外侧关节外手术降低初次前交叉韧带重建术后移植物失败率和轴移试验阳性率：系统评价与Meta分析
简介
一项纳入12项随机对照试验、共1327例患者的Meta分析显示，初次前交叉韧带重建（ACLR）联合外侧关节外手术（LEAP）可显著降低移植物失败率（P<0.001）和术后轴移试验阳性率（P<0.001）。Lysholm评分亦支持联合手术，但IKDC评分因存在天花板效应，组间差异无统计学意义。对于使用腘绳肌腱自体移植物的高风险患者，加行LEAP有助于改善临床结…
英文摘要
PURPOSE: To synthesize the existing literature on clinical outcomes and patient-reported outcome measures following primary anterior cruciate ligament reconstruction (ACLR) and lateral extra-articular procedures (LEAP) in randomized controlled trials, whereas also determining ceiling effects for the patient-reported outcome measures utilized. METHODS: A systematic review and meta-analysis were performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. PubMed, MEDLINE, and Embase databases were used for an electronic search of Level I-II randomized controlled trials. Publications which followed skeletally mature patients randomized to undergo primary ACLR with or without the addition of LEAP were considered. Studies with <9-month follow-up were excluded to ensure clinical relevance. RESULTS: Twelve publications met eligibility criteria for this review, including a total of 1327 patients with outcomes available for data extraction. Anterolateral ligament reconstruction was performed in 7 studies, and lateral extra-articular tenodesis was performed in 5 studies. A significant reduction in graft failure was found in patients who underwent ACLR plus LEAP ([0.235, 0.580], P < .001). A significantly lower rate of positive postoperative pivot shift was also found in this group ([0.324, 0.703], P < .001). Regarding patient-reported outcome measures, Lysholm scores favored the addition of LEAP to ACLR ([0.779, 3.093], P = .001), whereas International Knee Documentation Committee scores ([-0.521, 3.757], P = .138) and Tegner scores ([-0.304, 0.222], P = .760) showed no significant difference between groups. Using a 15% threshold of study subjects, significant ceiling effects were found in 3 of 4 studies reporting International Knee Documentation Committee scores and all studies reporting Lysholm scores. CONCLUSIONS: Clinical outcomes, including graft failure and persistent positive pivot shift following ACLR with hamstring autograft, are improved by the addition of LEAP. Lysholm scores also improved, favoring the addition of LEAP to ACLR. The nonsignificant finding for International Knee Documentation Committee scores should be interpreted with caution, as there is a ceiling effect observed in a majority of included trials. LEVEL OF EVIDENCE: Level II, meta-analysis of Level I and II studies.