No evidence that remnant-preserving anterior cruciate ligament reconstruction ensures better proprioceptive function than a standard single-bundle reconstruction: a systematic review of randomised controlled trials
Bibliographic record
Abstract
Importance Injury to the anterior cruciate ligament (ACL) causes significant mechanical instability and unequal functional deficits in patients with similar injury due to loss of proprioception. Therefore, the importance of the ACL remnant has been emphasised; it has the perceived potential to improve postoperative proprioception in knees with ACL reconstruction. However, the current literature shows unproven benefits of doing so, and thus the need for a systematic review. Objective The purpose of this systematic review was to review published randomised control trials (RCTs) to determine whether a remnant-preserving ACL reconstruction offers any proprioceptive benefit over a standard single-bundle ACL reconstruction. Evidence review The PRISMA checklist was used for all aspects of this systematic review. The PubMed, EMBASE, Cochrane and HuGE databases were searched from their inception until 15 June 15 2016 with specific keywords. Trial registry databases were also searched. Findings The initial search yielded 3081 articles. Out of these 2841 did not relate to the research question and were removed. The remaining 240 articles were screened for their abstracts. 178 articles which were either non-clinical studies or not related to ACL remnant preservation and proprioception were excluded. For the remaining 62 studies, full-text articles were studied and 57 were excluded from the study as they were not RCTs or dealt with remnant preservation techniques only in isolation or were non-comparative outcome studies or reviews. That left 5 RCTs. Out of these, 4 did not deal with proprioception as an outcome measure and were excluded. This left only 1 RCT by Hong et al available for the review. Conclusions and relevance At present there is no direct evidence to favour or refute ACL remnant preservation at the time of reconstruction.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.028 | 0.123 |
| Meta-epidemiology (narrow) | 0.002 | 0.002 |
| Meta-epidemiology (broad) | 0.016 | 0.016 |
| Bibliometrics | 0.008 | 0.008 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.005 | 0.004 |
| Open science | 0.003 | 0.002 |
| Research integrity | 0.004 | 0.002 |
| Insufficient payload (model declined to judge) | 0.009 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".