Introduction

Intra-operative and postoperative coalition of tunnels may occur in double-bundle (DB) anterior cruciate ligament reconstruction (ACLR). However, the incidence and effect on clinical outcomes of tunnel coalition following primary DB ACLR using a hamstring autograft has yet be analyzed, and thus remains unknown. The objective of this systematic review was to identify the incidence of tunnel coalition upon DB ACLR using hamstring autografts and to elucidate any clinical outcomes and/or complications that tunnel coalition may have postoperatively.

Hypothesis

The incidence of tunnel coalition would increase in respect to time from the index surgery, and that tunnel coalition would be related to poorer clinical outcomes compared to non-coalition cases.

Methods

Three databases (PubMed, EMBASE, Cochrane Library) were searched in accordance with PRISMA and R-AMSTAR guidelines on June 15, 2020. Relevant studies were screened in duplicate and data regarding patient demographics, incidence of femoral and tibial tunnel coalition, and outcomes were extracted. Coalition rate was also compared between follow up at 1 month or less defined as “shorter-term”, and 6 months or greater as “longer-term”. Coalition is defined as the missing of a bony bridge between the two tunnels.

Results

Thirty-six studies examining 1,574 patients, mean age 29.1 years, were included in this study. 29 studies (1,110 knees) reported the incidence of femoral coalition with a pooled rate of coalition of 8% (95% CI = 4–12%). 28 studies (1,129 knees) reported an incidence of tibial coalition with a pooled rate of coalition of 21% (95% CI = 13–30%). The incidence of tibial coalition was significantly higher than the incidence of femoral coalition across 21 comparative studies (OR = 3.37, 95% CI = 1.41–8.09, p = 0.0065). Only two studies (111 knees) compared tunnel coalition and non-coalition groups for clinical outcome and no significant differences were observed with regards to Lysholm score, Tegner activity scale, and knee laxity measured with a KT-1000 arthrometer.

Discussion

The rate of tibial tunnel coalition in DB ACLR is higher than femoral tunnel coalition, particularly at longer-term follow-up. Despite the higher radiographic evidence of coalition, the clinical effects of such remain to be ascertained, and further comparative studies are required to facilitate this understanding.

Level of evidence

IV, systematic review.

中文翻译：

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在使用腘绳肌移植物重建双束前交叉韧带中，胫骨隧道联合的发生率高于股骨隧道联合：系统评价

介绍

双束 (DB) 前交叉韧带重建 (ACLR) 中可能会发生术中和术后隧道联合。然而，尚未分析使用腘绳肌移植物进行原发性 DB ACLR 后隧道联合的发生率和对临床结果的影响，因此仍然未知。本系统评价的目的是确定使用腘绳肌自体移植物的 DB ACLR 后隧道联合的发生率，并阐明隧道联合术后可能出现的任何临床结果和/或并发症。

假设

隧道联合的发生率会随着指数手术后的时间而增加，并且与非联合病例相比，隧道联合与较差的临床结果有关。

方法

2020 年 6 月 15 日，根据 PRISMA 和 R-AMSTAR 指南搜索了三个数据库（PubMed、EMBASE、Cochrane Library）。相关研究一式两份进行筛选，并收集有关患者人口统计学、股骨和胫骨隧道联合发生率以及结果的数据提取。还比较了 1 个月或更短时间（定义为“短期”）和 6 个月或更长时间（定义为“长期”）的随访之间的联合率。联合定义为两条隧道之间缺少骨桥。

结果

本研究纳入了 36 项研究，共检查了 1,574 名平均年龄 29.1 岁的患者。29 项研究（1,110 个膝关节）报告了股骨联合的发生率，综合联合率为 8%（95% CI  =  4–12%）。28 项研究（1,129 个膝关节）报告了胫骨联合的发生率，联合发生率为 21%（95% CI  =  13–30%）。在 21 项比较研究中，胫骨联合的发生率显着高于股骨联合的发生率（OR  = 3.37，95  % CI  =  1.41–8.09，p  = 0.0065）。只有两项研究（111 个膝关节）比较了隧道联合组和非联合组的临床结果，并且在 Lysholm 评分、Tegner 活动量表和使用 KT-1000 关节计测量的膝关节松弛度方面没有观察到显着差异。

讨论

DB ACLR 中胫骨隧道联合的发生率高于股骨隧道联合，特别是在长期随访中。尽管有更高的联合放射学证据，但这种联合的临床效果仍有待确定，需要进一步的比较研究来促进这一理解。

证据等级

四、系统评价。