Non-comparative studies were analysed narratively. Risk of bias was assessed using the Risk of Bias in Non-randomised Studies of Interventions and the Cochrane risk-of-bias tools for randomised studies. Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach was used to assess the certainty of evidence.

Results: Forty-seven studies were included (n = 4289): 7 randomised and 40 non-randomised studies (21 comparative; 19 non-comparative). SA systems included InternalBrace (FiberTape, 16 studies), Ligament Augmentation and Reconstruction System (polyester, 5), Ligament Augmentation Device (polyethylene, 18) and other materials (8). GRADE assessment showed moderate-certainty evidence for improved mid-term RTS rate from eight studies (odds ratio [OR]: 1.58; 95% confidence interval (CI): 1.12-2.22; N = 716; I² = 0%; p = 0.01). Internal brace showed a reduction in re-rupture rates in the long-term (OR: 0.17, 95% CI: 0.04-0.64; N = 218; I² = 0%; p = 0.01); however, pooled analysis of all techniques showed no statistically significant difference. Contemporary studies showed a better return to sport rates with SA. PROs showed no clinically meaningful differences. Non-comparative studies showed low graft failure rates (<8.7% for InternalBrace; <16.4% for other SA), high RTS rates (>90% for InternalBrace; >56.7% for other SA) and satisfactory PROs.

Conclusions: SA, particularly InternalBrace, may improve RTS rates and reduce re-rupture risk, though PROs remain inconclusive. Findings are limited by a moderate-to-serious risk of bias, emphasising the need for high-quality research.

Level of evidence: Level III.

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ACL重建的合成增强可能降低再破裂率并增加重返运动率：一项系统回顾和荟萃分析。

目的：人工合成增强（SA）在前交叉韧带重建（ACLR）中的应用旨在提高移植物的耐久性，但其益处尚不清楚。评估ACLR中的SA是否能提高运动恢复率（RTS），减少移植物衰竭，提高患者报告的结果（PROs），以及不同材料和技术的有效性差异。方法：系统检索5个数据库至2025年2月。比较研究采用赫奇斯随机效应荟萃分析和基于材料和出版年份的亚组分析进行汇总。对非比较性研究进行叙述分析。使用非随机干预研究的偏倚风险和Cochrane随机研究的偏倚风险工具评估偏倚风险。采用推荐、评估、发展和评价等级（GRADE）方法评估证据的确定性。结果：纳入47项研究（n = 4289）： 7项随机研究和40项非随机研究(21项比较研究；19 non-comparative)。SA系统包括InternalBrace （FiberTape， 16项研究）、Ligament Augmentation and Reconstruction System （polyester， 5项）、Ligament Augmentation Device（聚乙烯，18项）等材料（8项）。GRADE评估显示，来自8项研究的中度确定性证据表明中期RTS率有所改善(优势比[OR]: 1.58；95%置信区间（CI）： 1.12-2.22；n = 716；i2 = 0%；p = 0.01)。内支具显示长期再破裂率降低(OR: 0.17, 95% CI: 0.04-0.64；n = 218；i2 = 0%；p = 0.01)；然而，所有技术的合并分析显示没有统计学上的显著差异。当代研究表明，SA患者的运动恢复率更高。PROs无临床意义差异。非比较研究显示移植物失败率低(InternalBrace 90%；（其他SA为56.7%）和满意的PROs。结论：SA，尤其是InternalBrace，可以提高RTS率，降低再破裂风险，尽管利弊尚不确定。研究结果受到中等至严重偏倚风险的限制，强调了对高质量研究的需求。证据等级：三级。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Knee Surgery, Sports Traumatology, Arthroscopy 医学-外科

CiteScore

8.10

自引率

18.40%

发文量

418

审稿时长

2 months

期刊介绍： Few other areas of orthopedic surgery and traumatology have undergone such a dramatic evolution in the last 10 years as knee surgery, arthroscopy and sports traumatology. Ranked among the top 33% of journals in both Orthopedics and Sports Sciences, the goal of this European journal is to publish papers about innovative knee surgery, sports trauma surgery and arthroscopy. Each issue features a series of peer-reviewed articles that deal with diagnosis and management and with basic research. Each issue also contains at least one review article about an important clinical problem. Case presentations or short notes about technical innovations are also accepted for publication. The articles cover all aspects of knee surgery and all types of sports trauma; in addition, epidemiology, diagnosis, treatment and prevention, and all types of arthroscopy (not only the knee but also the shoulder, elbow, wrist, hip, ankle, etc.) are addressed. Articles on new diagnostic techniques such as MRI and ultrasound and high-quality articles about the biomechanics of joints, muscles and tendons are included. Although this is largely a clinical journal, it is also open to basic research with clinical relevance. Because the journal is supported by a distinguished European Editorial Board, assisted by an international Advisory Board, you can be assured that the journal maintains the highest standards. Official Clinical Journal of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA).