Mo Saffarini, Robin Canetti, Julien Henry, Kinga Michalewska, Jacobus H. Müller, Michael T. Hirschmann, European Knee Associates (EKA)
{"title":"使用真正无限制运动学对位的全膝关节置换术术前和术后放射学角度的报告稀少且不一致:综述和二次荟萃分析。","authors":"Mo Saffarini, Robin Canetti, Julien Henry, Kinga Michalewska, Jacobus H. Müller, Michael T. Hirschmann, European Knee Associates (EKA)","doi":"10.1002/ksa.12494","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Purpose</h3>\n \n <p>To identify, synthesise and critically appraise findings of systematic reviews and meta-analyses on pre- and post-operative radiographic angles (lateral distal femoral angle [LDFA], medial proximal tibial angle [MPTA] and hip–knee–ankle [HKA] angle) of unrestricted kinematic alignment versus mechanical alignment in total knee arthroplasty (TKA).</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>Two authors searched MEDLINE, EMBASE and Epistemonikos for systematic reviews, with or without meta-analyses, that reported on TKA outcomes using unrestricted kinematic alignment. The methodological quality of the included systematic reviews and meta-analyses was independently assessed using A MeaSurement Tool to Assess systematic Reviews (AMSTAR-2). The effect size with its 95% confidence interval (CI) for radiographic angles was extracted from the systematic reviews and meta-analyses. The characteristics of clinical studies included in systematic reviews were listed and tabulated. Pre- and post-operative MPTA, LDFA and HKA angles were summarised using meta-analytic random-effects models.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Nineteen records were eligible for data extraction. Systematic reviews and meta-analyses included 44 clinical studies, of which 31 were on unrestricted kinematic alignment and 13 were on restricted versions of kinematic alignment. None of the included systematic reviews or meta-analyses fulfiled all seven critical AMSTAR-2 domains. Few comparative studies reported both pre- and post-operative angles (LDFA, <i>n</i> = 3; MPTA, <i>n</i> = 4; and HKA angle, <i>n</i> = 10). Mean pre- and post-operative LDFAs were 88.0° (range, 83–94°) and 88.0° (range, 80–96°) for the kinematic alignment group, and 88.2° (range, 83–95°) and 90.2° (range, 84–97°) for the mechanical alignment group. Mean pre- and post-operative MPTAs were 86.0° (range, 78–93°) and 87.1° (range, 78–94°) for the kinematic alignment group and 86.4° (range, 77–94°) and 89.6° (range, 84–95°) for the mechanical alignment group. Mean pre- and post-operative HKA angles were −3.3° (range, −24° to 24°) and −0.3° (range, −10° to 8°) for the kinematic alignment group and −6.9° (range, −25° to 7°) and −0.9° (range, −8° to 7°) for the mechanical alignment group.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>Most systematic reviews and meta-analyses that report outcomes of TKA using kinematic alignment do not distinguish between the different versions of kinematic alignment. The clinical studies included in systematic reviews are limited and inconsistent in their reporting of radiographic angles. Different alignment strategies are often grouped under the umbrella term of kinematic alignment, which contributes to conflicting reports, confusion and unresolved questions regarding the efficacy of true unrestricted kinematic alignment.</p>\n </section>\n \n <section>\n \n <h3> Level of Evidence</h3>\n \n <p>Level IV.</p>\n </section>\n </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 3","pages":"997-1014"},"PeriodicalIF":3.3000,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Sparse and inconsistent reporting of pre- and post-operative radiographic angles of total knee arthroplasty using true unrestricted kinematic alignment: An umbrella review and secondary meta-analysis\",\"authors\":\"Mo Saffarini, Robin Canetti, Julien Henry, Kinga Michalewska, Jacobus H. Müller, Michael T. Hirschmann, European Knee Associates (EKA)\",\"doi\":\"10.1002/ksa.12494\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Purpose</h3>\\n \\n <p>To identify, synthesise and critically appraise findings of systematic reviews and meta-analyses on pre- and post-operative radiographic angles (lateral distal femoral angle [LDFA], medial proximal tibial angle [MPTA] and hip–knee–ankle [HKA] angle) of unrestricted kinematic alignment versus mechanical alignment in total knee arthroplasty (TKA).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>Two authors searched MEDLINE, EMBASE and Epistemonikos for systematic reviews, with or without meta-analyses, that reported on TKA outcomes using unrestricted kinematic alignment. The methodological quality of the included systematic reviews and meta-analyses was independently assessed using A MeaSurement Tool to Assess systematic Reviews (AMSTAR-2). The effect size with its 95% confidence interval (CI) for radiographic angles was extracted from the systematic reviews and meta-analyses. The characteristics of clinical studies included in systematic reviews were listed and tabulated. Pre- and post-operative MPTA, LDFA and HKA angles were summarised using meta-analytic random-effects models.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>Nineteen records were eligible for data extraction. Systematic reviews and meta-analyses included 44 clinical studies, of which 31 were on unrestricted kinematic alignment and 13 were on restricted versions of kinematic alignment. None of the included systematic reviews or meta-analyses fulfiled all seven critical AMSTAR-2 domains. Few comparative studies reported both pre- and post-operative angles (LDFA, <i>n</i> = 3; MPTA, <i>n</i> = 4; and HKA angle, <i>n</i> = 10). Mean pre- and post-operative LDFAs were 88.0° (range, 83–94°) and 88.0° (range, 80–96°) for the kinematic alignment group, and 88.2° (range, 83–95°) and 90.2° (range, 84–97°) for the mechanical alignment group. Mean pre- and post-operative MPTAs were 86.0° (range, 78–93°) and 87.1° (range, 78–94°) for the kinematic alignment group and 86.4° (range, 77–94°) and 89.6° (range, 84–95°) for the mechanical alignment group. Mean pre- and post-operative HKA angles were −3.3° (range, −24° to 24°) and −0.3° (range, −10° to 8°) for the kinematic alignment group and −6.9° (range, −25° to 7°) and −0.9° (range, −8° to 7°) for the mechanical alignment group.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusion</h3>\\n \\n <p>Most systematic reviews and meta-analyses that report outcomes of TKA using kinematic alignment do not distinguish between the different versions of kinematic alignment. The clinical studies included in systematic reviews are limited and inconsistent in their reporting of radiographic angles. Different alignment strategies are often grouped under the umbrella term of kinematic alignment, which contributes to conflicting reports, confusion and unresolved questions regarding the efficacy of true unrestricted kinematic alignment.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Level of Evidence</h3>\\n \\n <p>Level IV.</p>\\n </section>\\n </div>\",\"PeriodicalId\":17880,\"journal\":{\"name\":\"Knee Surgery, Sports Traumatology, Arthroscopy\",\"volume\":\"33 3\",\"pages\":\"997-1014\"},\"PeriodicalIF\":3.3000,\"publicationDate\":\"2024-10-26\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Knee Surgery, Sports Traumatology, Arthroscopy\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1002/ksa.12494\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Knee Surgery, Sports Traumatology, Arthroscopy","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/ksa.12494","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
Sparse and inconsistent reporting of pre- and post-operative radiographic angles of total knee arthroplasty using true unrestricted kinematic alignment: An umbrella review and secondary meta-analysis
Purpose
To identify, synthesise and critically appraise findings of systematic reviews and meta-analyses on pre- and post-operative radiographic angles (lateral distal femoral angle [LDFA], medial proximal tibial angle [MPTA] and hip–knee–ankle [HKA] angle) of unrestricted kinematic alignment versus mechanical alignment in total knee arthroplasty (TKA).
Methods
Two authors searched MEDLINE, EMBASE and Epistemonikos for systematic reviews, with or without meta-analyses, that reported on TKA outcomes using unrestricted kinematic alignment. The methodological quality of the included systematic reviews and meta-analyses was independently assessed using A MeaSurement Tool to Assess systematic Reviews (AMSTAR-2). The effect size with its 95% confidence interval (CI) for radiographic angles was extracted from the systematic reviews and meta-analyses. The characteristics of clinical studies included in systematic reviews were listed and tabulated. Pre- and post-operative MPTA, LDFA and HKA angles were summarised using meta-analytic random-effects models.
Results
Nineteen records were eligible for data extraction. Systematic reviews and meta-analyses included 44 clinical studies, of which 31 were on unrestricted kinematic alignment and 13 were on restricted versions of kinematic alignment. None of the included systematic reviews or meta-analyses fulfiled all seven critical AMSTAR-2 domains. Few comparative studies reported both pre- and post-operative angles (LDFA, n = 3; MPTA, n = 4; and HKA angle, n = 10). Mean pre- and post-operative LDFAs were 88.0° (range, 83–94°) and 88.0° (range, 80–96°) for the kinematic alignment group, and 88.2° (range, 83–95°) and 90.2° (range, 84–97°) for the mechanical alignment group. Mean pre- and post-operative MPTAs were 86.0° (range, 78–93°) and 87.1° (range, 78–94°) for the kinematic alignment group and 86.4° (range, 77–94°) and 89.6° (range, 84–95°) for the mechanical alignment group. Mean pre- and post-operative HKA angles were −3.3° (range, −24° to 24°) and −0.3° (range, −10° to 8°) for the kinematic alignment group and −6.9° (range, −25° to 7°) and −0.9° (range, −8° to 7°) for the mechanical alignment group.
Conclusion
Most systematic reviews and meta-analyses that report outcomes of TKA using kinematic alignment do not distinguish between the different versions of kinematic alignment. The clinical studies included in systematic reviews are limited and inconsistent in their reporting of radiographic angles. Different alignment strategies are often grouped under the umbrella term of kinematic alignment, which contributes to conflicting reports, confusion and unresolved questions regarding the efficacy of true unrestricted kinematic alignment.
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).