Varying femoral-sided fixation techniques in anterior cruciate ligament reconstruction have similar clinical outcomes: a network meta-analysis
Notice bibliographique
Résumé
ImportanceThere is significant controversy regarding the optimal femoral fixation method in anterior cruciate ligament (ACL) reconstruction. Given the importance of ACL reconstruction in patient return to sport and quality of life, it is imperative to identify the optimal method of femoral fixation.ObjectiveThe primary objective of this study is to identify the optimal method of femoral fixation in ACL reconstruction with soft tissue grafts. There are three main techniques for femoral-sided fixation in ACL reconstruction: suspensory extracortical buttons (EC), interference screws (IS) and transfemoral crosspins (TF). Previous primary studies have provided conflicting results regarding the superior method, and prior systematic reviews have failed to identify a difference; however, these analyses were only able to make comparisons between two of the treatments directly. This study employed a network meta-analysis technique to maximise sample size and statistical power, increasing the validity of its findings.Evidence reviewA network meta-analysis was conducted using results from 19 randomised controlled trials. Only studies with level I or II evidence, directly comparing two interventions in ACL soft tissue graft reconstruction, were included. Graft failure rates, International Knee Documentation Committee scores and KT-1000 knee arthrometer scores were the primary outcomes measured. Secondary outcomes included Lysholm, Tegner, Lachman and Pivot Shift scores.FindingsAn overall sample of 1372 patients was analysed. No statistically significant differences were detected among outcomes, except for the KT-1000 analysis which slightly favoured EC over IS and TF fixation (mean difference (MD)=−0.53 mm; 95% CI −0.07 to –0.98), and TF over IS fixation (MD=−0.41 mm; 95% CI −0.05 to –0.76). The clinical consequences of this difference are likely minimal.ConclusionsBased on the results of this network meta-analysis, there is no clear statistically superior method of femoral fixation in soft tissue ACL reconstruction.Level of evidenceLevel II (systematic review of level I and II studies). There is significant controversy regarding the optimal femoral fixation method in anterior cruciate ligament (ACL) reconstruction. Given the importance of ACL reconstruction in patient return to sport and quality of life, it is imperative to identify the optimal method of femoral fixation. The primary objective of this study is to identify the optimal method of femoral fixation in ACL reconstruction with soft tissue grafts. There are three main techniques for femoral-sided fixation in ACL reconstruction: suspensory extracortical buttons (EC), interference screws (IS) and transfemoral crosspins (TF). Previous primary studies have provided conflicting results regarding the superior method, and prior systematic reviews have failed to identify a difference; however, these analyses were only able to make comparisons between two of the treatments directly. This study employed a network meta-analysis technique to maximise sample size and statistical power, increasing the validity of its findings. A network meta-analysis was conducted using results from 19 randomised controlled trials. Only studies with level I or II evidence, directly comparing two interventions in ACL soft tissue graft reconstruction, were included. Graft failure rates, International Knee Documentation Committee scores and KT-1000 knee arthrometer scores were the primary outcomes measured. Secondary outcomes included Lysholm, Tegner, Lachman and Pivot Shift scores. An overall sample of 1372 patients was analysed. No statistically significant differences were detected among outcomes, except for the KT-1000 analysis which slightly favoured EC over IS and TF fixation (mean difference (MD)=−0.53 mm; 95% CI −0.07 to –0.98), and TF over IS fixation (MD=−0.41 mm; 95% CI −0.05 to –0.76). The clinical consequences of this difference are likely minimal. Based on the results of this network meta-analysis, there is no clear statistically superior method of femoral fixation in soft tissue ACL reconstruction.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,007 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,005 | 0,003 |
| Bibliométrie | 0,002 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».