可调节铰链式膝关节支具不能改善前交叉韧带重建术后疗效：随机对照试验的系统评价与Meta分析
简介
该研究通过系统综述和荟萃分析6项I级随机对照试验（384例患者），比较了前交叉韧带（ACL）重建术后早期使用可调铰链式膝关节支具与不使用支具的临床效果。关键发现：两组在Lysholm评分、等速伸屈膝肌力、关节活动度、再手术率及再断裂率（支具组2.9% vs 非支具组3.6%）方面均无统计学差异；KT-1000测量的胫骨前移侧侧差值虽在支具组有微小优势（MD=…
英文摘要
PURPOSE: To determine whether the use of an adjustable hinged knee brace during the early postoperative period after anterior cruciate ligament (ACL) reconstruction provides measurable benefits compared with no bracing in terms of patient-reported outcomes, knee stability, muscle strength, range of motion, and complication rates. METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic search of PubMed, Ovid Medline, and Scopus was conducted through May 2025. Only Level I randomized controlled trials comparing adjustable hinged knee bracing versus no bracing after primary ACL reconstruction were included, and studies were excluded if they used any other brace type, lacked postoperative outcomes, or were nonclinical designs. Pooled effect sizes were calculated using fixed- or random-effects models based on I2 heterogeneity, with mean differences and odds ratios reported with 95% confidence intervals. Methodological quality was assessed using the Modified Coleman Methodology Score and the Risk of bias 2 tool. RESULTS: Six randomized controlled trials (384 patients) met inclusion criteria. The mean follow-up duration across the included trials was 21 months (range, 3-60 months). Meta-analyses showed no statistically significant differences between bracing and no bracing groups for Lysholm score (MD = -0.48; P = .72), isokinetic extension (MD = 0.06; P = .97) or flexion torque (MD = 2.15; P = .30), range of motion, or reoperation rate (OR = 0.61; P = .18). Rerupture rates were also comparable (brace: 2.9% vs no brace: 3.6%; P = .79). A small but statistically significant difference in side-to-side difference anterior tibial translation using instrumented arthrometers (e.g., KT-1000 or equivalent), favored the brace group (MD = -0.20 mm; P = .01); however, this was not clinically meaningful. Return to sport outcomes, including anterior cruciate ligament-return to sport after injury scores and time to sport resumption, were similar between groups (22-33 weeks). CONCLUSIONS: The use of an adjustable hinged knee brace early after ACL reconstruction did not statistically significantly improve patient-reported outcomes, muscle strength, range of motion or rates of reoperation and re-rupture compared with no brace, although it did provide a small but statistically significant improvement in anterior knee stability. LEVEL OF EVIDENCE: Level I, meta-analysis of Level I studies.