胫骨辅助固定对自体和异体软组织前交叉韧带重建的影响：稳定性适度增强和疼痛发生率增加：一项系统回顾和荟萃分析

IF 2.7 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics Pub Date : 2025-08-05 DOI:10.1002/jeo2.70390

Fuwen Zheng, Jiahao Gao, Chenyu Wang, Xu Zheng, Jinshuo Tang, Jinrui Zhang, Jianlin Zuo

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引用次数: 0

摘要

目的评价胫骨辅助固定在前交叉韧带重建中的关节功能、稳定性和安全性是否优于单纯胫骨螺钉固定。方法检索PubMed、Cochrane Library、EMBASE和Web of Science，追踪至2025年4月12日。符合条件的研究包括已发表的随机对照试验（RCTs）和低风险队列研究，比较胫骨螺钉干扰辅助固定（I组）和胫骨螺钉干扰单独或带鞘（II组）的临床结果和并发症。随机对照试验采用Cochrane偏倚风险评估工具进行评估，队列研究采用纽卡斯尔-渥太华量表和非随机研究的方法学指数进行评估。模型选择（随机或固定效应）基于数据异质性。本荟萃分析包括8项研究，943例患者（I组386例，II组557例）。与组II相比，组I在24个月时鞘亚组的侧侧差异（SSD）， 12和24个月时SSD <； 3mm, 9.1 kg，或24个月时的手动最大测试，8-12和24个月的Pivot测试，8-12个月的Lachman测试，24个月时国际膝关节文献委员会客观和主观评分方面没有显着差异。第一组SSD明显减少(平均差异：−1.02；95% CI:−1.79 ~−0.25；p = 0.009)和较低的Lachman试验阳性(优势比[OR] = 0.30；95%置信区间[CI]: 0.13-0.71；P = 0.01)。韧带再撕裂率相似；然而，组1的膝盖疼痛发生率明显更高(OR = 6.28；95% ci: 1.86-2.25；P < 0.01)，这一结果可能对患者的舒适度和长期功能恢复产生不利影响。结论与单纯干涉螺钉固定相比，自体和同种异体软组织辅助胫骨增强固定具有相似的关节功能和适度的稳定性增强，但与更高的疼痛发生率相关。证据水平III级，回顾性队列研究与随机对照试验一起进行了分析，因此这是证据水平。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

Impact of tibial supplementary fixation in anterior cruciate ligament reconstruction for soft tissue auto and allografts: Modest enhancement in stability and increased incidence of pain: A systematic review and meta-analysis

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Purpose

To evaluate whether the joint function, stability and safety of tibial supplementary fixation in anterior cruciate ligament reconstruction is superior compared with tibial screw fixation alone.

Methods

PubMed, Cochrane Library, EMBASE and Web of Science were searched, tracking until 12 April 2025. Eligible studies included published randomized controlled trials (RCTs) and low-risk cohort studies comparing clinical outcomes and complications between tibial screw interference with supplementary fixation (Group I) and tibial screw interference alone or with a sheath (Group II). RCTs were assessed using the Cochrane Risk of Bias tool, while cohort studies were evaluated with the Newcastle–Ottawa Scale and Methodological index for non-randomized studies. Model selection (random or fixed-effects) was based on data heterogeneity.

Results

This meta-analysis included eight studies with 943 patients (Group I: 386, Group II: 557). Group I showed no significant differences in side-to-side difference (SSD) in the sheath subgroup at 24 months, SSD <3 mm at 9.1 kg at 12 and 24 months, or manual maximum testing at 24 months, Pivot test at 8–12 and 24 months, Lachman test at 8–12 months, International Knee Documentation Committee objective and subjective score at 24 months compared to Group II. Group I demonstrated statistically significant reductions in SSD (mean difference: −1.02; 95% CI: −1.79 to −0.25; p = 0.009) in the no-sheath subgroup and lower Lachman test positivity (odds ratio [OR] = 0.30; 95% confidence interval [CI]: 0.13–0.71; p = 0.01) at 24 months. Ligament retear rates were similar; however, Group I experienced a substantially higher incidence of kneeling pain (OR = 6.28; 95% CI: 1.86–2.25; p < 0.01), an outcome that could adversely affect patient comfort and long-term functional recovery.

Conclusion

Enhanced supplementary tibial fixation with soft tissue autografts and allografts offers similar joint function and a modest enhancement of stability compared to tibial interference screw fixation alone, but is associated with a higher incidence of pain.