SPORTS MEDICINE
Single-bundle versus double-bundle reconstruction for anterior cruciate ligament rupture: a meta-analysis-does anatomy matter?
This report has been verified
by one or more authors of the
original publication.
Cette étude a été identifiée comme étant potentiellement à fort impact.
L'indicateur High Impact de l'ENP, basé sur l'IA, estime l'influence qu'un article est susceptible d'avoir en intégrant des signaux provenant à la fois de la revue dans laquelle il est publié et du contenu scientifique de l'article lui-même.
Développé à l'aide d'un traitement du langage naturel de pointe, le modèle High Impact de l'ENP prédit avec plus de précision les futures citations d'une étude que le seul facteur d'impact de la revue.
Cela permet d'identifier plus tôt les recherches cliniquement significatives et aide les lecteurs à se concentrer sur les articles les plus susceptibles d'influencer les pratiques futures.
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?
Oui = 1
Incertain = 0,5
Non pertinent = 0
Non = 0
L'évaluation des critères de rapport permet d'évaluer la transparence avec laquelle les auteurs rapportent les caractéristiques méthodologiques et les caractéristiques de l'essai dans la publication. L'évaluation est divisée en cinq catégories qui sont présentées ci-dessous.
4/4
Introduction
4/4
Accessing Data
4/4
Analysing Data
4/4
Results
3/4
Discussion
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
L'indice de fragilité est un outil qui aide à l'interprétation des résultats significatifs, en fournissant une mesure de la force d'un résultat. L'indice de fragilité représente le nombre d'événements consécutifs qui doivent être ajoutés à un résultat dichotomique pour que le résultat ne soit plus significatif. Un petit nombre représente un résultat plus faible et un grand nombre un résultat plus fort.
Pourquoi cette étude était-elle nécessaire maintenant ?
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.
Quelle était la principale question de recherche ?
Does double-bundle anterior cruciate ligament reconstruction lead to reduced anterior and rotational laxity and range of motion compared to single bundle repair?
Quels sont les résultats importants ?
- 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
De quoi dois-je me souvenir en priorité ?
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.
Comment cela affectera-t-il les soins prodigués à mes patients ?
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.
AVIS DE NON-RESPONSABILITÉ
Le contenu de cette page est fourni à titre d'information uniquement et n'est pas destiné à remplacer un avis médical, un diagnostic ou un traitement professionnel. Si vous avez besoin d'un traitement médical, demandez toujours l'avis de votre médecin ou rendez-vous au service des urgences le plus proche. Les opinions, croyances et points de vue exprimés par les individus sur le contenu de cette page ne reflètent pas les opinions, croyances et points de vue d'OrthoEvidence.
0 de 4 articles mensuels GRATUITS débloqués
