Reconstrução combinada intra e extra-articular versus reconstrução intra-articular isolada do ligamento cruzado anterior: revisão sistemática

• Ano de defesa: 2016
• Autor(a) principal: Rezende, Fernando Cury [UNIFESP]
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: Ligamento cruzado anterior; Reconstrução do ligamento cruzado anterior; Ligamentos articulares; Traumatismos do joelho
• Link de acesso: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=4149098; http://repositorio.unifesp.br/handle/11600/48660

Introduction: Anterior cruciate ligament reconstruction (ACL) aims to restore knee function and stability; however, rotational stability may not be completely restored by use of standard intraarticular reconstruction alone. This systematic review assesses whether combining extraarticular with intraarticular ACL reconstruction may show better results than intraarticular reconstruction alone. Purpose: To verify, through meta- analysis, the effects of combined intra- and extra-articular reconstruction compared to isolated intraarticular ACL reconstruction. Methods: To identify randomized controlled trials (RCTs) comparing combined intra- and extrarticular ACL reconstruction (combined reconstruction) with intraarticular ACL reconstruction only, we searched MEDLINE, EMBASE, SPORTDiscus, Latin American and Caribbean Health Sciences (LILACS), and the Cochrane Central Register of Controlled Trials, and followed the Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA) criteria. The main outcomes we sought were patient function and stability and complications after ACL reconstruction. Results: Of 386 identified studies, eight RCTs were included (n = 682 participants; followup, 12?84 months; men to women ratio, 2.17:1) in our meta-analysis. Study quality (internal validity) was assessed using the Cochrane risk-of- bias tool. When functional outcomes were compared, we found no difference between patients who underwent intraarticular ACL reconstruction only and those who underwent combined reconstruction (IKDC, return-to-activity, and Tegner Lysholm scores). However, patients who underwent combined reconstruction were more likely to show improved stability based on the pivot shift test (risk ratio [RR], 0.95; 95% CI, 0.91?0.99; p = 0.02) and Lachman test (RR, 0.93; 95% CI, 0.88?0.98; p = 0.01). In addition, our meta-analysis found no difference between the two treatments in terms of general complications or adverse events (RR, 1.31; 95% CI, 0.70?2.34; p = 0.40) and the proportion of patients whose reconstructions failed (RR, 2.88; 95% CI, 0.73?11.47; p = 0.13). Conclusions: Combined intra- and extraarticular ACL reconstruction provided improved knee stability and comparable failure rates but no difference in patient reported functional outcomes scores. Complications and adverse events such as knee stiffness may be underreported and technical factors such as graft placement were difficult to evaluate. In general, we found a moderate quality of evidence of the included randomized controlled trials.