经胫骨隧道ACL重建术较原生ACL产生更大的矢状倾斜角：一项基于2047例膝关节MRI测量的系统综述与Meta分析
简介
这项系统评价与荟萃分析纳入21项研究共2047膝，基于MRI测量比较了经胫骨、前内侧入路及外向内三种ACL重建技术移植物与原生ACL的矢状面与冠状面倾斜角度。结果显示，原生ACL矢状面平均倾斜角为50.4°，而经胫骨技术重建后的矢状面倾斜角显著更大（更陡），前内侧入路与外向内技术则与原生角度相当；冠状面角度在各技术间无显著差异。该发现提示经胫骨技术可能难以恢…
英文摘要
PURPOSE: The aim of this systematic review and meta-analysis was twofold: (1) to synthesize magnetic resonance imaging (MRI)-based sagittal inclination angle (SIA) and coronal inclination angle (CIA) of the native anterior cruciate ligament (ACL) using standardized, tibial-axis-referenced measurements and (2) to compare inclination angles achieved by contemporary ACL reconstruction techniques relative to native ACL anatomy. METHODS: A systematic search of MEDLINE, Embase and Cochrane CENTRAL was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. The review was registered on Open Science Framework (OSF); registration number 10.17605/OSF.IO/K8HWRDEDXX. Studies reporting SIA and/or CIA of the native ACL or reconstructed ACL graft measured on MRI using tibial-axis-referenced techniques on true sagittal (for SIA) and true coronal (for CIA) imaging planes were included. Studies using alternative reference frames, oblique imaging, non-MRI modalities, cadaveric or animal models, double-bundle reconstruction or predominantly skeletally immature populations were excluded. Random-effects meta-analyses calculated pooled mean inclination angles with 95% confidence intervals (CIs). RESULTS: Twenty-one studies comprising 2047 knees met the inclusion criteria. The pooled mean native ACL sagittal inclination angle was 50.4° (95% CI 49.0°-52.0°), whereas the pooled native coronal inclination angle was higher and more variable at 67.5° (95% CI 63.3°-71.8°). Anteromedial portal and outside-in techniques achieved sagittal and coronal graft orientations comparable to native ACL values. In contrast, transtibial reconstruction demonstrated significantly higher sagittal inclination angles. No significant differences in coronal inclination were observed across techniques. CONCLUSION: Sagittal graft orientation differs by technique, whereas coronal inclination shows substantial overlap, providing an anatomy-referenced framework for interpreting MRI-based graft alignment. LEVEL OF EVIDENCE: Level IV, systematic review and meta-analysis of Level III and IV studies.