{"title":"联合前外侧和前交叉韧带重建与孤立前交叉韧带重建相比，可改善支点移位和胫骨前平移，其结果相似：随机对照试验的系统回顾和荟萃分析。","authors":"Guangqing Cai, Xing Li, Yun Zhou, Zihao Ren, Zheng Hu, Shengwen Xiang, Zhijian Ao, Weiguo Hu, Yangbo Liu, Licheng Wei","doi":"10.1016/j.arthro.2025.03.047","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to compare the subjective measurement indicators between isolated anterior cruciate ligament reconstruction (ACLR) and combined ACLR with anterolateral ligament reconstruction (ALLR) in patients with ACL injuries.</p><p><strong>Methods: </strong>The Ovid MEDLINE and the Cochrane Central Registry of Controlled Trials were searched for Randomized Controlled Studies (RCTs) with a level of evidence (LOE) I-II published until September 2024 that evaluated subjective and safety outcomes between ACLR+ALLR and isolated ACLR. The Cochrane Risk of Bias 2.0 tool was used to evaluate publication bias.</p><p><strong>Results: </strong>After literature reviews, 5 RCT studies were identified. The follow-up data were obtained for 377 patients; 184 underwent isolated ACLR, and 193 underwent ACLR+ALLR. The patients who achieved pivot shift test grade I or more after surgery were reported in all five studies, and it was significantly lower in the ACLR+ALLR group compared to the isolated ACLR group [(risk ratio (RR):0.47, 95% confidence interval (CI): 0.23-0.96, P=0.04, I<sup>2</sup>=20%). Moreover, the degree of anterior tibial translation after surgery was reported in four studies, and it was also significantly lower in the ACLR+ALLR group [mean difference (MD): -0.65, 95%CI: -1.26 - -0.04, P=0.04, I<sup>2</sup>=83%)]. The operative and follow-up outcomes were similar between the two groups.</p><p><strong>Conclusions: </strong>Through a meta-analysis with LOE I-II and minimum 1-year follow-up data with similar outcomes, we proved that the combined ACLR+ALLR approach yielded superior residual laxity and pivot-shift test compared to isolated ACLR.</p><p><strong>Level of evidence: </strong>Level II, meta-analysis of randomized controlled trials.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4000,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Combined Anterolateral and Anterior Cruciate Ligament Reconstruction Improves Pivot Shift and Anterior Tibial Translation with Similar Outcomes Compared with Isolated Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis of Randomized Controlled Trials.\",\"authors\":\"Guangqing Cai, Xing Li, Yun Zhou, Zihao Ren, Zheng Hu, Shengwen Xiang, Zhijian Ao, Weiguo Hu, Yangbo Liu, Licheng Wei\",\"doi\":\"10.1016/j.arthro.2025.03.047\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>This study aimed to compare the subjective measurement indicators between isolated anterior cruciate ligament reconstruction (ACLR) and combined ACLR with anterolateral ligament reconstruction (ALLR) in patients with ACL injuries.</p><p><strong>Methods: </strong>The Ovid MEDLINE and the Cochrane Central Registry of Controlled Trials were searched for Randomized Controlled Studies (RCTs) with a level of evidence (LOE) I-II published until September 2024 that evaluated subjective and safety outcomes between ACLR+ALLR and isolated ACLR. The Cochrane Risk of Bias 2.0 tool was used to evaluate publication bias.</p><p><strong>Results: </strong>After literature reviews, 5 RCT studies were identified. The follow-up data were obtained for 377 patients; 184 underwent isolated ACLR, and 193 underwent ACLR+ALLR. The patients who achieved pivot shift test grade I or more after surgery were reported in all five studies, and it was significantly lower in the ACLR+ALLR group compared to the isolated ACLR group [(risk ratio (RR):0.47, 95% confidence interval (CI): 0.23-0.96, P=0.04, I<sup>2</sup>=20%). Moreover, the degree of anterior tibial translation after surgery was reported in four studies, and it was also significantly lower in the ACLR+ALLR group [mean difference (MD): -0.65, 95%CI: -1.26 - -0.04, P=0.04, I<sup>2</sup>=83%)]. The operative and follow-up outcomes were similar between the two groups.</p><p><strong>Conclusions: </strong>Through a meta-analysis with LOE I-II and minimum 1-year follow-up data with similar outcomes, we proved that the combined ACLR+ALLR approach yielded superior residual laxity and pivot-shift test compared to isolated ACLR.</p><p><strong>Level of evidence: </strong>Level II, meta-analysis of randomized controlled trials.</p>\",\"PeriodicalId\":55459,\"journal\":{\"name\":\"Arthroscopy-The Journal of Arthroscopic and Related Surgery\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":4.4000,\"publicationDate\":\"2025-03-28\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Arthroscopy-The Journal of Arthroscopic and Related Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.arthro.2025.03.047\",\"RegionNum\":1,\"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":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.arthro.2025.03.047","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
Combined Anterolateral and Anterior Cruciate Ligament Reconstruction Improves Pivot Shift and Anterior Tibial Translation with Similar Outcomes Compared with Isolated Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis of Randomized Controlled Trials.
Purpose: This study aimed to compare the subjective measurement indicators between isolated anterior cruciate ligament reconstruction (ACLR) and combined ACLR with anterolateral ligament reconstruction (ALLR) in patients with ACL injuries.
Methods: The Ovid MEDLINE and the Cochrane Central Registry of Controlled Trials were searched for Randomized Controlled Studies (RCTs) with a level of evidence (LOE) I-II published until September 2024 that evaluated subjective and safety outcomes between ACLR+ALLR and isolated ACLR. The Cochrane Risk of Bias 2.0 tool was used to evaluate publication bias.
Results: After literature reviews, 5 RCT studies were identified. The follow-up data were obtained for 377 patients; 184 underwent isolated ACLR, and 193 underwent ACLR+ALLR. The patients who achieved pivot shift test grade I or more after surgery were reported in all five studies, and it was significantly lower in the ACLR+ALLR group compared to the isolated ACLR group [(risk ratio (RR):0.47, 95% confidence interval (CI): 0.23-0.96, P=0.04, I2=20%). Moreover, the degree of anterior tibial translation after surgery was reported in four studies, and it was also significantly lower in the ACLR+ALLR group [mean difference (MD): -0.65, 95%CI: -1.26 - -0.04, P=0.04, I2=83%)]. The operative and follow-up outcomes were similar between the two groups.
Conclusions: Through a meta-analysis with LOE I-II and minimum 1-year follow-up data with similar outcomes, we proved that the combined ACLR+ALLR approach yielded superior residual laxity and pivot-shift test compared to isolated ACLR.
Level of evidence: Level II, meta-analysis of randomized controlled trials.
期刊介绍：
Nowhere is minimally invasive surgery explained better than in Arthroscopy, the leading peer-reviewed journal in the field. Every issue enables you to put into perspective the usefulness of the various emerging arthroscopic techniques. The advantages and disadvantages of these methods -- along with their applications in various situations -- are discussed in relation to their efficiency, efficacy and cost benefit. As a special incentive, paid subscribers also receive access to the journal expanded website.
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