The Curative Effect Of Two Methods Of Femoral Tunnel Establishment After Reconstruction Of Anterior Cruciate Ligament:A Systematic Review And Meta-analysis

ObjectiveTo investigate whether there is any difference in the clinical efficacy between the anteromedial portal(AMP)and the transtibial approach(TT)for the establishment of the femoral tract during knee anterior cruciate ligament reconstruction.MethodsAfter formulating search strategies and document inclusion and exclusion criteria,the computer comprehensively searched China Knowledge Network(CNKI,China National Knowledge Infrastructure,hereinafter referred to as HowNet),Wanfang Data(WANFANG DATA,hereinafter referred to as Wanfang),and China Biomedical Literature Database(China Biology Medicine disc,CBMdisc(hereinafter referred to as CBM),PubMed,EMBASE,Cochrane Library.Screening and weight reduction of the retrieved documents,after obtaining the required documents,extract the data required for Meta analysis,and use the Review Manager 5.3 software provided by the Cochrane Collaboration Network for document quality evaluation and Meta analysis.Results1.This Meta analysis included a total of 724 cases in 9 studies,including 358 cases in the AMP group and 366 cases in the TT group.2.The IKDC subjective evaluation system score included 4 studies,and there was no statistically significant difference between AMP and TT[MD=1.39,95%CI(-0.96,3.74),P=0.25,I~2=0%].3.IKDC objective scoring system rating included 4 studies,the difference between AMP and TT was not statistically significant[OR=2.34,95%CI(0.82,6.71),P=0.85,I~2=0%].4.Lysholm knee score was included in 6 studies.The postoperative Lysholm knee score of the AMP group was better than that of the TT group,the difference was statistically significant[MD=1.22,95%CI(0.10,2.33),P=0.03,I~2=0%].5.The Lachman test included 4 studies.The negative rate of the Lachman test after the AMP group was superior,and the difference was statistically significant[OR=1.82,95%CI(1.00,3.30),P=0.05,I~2=0%].6.A total of 5 studies were included in the axial shift test.The negative rate of the axial shift test in the AMP group was higher than that in the TT group,the difference was statistically significant[OR=2.18,95%CI(1.25,3.82),P=0.006,I~2=0%].7.The results of KT-1000/2000 were included in 4 studies,the difference between AMP and TT was not statistically significant,[MD=-0.11,95%CI(-0.23,0.01),P=0.08,I~2=0%].Conclusion:In anterior cruciate ligament reconstruction,the establishment of the femoral tract through the anteromedial portal and transtibial approach can obtain good postoperative efficacy,but based on the current RCT study,the establishment of the femoral tract through the anteromedial portal can obtain better knee stability and function.