Lei Yan1,2, Jiao Jiao Li3,4, Yuanyuan Zhu5, Haifeng Liu1, Ruxing Liu1, Bin Zhao6, Bin Wang7,8. 1. Department of Orthopaedic Surgery, Shanxi Medical University Second Affiliated Hospital, Taiyuan, China. 2. Shanxi Medical University, Taiyuan, China. 3. Kolling Institute, University of Sydney, Sydney, NSW, Australia. 4. School of Biomedical Engineering, Faculty of Engineering and IT, University of Technology Sydney (UTS), Ultimo, NSW, Australia. 5. Department of Pharmacy, Shanxi Medical University Second Affiliated Hospital, Taiyuan, China. 6. Department of Orthopaedic Surgery, Shanxi Medical University Second Affiliated Hospital, Taiyuan, China. zzbb2005@163.com. 7. Department of Orthopaedic Surgery, Shanxi Medical University Second Affiliated Hospital, Taiyuan, China. wangbin_pku@163.com. 8. Department of Sports Medicine and Adult Reconstruction Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, China. wangbin_pku@163.com.
Abstract
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.
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.
Authors: R Becker; D Voigt; C Stärke; M Heymann; G A Wilson; W Nebelung Journal: Knee Surg Sports Traumatol Arthrosc Date: 2001-06-21 Impact factor: 4.342
Authors: Christopher S Ahmad; Thomas R Gardner; Megan Groh; Johnny Arnouk; William N Levine Journal: Am J Sports Med Date: 2004 Apr-May Impact factor: 6.202
Authors: A Cannas; D Goletti; E Girardi; T Chiacchio; L Calvo; G Cuzzi; M Piacentini; H Melkonyan; S R Umansky; F N Lauria; G Ippolito; L D Tomei Journal: Int J Tuberc Lung Dis Date: 2008-02 Impact factor: 2.373
Authors: Joshua A Baumfeld; David R Diduch; L Joseph Rubino; Jennifer A Hart; Mark D Miller; Michelle S Barr; Joseph M Hart Journal: Knee Surg Sports Traumatol Arthrosc Date: 2008-09-13 Impact factor: 4.342