Purpose

Anterior cruciate ligament (ACL) reconstruction is widely accepted as the first choice of treatment for ACL injury, but there is disagreement in the literature regarding the optimal femoral fixation method. This meta-analysis assesses the evidence surrounding three common femoral fixation methods: cortical button (CB), cross-pin (CP) and interference screws (IS).

Methods

A systematic search was conducted in Medline, EMBASE and the Cochrane Library to identify studies with evidence level I or II that compared at least two femoral fixation methods with hamstring autograft for ACL reconstruction. Ten primary outcomes were collected. Risk of bias was assessed following the Cochrane Handbook for Systematic Reviews of Interventions. Standardized mean differences (SMD) were estimated using random-effects network meta-analysis in a Bayesian framework. Probability of ranking best (ProBest) and surface under the cumulative ranking curve (SUCRA) were used to rank all treatments. Funnel plots were used to identify publication bias and small-study effects.

Results

Sixteen clinical trials were included for analysis out of 2536 retrieved studies. Bayesian network meta-analysis showed no significant differences among the three fixation methods for the ten primary outcome measures. Based on the 10 outcome measures, the IS, CB and CP had the highest ProBest in 5, 5 and 0 outcomes, and the highest SUCRA values in 5, 4 and 1 outcomes, respectively. No substantial inconsistency between direct and indirect evidence, or publication bias was detected in the outcomes.

Conclusion

There were no statistical differences in performance among the CP, CB and IS femoral fixation methods with hamstring autograft in ACL reconstruction, although the IS was more likely to perform better than CB and CP based on the analysis of outcome measures from the included studies.

Level of evidence

1.

中文翻译：

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对于ACL重建中的绳肌自体移植，干涉螺钉比皮质钮扣和交叉钉固定更有可能表现得更好：贝叶斯网络荟萃分析。

目的

前交叉韧带（ACL）重建术被广泛接受为ACL损伤治疗的首选方法，但关于最佳股骨固定方法的文献尚存在分歧。这项荟萃分析评估了围绕三种常见股骨固定方法的证据：皮质钮扣（CB），十字钉（CP）和干涉螺钉（IS）。

方法

在Medline，EMBASE和Cochrane库中进行了系统的搜索，以鉴定证据水平为I或II的研究，该研究比较了至少两种股骨固定方法与string绳肌自体植骨进行ACL重建。收集了十项主要结果。根据《 Cochrane干预措施系统评价手册》评估偏倚风险。使用贝叶斯框架中的随机效应网络荟萃分析估算标准化均值差异（SMD）。使用排名最高的概率（ProBest）和累积排名曲线下的表面（SUCRA）对所有处理进行排名。漏斗图用于识别出版偏倚和小研究效应。

结果

包括16项临床试验用于2536项检索研究中的分析。贝叶斯网络荟萃分析显示，对于十种主要结果指标，三种固定方法之间没有显着差异。基于10个结果指标，IS，CB和CP在5、5和0个结果中的ProBest最高，在5、4和1个结果中的SUCRA值最高。在直接和间接证据之间未发现实质性不一致，或在结果中未发现发表偏倚。

结论

在ACL重建中，使用绳肌自体植骨的CP，CB和IS股骨固定方法之间的性能无统计学差异，尽管根据纳入研究的结局指标分析，IS的表现比CB和CP更好。

证据水平

1。