SPORTS MEDICINE
Single-bundle or double-bundle for anterior cruciate ligament reconstruction: A meta-analysis
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OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(2):218 Knee. 2013 Jan 7. pii: S0968-0160(12)00236-0. doi: 10.1016/j.knee.2012.12.00419 randomized controlled trials (RCTs) involving 1686 patients were identified to examine the clinical outcomes of anterior cruciate ligament (ACL) reconstruction with double- and single-bundle techniques. Results revealed that the double-bundle technique led to better outcomes in rotational laxity (measured by the pivot-shift test, KT and IKDC grading). However, no significant difference was observed between the two techniques in terms of functional recovery.
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Was the validity of all of the studies referred to in the text assessed with use of appropriate criteria (either in selecting the studies for inclusion or in analyzing the studies that were cited)?
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はい = 1
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報告基準評価では、著者が出版物内で試験の方法論的特徴や試験特性を報告する際の透明性を評価します。評価は以下の5つのカテゴリーに分類されます。
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Introduction
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Accessing Data
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Analysing Data
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Results
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Discussion
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
Fragility Indexは、重要な所見の解釈を助けるツールで、結果の強さの尺度を提供します。Fragility Indexは、その所見が有意でなくなるために、二項対立の結果に追加する必要がある連続した事象の数を表します。数値が小さいほど弱い所見を表し、数値が大きいほど強い所見を表します。
なぜ今この研究が必要なのですか？
While the single-bundle technique has been considered the gold standard for ACL reconstruction, a failure rate of 11-30% with persistent instability of the knee has been reported. The double-bundle technique was proposed to overcome these limitations, where the treatment was able to more closely restore normal kinematics to the knee. However, previous clinical results comparing these two techniques were riddled with controversial results. Therefore, this meta-analysis aimed to compare the outcome of single- and double-bundle reconstruction of the ACL.
主な研究課題は何ですか？
Did a double-bundle ACL reconstruction technique lead to better clinical and functional outcomes than the single-bundle technique?
重要な知見は？
- According to 10 studies, a significant difference in Pivot shift grading between single and double-bundle techniques was observed (OR, 0.27, 95% CI 0.20, 0.36; P = 0.000, I-squared = 67.3%).
- 2 trials indicated significant differences in KT grading between the two reconstruction techniques (OR, 0.44, 95% CI 0.21, 0.95; P = 0.035, I-squared = 0.00%).
- 6 studies reported a significant difference in IKDC grading between the two methods (OR, 0.59, 95% CI 0.40, 0.87; P = 0.008, I-squared = 0.00%).
- No significant differences were observed in complications, IKDC scores, Lysholm Knee scores, and Tegner activity scores between the two treatments.
- While no significant difference was observed in KT arthrometer between the groups (from 9 studies), none of the co-variables (year P = 0.439, study type P = 0.764) could explain heterogeneity by meta-regression, and the heterogeneity may be due to different follow-up.
最も覚えておくべきことは？
This study demonstrated that double-bundle ACL reconstruction led to better outcomes in rotational laxity (assessed through the pivot-shift test, KT and IKDC grading) compared to the single-bundle technique. However, no significant difference was observed in functional outcome measures such as IKDC scores, KT arthrometer, Lysholm knee, or Tegner activity scores.
それが私の患者ケアにどのように影響するか？
The double-bundle ACL reconstruction technique seems to be superior to the single-bundle method in terms of objective measures. However, the reliability of these findings is uncertain as the methodological quality of the included RCTs was difficult to assess (due to lack of randomization and concealment). Furthermore, it is unclear how more 'anatomic' single bundle reconstruction techniques fare against the double-bundle techniques. As clinical results seem equivalent based on available data, further results could be aimed at determining if the suggested improvement in mechanical stability affords improved clinical benefits in some population groups (i.e. high performance athletes).
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