Effect of remnant preservation on recovery of knee proprioception in arthroscopic anterior cruciate ligament reconstruction: a meta-analysis

doi:10.3969/j.issn.2095-4344.2017.03.026

Abstract

Abstract:

BACKGROUND: Arthroscopic anterior cruciate ligament (ACL) reconstruction is the conventional surgical treatment at present for patients with severe anterior cruciate ligament injury or fracture. However, the opinions varies about whether the ACL remnant should be preserved, and its impact on the knee proprioception gets more and more attention．

OBJECTIVE: To compare the influence of arthroscopic ACL reconstruction with remnant preservation or not on the proprioception of the knee joint using a meta-analysis.

METHODS: We retrieved randomized controlled studies on arthroscopic ACL reconstruction with remnant preservation or not from 2001 to 2016. Meta-analysis was used to compare postoperative threshold to detection of passive motion (TTDPM), passive angle regeneration test, joint position sense and KT-1000/2000, IKDC, and Lysholm scores between remnant preservation or not.

RESULTS AND CONCLUSION: (1) A total of 11 randomized controlled trials were included. (2) The meta-analysis results showed that postoperative TTDPM [OR=-0.50,95%CI(-0.74, -0.26), P < 0.0001], passive angle reproduction [OR=-0.13, 95%CI(-0.26, -0.01), P=0.03 < 0.05] and Lysholm scores [OR=1.25, 95%CI(0.63, 2.06), P=0.0002], IKDC scores (OR=1.28, 95%CI([0.27, 2.28], P=0.01] in preserving-remnant were superior to removing-remnant for arthroscopic ACL reconstruction. However, there were no statistically significant differences in KT1000/2000 scores [OR=-0.05, 95%CI(-0.13, 0.03), P=0.24] and joint position sense [OR=-0.30, 95%CI(-0.79, 0.18), P=0.22]. (3) In the arthroscopic ACL reconstruction, retained stump postoperative proprioception recovered well and can obtain satisfactory clinical effect. However, prospective large-sample long-term randomized controlled trials are needed for verification.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Anterior Cruciate Ligament, Proprioception, Meta-Analysis, Tissue Engineering

CLC Number:

R318

Zhang Tai-liang, Zhang Lei, Lian Zhi-ming, Yang Guang-zhong. Effect of remnant preservation on recovery of knee proprioception in arthroscopic anterior cruciate ligament reconstruction: a meta-analysis [J]. Chinese Journal of Tissue Engineering Research, 2017, 21(3): 471-477.

Figures/Tables 4

2.3 Meta分析结果 2.3.1 被动活动感知阈值有6篇文献报道了术后膝关节被动活动感知阈值[10-11，16，18-20]，其中保留残端组288例，不保留残端组197例。异质性分析显示，各研究有明显异质性(P < 0.000 01，I2=84%)，故采用随机效应模型分析，Meta分析结果如图3，两种手术术后膝关节被动活动感知阈值差异有显著性意义[OR=-0.50，95%CI(-0.74，-0.26)， P，保残组术后膝关节的被动活动感知阈值优于不保残组。 < 0.000 1] 2.3.2 被动角度再生试验有5篇文献报道了术后膝关节被动角度再生试验[13-17]，其中保留残端组219例，不保留残端组203例。异质性分析显示，各研究无明显异质性(P=0.53，2=0%)，故采用固定效应模型分析，Meta分析结果如图4，两种手术术后膝关节被动角度再生恢复情况差异有显著性意义[OR=-0.13，95%CI(-0.26，-0.01) ， P=0.03 < 0.05]，保残组术后膝关节的被动角度再生恢复情况优于不保残组。 2.3.3 关节位置觉有3篇文献报道了术后膝关节的关节位置觉恢复情况[12，19-20]，其中保留残端组52例，不保留残端组52例。异质性分析显示，各研究无明显异质性(P=0.42，I2=0%)，故采用固定效应模型分析，Meta分析结果如图5，两种手术术后膝关节关节位置觉恢复情况差异无显著性意义[OR=-0.30，95%CI(-0.79，0.18)，P=0.22]。 2.3.4 Lysholm评分有7篇文献报道了术后膝关节Lysholm评分情况[10-16]，其中保留残端组391例，不保留残端组292例。异质性分析显示，各研究无明显异质性(P=0.83，I2=0%)，故采用固定效应模型分析，Meta分析结果如图6，两种手术术后膝关节Lysholm评分情况差异有显著性意义[OR=1.25，95%CI(0.63，2.06)，P=0.000 2]，保残组术后膝关节Lysholm评分高于不保残组。 2.3.5 IKDC评分有4篇文献报道了术后膝关节 IKDC评分情况[12-13，15，17]，其中保留残端组153例，不保留残端组144例。异质性分析显示，各研究无明显异质性(P=0.94，I2=0%)，故采用固定效应模型分析，Meta分析结果如图7，两种手术术后膝关节 IKDC评分情况差异有显著性意义[OR=1.28，95%CI(0.27，2.28)，P=0.01]，保残组术后膝关节 IKDC评分高于不保残组。 2.3.6 KT 1000/2000评分有2篇文献报道了术后膝关节 KT 1000/2000评分情况[13-14]，其中保留残端组63例，不保留残端组58例。异质性分析显示，各研究无明显异质性(P=0.40，I2=0%)，故采用固定效应模型分析，Meta分析结果如图8，两种手术术后膝关节 KT 1000/2000评分情况差异无显著性意义[OR=-0.05，95%CI(-0.13，0.03) ，P=0.24]。"

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