Arciero技术后外侧角重建的临床结果：系统回顾和荟萃分析

Q2 Medicine

Journal of Clinical Orthopaedics and Trauma Pub Date : 2025-05-16 DOI:10.1016/j.jcot.2025.103061

S. Ali Ghasemi , Benjamin C. Murray , Joseph McCahon , Shervin Rashidi , James Raphael , Robert Arciero

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引用次数: 0

摘要

目前文献描述了几种后外侧角（PLC）重建的手术技术，但缺乏对Arciero技术的全面分析。这种以腓骨为基础的双股隧道技术的临床疗效尚未得到评估。方法对PubMed和Scopus进行系统的文献检索，确定已发表的关于双股骨隧道、腓骨为基础的PLC重建临床结果的研究。纳入标准是采用Arciero技术或对其进行改良的手术PLC重建的结果研究，特别是两个股骨和一个腓骨固定点。采用修正Coleman方法学评分（MCMS）对文章的证据水平和方法学进行评估。记录人口统计学、临床结果（Lysholm、主客观IKDC、Tegner）、关节生物力学稳定性（内翻应力测试、dial测试、内翻x线摄影）、并发症和失败。使用标准化平均差异来估计术前和术后评分之间的总体效应大小。普洛斯彼罗2025 crd420251045883。结果8项研究（203例）符合纳入标准。年龄16 ~ 61岁，随访1 ~ 10年。Lysholm和Tegner评分显示出良好的结果。加权平均IKDC得分为76.88。术后客观临床结果评估显示77.8%的IKDC评分为A级或B级，内翻x线片两侧差异0.6 mm， 81%的患者内翻压力测试正常，75%的患者dial测试阴性。报告了5例并发症（2.5%），没有失败需要翻修。平均MCMS为56（范围50-63）。结论以腓骨为基础的双股隧道（Arciero）技术用于PLC重建具有良好的临床效果。外科医生应根据他们的经验、培训和患者的具体需求选择PLC重建方法，当技术要求较高的手术或膝关节过度约束的风险超过以解剖结构为基础的胫骨和腓骨联合重建的潜在益处时，应考虑使用Arciero技术。

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Clinical outcomes of the Arciero technique in posterolateral corner reconstruction: A systematic review and meta-analysis

Background

Current literature describes several surgical techniques for posterolateral corner (PLC) reconstruction, but lacks a comprehensive analysis of the Arciero technique. The clinical efficacy of this dual femoral tunnel, fibular-based technique remains unevaluated.

Methods

A systematic literature search of PubMed and Scopus identified published studies reporting clinical outcomes following a dual femoral tunnel, fibular-based PLC reconstruction. Inclusion criteria were outcome studies of surgical PLC reconstruction utilizing either the Arciero technique or a modification of it, specifically with two femoral and one fibular fixation point. Articles were assessed for level of evidence and methodology using the Modified Coleman Methodology Score (MCMS). Demographics, clinical outcomes (Lysholm, subjective and objective IKDC, Tegner), biomechanical joint stability (varus stress test, dial test, varus radiography), complications and failures were recorded. Standardized mean differences were used to estimate the overall effect size between pre- and post-operative scores. PROSPERO 2025 CRD420251045883.

Results

Eight studies (203 patients) met inclusion criteria. Ages ranged 16–61 years and follow-up ranged 1–10 years. Lysholm and Tegner scores indicated favorable outcomes. The weighted average IKDC score was 76.88. Post-operative objective clinical outcome evaluations showed 77.8 % of IKDC scores were grade A or B, a 0.6 mm side-to-side difference on varus radiography, normal varus stress tests in 81 % of patients, and a negative dial test in 75 % of patients. Five complications (2.5 %) were reported with no failures requiring revision. The mean MCMS was 56 (range 50–63).

Conclusion

The fibular-based dual femoral tunnel (Arciero) technique for PLC reconstruction results in strong clinical outcomes. Surgeons should select a PLC reconstruction method tailored to their experience, training, and specific patient needs, considering the Arciero technique when the difficulties associated with a more technically demanding procedure or the risks of knee over-constraint outweigh the potential benefits of more anatomic combined tibia and fibula-based reconstructions.

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来源期刊

Journal of Clinical Orthopaedics and Trauma Medicine-Orthopedics and Sports Medicine

CiteScore

4.30

自引率

0.00%

发文量

181

审稿时长

92 days

期刊介绍： Journal of Clinical Orthopaedics and Trauma (JCOT) aims to provide its readers with the latest clinical and basic research, and informed opinions that shape today''s orthopedic practice, thereby providing an opportunity to practice evidence-based medicine. With contributions from leading clinicians and researchers around the world, we aim to be the premier journal providing an international perspective advancing knowledge of the musculoskeletal system. JCOT publishes content of value to both general orthopedic practitioners and specialists on all aspects of musculoskeletal research, diagnoses, and treatment. We accept following types of articles: • Original articles focusing on current clinical issues. • Review articles with learning value for professionals as well as students. • Research articles providing the latest in basic biological or engineering research on musculoskeletal diseases. • Regular columns by experts discussing issues affecting the field of orthopedics. • "Symposia" devoted to a single topic offering the general reader an overview of a field, but providing the specialist current in-depth information. • Video of any orthopedic surgery which is innovative and adds to present concepts. • Articles emphasizing or demonstrating a new clinical sign in the art of patient examination is also considered for publication. Contributions from anywhere in the world are welcome and considered on their merits.