SPORTS MEDICINE
Single-bundle versus double-bundle reconstruction for anterior cruciate ligament rupture: a meta-analysis-does anatomy matter?
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تم تحديد هذه الدراسة على أنها ذات تأثير كبير محتمل.
يُقدّر مقياس التأثير العالي الذي يعتمد على الذكاء الاصطناعي من OE التأثير المحتمل لورقة بحثية ما من خلال دمج الإشارات من كل من المجلة التي نُشرت فيها والمحتوى العلمي للمقالة نفسها.
تم تطوير نموذج OE High Impact باستخدام أحدث تقنيات معالجة اللغة الطبيعية، ويتنبأ نموذج OE High Impact بدقة أكبر بأداء الاقتباس المستقبلي للدراسة أكثر من معامل تأثير المجلة وحده.
وهذا يتيح التعرف المبكر على الأبحاث ذات المغزى السريري ويساعد القراء على التركيز على المقالات التي من المرجح أن تشكل الممارسة المستقبلية.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(12):225 Arthroscopy. 2012 Mar;28(3):405-24From the literature, 12 studies were identified (5 randomized trials and 7 observational studies) that were compiled for meta-analysis of double and single bundle ACL reconstructions. Primary outcomes of concern were anterior and rotational laxity and the range of motion (ROM). Secondary outcomes were IKDC, Lachman test, Lysholm score and Tegner test. The meta-analysis of randomized trials indicated favorable results for double bundle reconstruction in terms of anterior and rotational laxity, while no differences in ROM were present.
Were the search methods used to find evidence (original research) on the primary question or questions stated?
Was the search for evidence reasonably comprehensive?
Were the criteria used for deciding which studies to include in the overview reported?
Was the bias in the selection of studies avoided?
Were the criteria used for assessing the validity of the included studies reported?
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)?
Were the methods used to combine the findings of the relevant studies (to reach a conclusion) reported?
Were the findings of the relevant studies combined appropriately relative to the primary question that the overview addresses?
Were the conclusions made by the author or authors supported by the data and or analysis reported in the overview?
How would you rate the scientific quality of this evidence?
نعم = 1
غير مؤكد = 0.5
غير ذي صلة = 0
لا = 0
يقيّم تقييم معايير الإبلاغ الشفافية التي يبلغ بها المؤلفون عن الخصائص المنهجية والتجريبية للتجربة في المنشور. ينقسم التقييم إلى خمس فئات معروضة أدناه.
4/4
Introduction
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Accessing Data
4/4
Analysing Data
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Results
3/4
Discussion
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
مؤشر الهشاشة هو أداة تساعد في تفسير النتائج المهمة، وتوفر مقياسًا لقوة النتيجة. ويمثل مؤشر الهشاشة عدد الأحداث المتتالية التي يجب إضافتها إلى نتيجة ثنائية التفرع لجعل النتيجة غير مهمة. يمثل الرقم الصغير نتيجة أضعف ويمثل الرقم الكبير نتيجة أقوى.
لماذا كانت هناك حاجة لهذه الدراسة الآن؟
A number of different reconstruction methods are used for the repair of ACL deficient knees, and single bundle reconstruction is currently the standard. However, double bundle reconstruction allegedly provides superior anterior and rotational laxity when compared to single bundle, due to a more anatomical restoration of the double bundles of the ACL when placed at the native ACL insertion site. This meta-analysis was conducted to determine if double bundle ACL reconstruction leads to better clinical outcomes. Sub group analysis of studies with greater than two year follow-up and those that used anatomical reconstruction was also completed.
ما هو سؤال البحث الرئيسي؟
Does double-bundle anterior cruciate ligament reconstruction lead to reduced anterior and rotational laxity and range of motion compared to single bundle repair?
ما هي النتائج المهمة؟
- Double bundle ACL reconstruction provided superior anterior laxity scores measured by KT 1000 arthrometer, with a mean difference of 0.56mm when compared to single bundle reconstruction in the randomized trials (95% CI; -0.98 - -0.14) (p=0.009)
- Pivot shift testing in the randomized trials favored double bundle reconstruction with an RR 0.31 (95% CI; 0.16 - 0.61) (p=0.0007) indicating a 69% reduction in the risk of a positive pivot shift test
- There were no differences in range of motion between single and double bundle reconstructions in the randomized or observational trials
- The observational studies demonstrated a 67% reduction in the risk of a positive Lachman test for double bundle reconstruction (RR 0.33; 95% CI; 0.17 to 0.65 p=0.001)
- Assessment of anatomical reconstructions demonstrated favorable results for KT arthrometer, mean difference -0.70mm, and pivot shift test, RR 0.29, for anatomical double bundle reconstruction compared to single bundle
- Non-anatomical double bundle reconstruction had a relative risk of extension deficit that was 2.7 times greater than non-anatomical single bundle reconstruction
ما الذي يجب أن أتذكره أكثر؟
The meta-analysis demonstrated that double bundle ACL reconstruction provided superior anterior laxity and rotational laxity as measure by KT arthrometer, Lachman test and pivot shift test. Subgroup analyses of studies with a follow-up greater than two years and anatomical double and single bundle reconstruction also found similar results.
كيف سيؤثر ذلك على رعاية مرضاي؟
Further study using long-term follow-up are required to detect and assess degenerative changes due to abnormal kinematics. Until this research provides conclusive results both anatomical single and double bundle reconstruction are adequate options for those with ACL deficient knees.
تنويه
هذا المحتوى الموجود في هذه الصفحة هو لأغراض إعلامية فقط وليس الغرض منه أن يكون بديلاً عن المشورة الطبية المتخصصة أو التشخيص أو العلاج. إذا كنت بحاجة إلى علاج طبي، اطلب دائمًا مشورة طبيبك أو اذهب إلى أقرب قسم طوارئ إليك. الآراء والمعتقدات ووجهات النظر التي يعبر عنها الأفراد في المحتوى الموجود في هذه الصفحة لا تعكس آراء ومعتقدات ووجهات نظر أورثوإيفيدنس.
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