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Single-bundle versus double-bundle reconstruction for anterior cruciate ligament rupture: a meta-analysis-does anatomy matter?
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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.
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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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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。
4/4
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？
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.
主な研究課題は何ですか？
Does double-bundle anterior cruciate ligament reconstruction lead to reduced anterior and rotational laxity and range of motion compared to single bundle repair?
重要な知見は？
- 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
最も覚えておくべきことは？
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.
それが私の患者ケアにどのように影響するか？
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.
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