缝合增强前交叉韧带修复可获得类似的短期功能，但与前交叉韧带重建相比，其再破裂风险略高：一项系统回顾和荟萃分析

IF 2.7 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics Pub Date : 2025-09-03 DOI:10.1002/jeo2.70404

Alessandro Carrozzo, Émilie Bérard, Valerio Nasso, Edoardo Monaco, Jonathan Rioual, Régis Pailhé, Etienne Cavaignac

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引用次数: 0

摘要

目的本研究的目的是对目前关于前交叉韧带（ACL）断裂的缝合增强ACL修复（SA-ACLRep）与金标准ACL重建（ACLR）治疗的文献进行荟萃分析。荟萃分析旨在提供临床结果，包括再破裂率（作为主要终点）、膝关节稳定性、功能结果、恢复运动和并发症。方法根据系统评价和meta分析的首选报告项目指南，系统检索PubMed、Embase和Cochrane图书馆截至2024年8月30日的文献。如果对SA-ACLRep与ACLR的临床结果进行了至少2年随访（FU）的比较分析，则纳入比较临床研究。主要观察指标为ACL再破裂率；次要结果包括并发症、膝关节稳定性（关节计测量）、患者报告的结果测量（PROMs）和恢复运动。所有合并分析均采用随机效应模型（基于限制最大似然法）。结果4项研究符合纳入标准，共纳入687例患者（276例SA-ACLRep， 411例ACLR）。两组再破裂率差异无统计学意义（SA-ACLRep组为11.5%，ACLR组为8.4%,p = 0.094）。包括国际膝关节文献委员会、膝关节损伤和骨关节炎结局评分亚量表、Lysholm、视觉模拟疼痛量表、单一评估数字评估和Tegner评分在内的PROMs在SA-ACLRep和ACLR之间无显著差异。恢复运动率（SA-ACLRep组为72.3%，ACLR组为65.0%,p = 0.541）或时间（平均差异= - 0.93个月[95%可信区间：- 2.54,0.69];p = 0.261）无显著差异。结论SA-ACLRep内支具与ACLR短期（≥24个月）FU效果相当，在再破裂率、PROMs或恢复率方面无统计学差异。这可能表明SA-ACLRep可能是一种可行的替代方法，用于适当指示的近端前交叉韧带撕裂。研究设计的异质性、纳入的研究数量少、修复时间和重建技术限制了结果的普遍性。证据水平III级，II级和III级研究的荟萃分析。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

Suture-augmented anterior cruciate ligament repair leads to comparable short-term function but a modestly higher re-rupture risk than anterior cruciate ligament reconstruction: A systematic review and meta-analysis

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Purpose

The aim of this study was to conduct a meta-analysis of the current literature on the treatment of anterior cruciate ligament (ACL) rupture with suture-augmented ACL repair (SA-ACLRep) compared to the gold standard ACL reconstruction (ACLR). The meta-analysis was designed to provide clinical outcomes, including re-rupture rates (as primary end point), knee stability, functional outcomes, return to sport and complications.

Methods

A systematic literature search was conducted in PubMed, Embase and the Cochrane Library up to 30 August 2024, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Comparative clinical studies were included if they conducted a comparative analysis on the clinical outcome of SA-ACLRep versus ACLR with a minimum of 2 years of follow-up (FU). The primary outcome was ACL re-rupture rate; secondary outcomes included complications, knee stability (arthrometer measurements), patient-reported outcome measures (PROMs) and return-to-sport. A random effects model (based on the restricted maximum likelihood method) was used for all pooled analyses.

Results

Four studies met the inclusion criteria and included 687 patients (276 SA-ACLRep and 411 ACLR). There was no statistically significant difference between the two groups in terms of re-rupture rates (11.5% with SA-ACLRep and 8.4% with ACLR; p = 0.094). PROMs, including International Knee Documentation Committee, Knee injury and Osteoarthritis Outcome Score subscales, Lysholm, visual analogue scale pain, Single Assessment Numeric Evaluation and Tegner scores, showed no significant differences between SA-ACLRep and ACLR. No significant differences were found in return to sport rates (72.3% with SA-ACLRep and 65.0% with ACLR; p = 0.541) or timing (mean difference = −0.93 months [95% confidence interval: −2.54, 0.69]; p = 0.261).

Conclusions

SA-ACLRep with internal bracing and ACLR showed comparable short-term (≥24 months) FU results, with no statistically significant differences observed in re-rupture rates, PROMs or return-to-play rates. This may suggest that SA-ACLRep may be a viable alternative for appropriately indicated proximal ACL tears. Heterogeneity in study design, the small number of studies included, the repair timing and reconstruction techniques limit the generalizability of the results.