早期前交叉韧带治疗可能是急性前交叉韧带和内侧副韧带联合损伤的关键：各种治疗策略的系统回顾

IF 4.4 1区医学 Q1 ORTHOPEDICS Arthroscopy-The Journal of Arthroscopic and Related Surgery Pub Date : 2024-08-01 DOI:10.1016/j.arthro.2024.01.009

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引用次数: 0

摘要

目的评估文献中关于急性、合并、完全性前交叉韧带（ACL）和内侧副韧带（MCL）损伤的管理和疗效。方法按照系统综述和元分析首选报告项目（PRISMA）指南，利用 PubMed、Embase、Scopus 和 Cochrane Reviews 进行文献检索。纳入标准为至少随访 12 个月并报告前交叉韧带-后交叉韧带完全损伤结果的研究。结果共纳入 27 项研究，821 名患者（平均年龄 29 岁，61% 为男性，平均随访 27 个月）。其中 4 项研究为随机试验，10 项为 III 级研究，13 项为 IV 级研究。前交叉韧带非手术治疗和急性前交叉韧带修复与前交叉韧带非手术治疗相比，前交叉韧带急性重建与前交叉韧带急性重建相比，前交叉韧带非手术治疗和急性前交叉韧带修复与前交叉韧带非手术治疗在屈曲30°时的外翻稳定率较低（分别为27-68%和36-77%），而急性前交叉韧带重建与前交叉韧带非手术治疗（80-100%）、急性前交叉韧带修复（65-100%）和急性前交叉韧带重建（81-100%）相比，前交叉韧带急性重建与前交叉韧带非手术治疗（80-100%）、急性前交叉韧带修复（65-100%）和急性前交叉韧带重建（81-100%）的外翻稳定率较高。结论本系统综述的结果表明，在急性期进行前交叉韧带稳定治疗可能会导致最低的残余外翻松弛率，而不同的 MCL 治疗方法与急性前交叉韧带重建之间并无明显差异。采用非手术或延迟前交叉韧带重建的非手术 MCL 治疗，以及采用非手术或延迟前交叉韧带重建的急性 MCL 修复，会导致更高的外翻松弛率。

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Early Anterior Cruciate Ligament Treatment Might Be Crucial for Acute Combined Anterior Cruciate Ligament and Medial Collateral Ligament Injuries: A Systematic Review of the Various Treatment Strategies

Purpose

To assess the outcomes of acute, combined, complete anterior cruciate ligament (ACL) and medial collateral ligament (MCL) injuries in the literature.

Methods

A literature search using PubMed, Embase, Scopus, and Cochrane Reviews was performed following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. The inclusion criteria were studies reporting outcomes of complete ACL-MCL injuries at a minimum of 12 months’ follow-up. Data were presented as ranges.

Results

Twenty-seven studies with 821 patients were included (mean age, 29 years; 61% male patients; mean follow-up period, 27 months). There were 4 randomized trials, 10 Level III studies, and 13 Level IV studies. Nine different strategies were noted, of which nonoperative MCL treatment with acute ACL reconstruction and acute MCL repair with acute ACL reconstruction were most commonly performed. Nonoperative MCL-ACL treatment and acute MCL repair with nonoperative ACL treatment led to low rates of valgus stability at 30° of flexion (27%-68% and 36%-77%, respectively) compared with acute ACL reconstruction with either nonoperative MCL treatment (80%-100%), acute MCL repair (65%-100%), or acute MCL reconstruction (81%-100%). Lysholm scores were not different between the strategies.

Conclusions

Outcomes in this systematic review suggest that ACL stabilization in the acute setting might result in the lowest rates of residual valgus laxity, whereas there is no clear difference between the different MCL treatments along with acute ACL reconstruction. Nonoperative MCL treatment with either nonoperative or delayed ACL reconstruction, as well as acute MCL repair with either nonoperative or delayed ACL reconstruction, leads to higher rates of valgus laxity.

Level of Evidence

Level IV, systematic review of Level I to IV studies.

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来源期刊

Arthroscopy-The Journal of Arthroscopic and Related Surgery 医学-外科

CiteScore

9.30

自引率

17.00%

发文量

555

审稿时长

58 days

期刊介绍： Nowhere is minimally invasive surgery explained better than in Arthroscopy, the leading peer-reviewed journal in the field. Every issue enables you to put into perspective the usefulness of the various emerging arthroscopic techniques. The advantages and disadvantages of these methods -- along with their applications in various situations -- are discussed in relation to their efficiency, efficacy and cost benefit. As a special incentive, paid subscribers also receive access to the journal expanded website.