Meta-analysis on double-bundle versus single-bundle autoallergic hamstring for the reconstruction of anterior cruciate ligament

doi:10.3969/j.issn.2095-4344.2013.04.027

Abstract

Abstract:

BACKGROUND: Doctors often use autoallergic hamstring double-bundle and single-bundle for the reconstruction of anterior cruciate ligament, but there is a controversy on which method is better.
OBJECTIVE: To evaluate the clinical outcome of double-bundle versus single-bundle autoallergic hamstring for the reconstruction of anterior cruciate ligament.
METHODS: Randomized controlled trials about comparing double-bundle with single-bundle autoallergic hamstring for the reconstruction of anterior cruciate ligament were collected from PubMed database, Cochrane library, Springerlink database, CNKI database and CBM database. The Jadad’s scale was usedto assess the methodological quality of the randomized controlled trials and Cochrane collaboration’s RevMan 5.0 software was used to perform the Meta analysis.
RESULTS AND CONCLUSION: Fifteen randomized controlled trials totally 1 008 patients met the inclusion criteria and included. Meta-analysis results showed that there was statistical difference of postoperative KT-1000 or KT-2000 arthrometer mesurement between double-bundle and single-bundle reconstruction [weighted mean difference (WMD)=-0.51, 95% confidence interval (CI) (-0.74, -0.28), P < 0.000 1], there was significant difference of the negative pivot-shift testing [relative risk (RR)=1.27，95%CI(1.11,1.45), P=0.000 3], as well as the postoperative Lysholm scores [WMD=-2.10, 95%CI(-3.65, -0.55), P=0.008]. But there was no statistical differences of IKDC final score [RR=1.04，95%CI(0.99, 1.06), P=0.10]. The double-bundle autoallergic hamstring is superior to single-bundle for anterior cruciate ligament reconstruction on recovering stability of knee joint, but they are similar in recovering the functions of knee joint.

Key words: bone and joint implants, evidence-based medicine of bone and joint implants, knee joint, anterior cruciate ligament, autogenous hamstring tendon, dual beam, single beam, Meta-analysis

CLC Number:

R318

Xu Ming-ming, Yu Xiao-hua, Luo Xi, Ma Chuan-yu, Zhao Zhu-ying. Meta-analysis on double-bundle versus single-bundle autoallergic hamstring for the reconstruction of anterior cruciate ligament[J]. Chinese Journal of Tissue Engineering Research, 2013, 17(4): 744-749.

Figures/Tables 5

2.1 文献检索结果按照检索策略初检出相关文献843篇，其中Pubmed数据库441篇、Cochrane图书管39篇、Springerlink数据库286篇、中国期刊全文数据库46篇、中国生物医学文献数据库31篇。利用文献管理软件查重及阅读文献题目、摘要信息筛除815篇，剩余28篇。进一步阅读全文筛除13篇不符合纳入标准文献，其中4篇为队列研究，1篇为动物实验研究，2篇附加了其他手术方法，3篇移植物采用了骨-髌腱-骨，3篇是术中评价及随访时间<12个月。最终纳入文献15篇[3-5,8-19]，全部为英文文献，发表时间在2004年至2011年之间。 2.2 纳入文献研究特征及质量评价纳入的15篇文献均为双束对比单束重建前交叉韧带的临床随机对照试验，移植物均为自体腘绳肌腱，固定技术不同，随访期均>12个月。纳入文献的总体样本量为1 008例，其中实施双束重建术509例，单束重建术499例。所纳入文献术前基线均可比。15篇文献中，2篇正确描述了随机方法；3篇采用了依据生日、性别和住院号等错误的随机方法，为半随机对照试验；其余10篇仅提到随机但未描述具体方法。15篇文献中2篇描述了随机分配隐藏。15篇文献中有12篇采用了评价者盲法，但都未具体描述操作方法。所有文献均描述了撤出和失访的具体数量和理由，失访率均<20%，所有文献均存在不同程度的偏移风险。具体研究基本特征及评分见表1。 2.3 Meta分析结果 2.3.1 KT-1000或KT-2000关节动度测量值的评价分析有13篇文献术后进行了KT-1000或KT-2000关节动度测量，其中1篇结果报告为等级分类变量，其余12篇报告为连续性变量，剔除等级资料，对12篇连续性变量资料进行分析(378例双束，361例单束)。各研究间统计学异质性不明显(P=0.10，I2=37%)，采用固定效应模型分析，结果显示双束重建术与单束重建术后KT值的差异有显著性意义[WMD=-0.51，95%CI(-0.74，-0.28)，P < 0.000 1]，见图1。 2.3.2 轴移试验阴性的评价分析有11篇研究术后进行了轴移试验，结果均为分类变量，对轴移试验阴性进行了分析(348例双束，329例单束)。各研究间无统计学异质性(P=0.010，I2=57%)，采用随机效应模型分析，结果显示双束重建术与单束重建术后轴移试验阴性的差异有显著性意义[RR=1.27，95%CI(1.11，1.45)，P=0.000 3]，见图2。"

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