前内侧钻孔改善前交叉韧带重建的旋转稳定性但不改善临床结局：一项针对I级Meta分析的伞状综述
简介
该伞状综述纳入4项I级Meta分析，比较前交叉韧带重建术中前内侧入路与经胫骨隧道技术。结果显示，前内侧入路虽能显著改善Lachman试验和轴移试验所评估的旋转稳定性，但移植物失败率及IKDC、Lysholm等患者报告功能结局无临床意义差异。提示该技术带来的生物力学优势尚未转化为患者可感知的功能获益。
英文摘要
BACKGROUND: Anterior cruciate ligament (ACL) injuries are among the most common knee injuries. Treatment options include conservative management as well as surgical repair and reconstruction. Given the well-documented risk of secondary joint damage, such as meniscal injury, cartilage degeneration, and the progression to osteoarthritis in persistently unstable knees, ACL reconstruction has become a widely accepted standard of care. Various surgical techniques have been developed. Among these, anteromedial femoral tunnel drilling has gained increasing attention as a more anatomic alternative to the transtibial technique, with the potential to overcome its limitations and improve clinical outcomes. METHODS: An umbrella review of meta-analyses was conducted in accordance with established methodological standards. Meta-analyses of randomised controlled trials (RCTs) directly comparing anteromedial (transportal) and transtibial femoral tunnel drilling techniques in primary ACL reconstruction were included. Quantitative data were extracted for patient-reported outcome measures (PROMs) and consistently reported clinical endpoints, including subjective and objective International Knee Documentation Committee (IKDC) scores, Lysholm and Tegner scores, graft failure rates, instrumented laxity, and clinical stability tests (Lachman and pivot-shift tests). Pooled effect estimates with corresponding confidence intervals were calculated using random-effects models. Between-study heterogeneity was assessed using the I2 statistic, and the robustness of the findings was evaluated through sensitivity analyses. RESULTS: Four level I meta-analyses were included. Graft failure rates did not differ significantly between anteromedial and transtibial drilling techniques (RR 0.67, 95% CI 0.42-1.09). Functional outcomes were largely comparable, with no significant differences observed in objective IKDC, Lysholm, or Tegner scores; subjective IKDC scores demonstrated only a small advantage for the anteromedial technique (MD 1.02, 95% CI 0.04-2.00). In contrast, anteromedial drilling was consistently associated with improved clinical stability, reflected by higher rates of negative Lachman (RR 1.12, 95% CI 1.05-1.19) and pivot-shift tests (RR 1.17, 95% CI 1.10-1.24). Sensitivity analyses confirmed the robustness of the stability outcomes, whereas functional measures appeared more susceptible to heterogeneity. CONCLUSIONS: Anteromedial femoral tunnel drilling in ACL reconstruction confers superior rotational knee stability compared with the transtibial technique; however, this biomechanical advantage fails to translate into clinically meaningful improvements in functional outcomes or patient-reported measures.