SPORTS MEDICINE
Outcomes of Anterior Cruciate Ligament Reconstruction Using Single-Bundle Versus Double-Bundle Technique: Meta-analysis of 19 Randomized Controlled Trials
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OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(3):101 Arthroscopy. 2013 Feb;29(2):357-65. doi: 10.1016/j.arthro.2012.08.02419 randomized controlled trials (RCTs) (1676 patients) examining the effects of double-bundle (DB) and single-bundle (SB) anterior cruciate ligament (ACL) reconstructions were evaluated to determine which of the two techniques provided better stability and functional outcomes. Following comparisons, results indicated that DB ACL reconstruction provided better anterior and rotational stability and higher IKDC score than SB ACL reconstruction.
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?
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Sí = 1
Incierto = 0,5
No relevante = 0
No = 0
La evaluación de los criterios de información evalúa la transparencia con la que los autores informan de las características metodológicas y del ensayo dentro de la publicación. La evaluación se divide en cinco categorías que se presentan a continuación.
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
El Índice de Fragilidad es una herramienta que ayuda en la interpretación de hallazgos significativos, proporcionando una medida de fuerza para un resultado. El Índice de Fragilidad representa el número de eventos consecutivos que es necesario añadir a un resultado dicotómico para que el hallazgo deje de ser significativo. Un número pequeño representa un hallazgo más débil y un número grande un hallazgo más fuerte.
¿Por qué se necesitaba ahora este estudio?
ACL ruptures are one of the most common injuries in those taking part in athletic activities. ACL reconstructions are typically performed using the SB approach, but recent studies have suggested that the DB method provides better clinical outcomes and a lower risk of developing osteoarthritis. However, there is not enough evidence to confirm this. Therefore, this meta-analysis aimed to determine whether DB ACL reconstruction resulted in better functional results than SB ACL reconstruction.
¿Cuál era la pregunta principal de la investigación?
Does DB ACL reconstruction better restore normal knee kinematics and provide better clinical outcomes than SB ALC reconstruction?
¿Cuáles fueron los hallazgos importantes?
- Heterogeneity across 14 studies with results for the pivot shift test (grades A, B, C, D) was high (I-squared: 83.8%). The RR for patient being graded A was 0.77 (95% CI: 0.67 to 0.89), this suggested that there were significantly more patients graded A in the DB group.
- For anterior stability, measured using the Lachman test, the RR was 0.84 (95% CI: 0.78 to 0.92), which suggested that more patients in the DB group were graded A. Heterogeneity was relatively small (I-squared: 38.8%).
- For anterior stability, measured using KT-2000 and KT-1000, the overall combined SMD values significantly preferred DB ACL reconstruction (SMD: 0.26; 95% CI: 0.05 to 0.46).
- The IKDC objective score (SMD: -0.08 (-0.43, 0.15)) for functional outcome displayed a significant difference between SB and DB groups, favouring DB reconstruction (RR: 0.80 (0.68, 0.93)).
- The correlation coefficient between the SMDs and RRs was calculated to be 0.034.
- Begg's test indicated that no publication bias existed in the pivot shift test (p=0.635).
¿Qué es lo que más debo recordar?
The results from this meta-analysis indicated that better anterior and rotational stability and higher IKDC scores were obtained in those patients who underwent DB ACL reconstruction compared to SB ACL reconstruction. No significant differences were displayed between the two techniques for subjective outcomes.
¿Cómo afectará esto al cuidado de mis pacientes?
DB ACL reconstruction is better than SB ACL for re-establishing stability, however, there were no significant differences in subjective outcomes between these methods of reconstruction. For this reason it is still unclear which method of reconstruction should be recommended. Additional RCTs with larger sample sizes and longer follow-up periods should be conducted in order to provide more evidence for any future meta-analyses regarding this topic. Additional research also needs to be conducted to examine differences between anatomical reconstructions.
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