前交叉韧带重建中固定袢与可调袢股骨端固定疗效相当：一项比较研究的Meta分析
简介
一项纳入22项对比研究、逾1.6万例患者的meta分析比较了ACL重建术中固定袢与可调袢股骨悬吊固定的疗效，结果显示两种方式在IKDC、Lysholm、Tegner评分及KT-1000测量等指标上均无显著差异；可调袢组Lachman试验0级比例虽略高（72.7%对65.0%），但轴移试验、移植物失败率及再手术率均相当。固定方式的选择应基于术者经验与术中情况，…
英文摘要
PURPOSE: To compare clinical outcomes, knee stability, and complications between fixed-loop and adjustable-loop femoral suspensory fixation in anterior cruciate ligament (ACL) reconstruction. METHODS: A systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Comparative studies evaluating adjustable- versus fixed-loop femoral fixation in patients undergoing ACL reconstruction were included. Random-effects meta-analyses were performed. Primary outcomes were the International Knee Documentation Committee (IKDC) score, Lysholm score, Tegner Activity Scale, KT-1000 arthrometer measurements, and Lachman and pivot-shift test grades. Secondary outcomes included graft failure and reoperation rates. RESULTS: Twenty-two comparative studies including 16,105 patients (3938 adjustable-loop and 12,167 fixed-loop) were analysed. No significant differences were observed in age or follow up. Patient-reported outcomes were comparable, including Tegner (5.7 vs. 5.8; P = 0.828), Lysholm (91.6 vs. 91.5; P = 0.918), and IKDC scores (85.7 vs. 86.2; P = 0.786). KT-1000 measurements were similar (1.7 vs. 1.6 mm; P = 0.894). Adjustable-loop fixation showed a higher proportion of grade 0 Lachman examinations (72.7% vs. 65.0%; P = 0.026), whereas grade 1 laxity was more frequent with fixed-loop fixation (31.1% vs. 24.4%; P = 0.043). Pivot-shift grades, graft failure, and reoperation rates were comparable. CONCLUSIONS: Adjustable-loop and fixed-loop femoral fixation provide comparable clinical, functional, and stability outcomes following ACL reconstruction. Although adjustable-loop fixation was associated with more grade 0 Lachman examinations, this did not translate into differences in objective stability or patient-reported outcomes. Fixation choice should be guided by surgical considerations rather than expectations of superior outcomes.