Raju Vaishya, Mohit Kumar Patralekh, Abhishek Vaish, Luke V. Tollefson, Robert F. LaPrade
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引用次数: 0
摘要
背景和目的膝关节多韧带损伤（MLKI）是一种严重的、具有挑战性的损伤。本研究旨在阐明手术时机对多韧带膝关节损伤早期和长期预后的影响。方法在 PubMed、Scopus、Web of Science 和 Cochrane Library 中采用了综合搜索策略。采用包含 "多韧带膝关节损伤"、"膝关节脱位"、"重建"、"修复"、"手术 "和 "时机 "及其同义词的相关关键词组合，并使用适当的布尔运算符来确定研究。文章（系统综述和荟萃分析）的选择遵循预定义的纳入和排除标准。此外，还利用从主要研究中提取的数据进行了一项荟萃分析。结果MLKI的早期手术比延迟手术具有显著优势，这体现在Lysholm评分明显更高（平均差 [MD] 3.51; 95% Confidence Interval [CI] 1.79, 5.22）、IKDC 客观评分（Mantel-Haenszel Odds Ratio [MH-OR] 2.95; 95% CI 1.30, 6.69）、Tegner 活动评分（MD 0.38; 95% CI 0.08, 0.69）和 Mayer 评分（MH-OR 5.47; 95% CI 1.27, 23.56）。此外，我们还发现，早期手术组发生继发性软骨损伤的风险明显降低（MH-OR 0.33；95% CI 0.23，0.48），胫骨前方器械移位较低（MD -0.92；95% CI -1.83，-0.01），但两组在继发性半月板撕裂方面无明显差异。然而，早期手术组膝关节僵硬的风险也明显增加（MH-OR 2.47; 95% CI 1.22, 5.01），需要在麻醉下进行操作的可能性也更大（MH-OR 3.91; 95% CI 1.10, 13.87）。
Effect of Timing of Surgery on the Outcomes and Complications in Multi-ligament Knee Injuries: An Overview of Systematic Reviews and A Meta-analysis
Background and Aims
Multi-ligament knee injuries (MLKI) are serious and challenging to manage. This study aimed to elucidate the impact of surgical timing on both early and long-term outcomes following an MLKI.
Methods
A comprehensive search strategy was employed across PubMed, Scopus, Web of Science, and the Cochrane Library. Studies were identified using a combination of relevant keywords encompassing “multi-ligament knee injury,” “knee dislocation,” “reconstruction,” “repair,” “surgery,” and “timing,” and their synonyms, along with appropriate Boolean operators. Selection of articles (systematic reviews and meta-analyses) adhered to predefined inclusion and exclusion criteria. Furthermore, a meta-analysis was conducted utilizing data extracted from primary studies.
Results
Early surgery for MLKI demonstrated a significant advantage over delayed surgery, reflected by significantly higher Lysholm scores (Mean Difference [MD] 3.51; 95% Confidence Interval [CI] 1.79, 5.22), IKDC objective scores (Mantel–Haenszel Odds Ratio [MH-OR] 2.95; 95% CI 1.30, 6.69), Tegner activity scores (MD 0.38; 95% CI 0.08, 0.69), and Mayer’s ratings (MH-OR 5.47; 95% CI 1.27, 23.56). In addition, we found a significantly reduced risk of secondary chondral lesions (MH-OR 0.33; 95% CI 0.23, 0.48), lower instrumented anterior tibial translation in the early surgery group (MD −0.92; 95% CI −1.83, −0.01), but no significant difference was observed in the secondary meniscal tears, between the two groups. However, the early surgery group also exhibited a significantly increased risk of knee stiffness (MH-OR 2.47; 95% CI 1.22, 5.01) and a greater likelihood of requiring manipulation under anaesthesia (MH-OR 3.91; 95% CI 1.10, 13.87).
Conclusion
Early surgery for MLKI improves function, and stability, and reduces further articular cartilage damage, but increases the risk of stiffness.
期刊介绍：
IJO welcomes articles that contribute to Orthopaedic knowledge from India and overseas. We publish articles dealing with clinical orthopaedics and basic research in orthopaedic surgery. Articles are accepted only for exclusive publication in the Indian Journal of Orthopaedics. Previously published articles, articles which are in peer-reviewed electronic publications in other journals, are not accepted by the Journal. Published articles and illustrations become the property of the Journal. The copyright remains with the journal. Studies must be carried out in accordance with World Medical Association Declaration of Helsinki.
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