| Objectives:As an important anatomical structures,anterior cruciate ligament(ACL)play a key role to maintain knee stability.Anterior cruciate ligament injury cause for osteoarthritis and advocate to reconstruction anterior cruciate ligament under arthroscopy.Recently,there is a controversial question about ACL reconstruction use remnant preserving or remnant sacrificing techniques.Someone maintain possitive opinion bacause of remnant preserving techniques could promote recovery for proprioceptive function of the knee and vascularization of the graft.scientist found fiber cells that promote graft vascularization,stellate glial cells,mesenchy-malstem cells that has independence and characteristics to help graft regeneration and lots of mechanicoreceptor that can recover proprioceptive function of the knee in ACL stump.Some others have just the opposite opinion.At first,Some people think that remnant preserving will cause some complications,such as Cyclops syndrome lead to loss of extension.At second,Remnant preserving techniques increase patients anesthesia time and intraoperative blood loss.This study aimed to according to meta analysis to clearly the question' answer of anterior cruciate ligament stump leave it or not.Methods:The authors systematically searched electronic databases,randomized controlled trials(RCTs),quasi-randomized controlled trials and Prospective cohort study were collected from Pubmed,Embase,Ovid,Cochrane,CNKI,VIP,Wan-fang,CBM to identify prospective studies which compared remnant preserving with remnant sacrificing for primary ACL reconstruction.Search results has been filter based on some standards.Finally,12 studies met the inclusion criteria,this studies has been evaluate and extract 9 clinical outcomes data:Lysholm Score,IKDC Score,KT-2000,Joint position sense,Range of motion of knee,Signal-to-noise quotient,Pivot Shift,Lachman test,Cyclops lesions.The results of the clinical outcomes data were analysed by using the Rstudio software.Results:The results of meta-analysis:1.Lysholm Scorepreoperative(MD=0.35,95%CI(-0.55;1.24),p=0.45),3months after operation(MD=3.07,95%CI(-2.28;8.43),p=0.26),6 months after operation(MD=3.84,95%CI(-0.45;8.12),p=0.08),9 months after operation(MD=2.53,95%CI(-1.04;6.11),p=0.17),12months after operation(MD=1.93,95%CI(0.14,3.72);p=0.03),the last follow-up(MD=2.01,95%CI(0.38;2.64),p=0.01).2.IKDC Scorepreoperative(MD=0.38,95%CI(-0.4;1.24),p=0.38),6 months after operation(MD=7.23,95%CI(5.79;8.67),p<0.01),12 months a:fter operation(MD=5.52,95%CI(-0.06;11.09),p=0.05),the last follow-up(MD=1.80,95%CI(1.29;2.32),p<0.01).3.KT-2000 preoperative(MD=-0.19,95%CI(-0.51,0.14),p=0.27),6 months after operation(MD=-0.08,95%CI(-0.13;-0.03),p<0.01),12 months after operation(MD=-0.22,95%CI(-0.28;-0.16);,p<0.01),the last follow-up(MD=-0.19,95%CI(-0.27;-0.12),p<0.01).4 Joint position sense3 months after operation(MD=-0.45,95%CI(-1.78;0.87),p=:0.50),6 months after operation(MD=0.05,95%CI(-1.01;1.11),p=0.93),9 months after operation(MD=0.27,95%CI(-0.53;1.08),p=0.50),12 months after operation(MD=0.16,95%CI(-0.45;0.77),p=0.60);JPS of 12 months after operation,0?35°(MD=-0.69,95%CI(-1.68;0.30),p=0.17),36?65°(MD=-0.48,95%CI(-0.90;-0.07),p=0.02),66?1000(MD=-0.39,95%CI(-0.84;0.06),p=0.09).5.Range of motion of knee(MD=1.83,95%CI(-3.57;-7.24),p=0.51).6.Signal-to-noise quotient2-4 months after operation,proximal(MD=3.02,95%CI(-2.33;8.36),p=0.27),middle(MD=3.53,95%CI(-0.04;7.11),p=0.05),distal(MD=1.71,95%CI(0.89;2.53),p<0.01);6-9 months after operation,proximal(MD=-1.21,95%CI(-1.81;-0.62),p<0.01),middle(MD=-2.18,95%CI(-2.80;-1.56),p<0.01),distal(MD=-0.69,95%CI(-1.29;-0.10),p=0.02);12-18 months after operation,proximal(MD=-1.58,95%CI(-1.98;-1.17),p<0.01),middle(MD=-1.50,95%CI(-1.97;-1.03),p<0.01),distal(MD=0.49,95%CI(0.15;1.60),p=0.24).7.Pivot Shiftpreoperative(MD=0.97,95%CI(0.93;1.02),p=0.27),Postoperation(MD= 1.06,95%CI(1.01;1.12),p=0.02).8.Lachman testpreoperative(MD=1.00,95%CI(0.97;1.03),p=0.90),postoperation(MD=1.02,95%CI(0.96,1.09),p=0.48).9.Cyclops lesions(MD=0.59,95%CI(0.08;4.52),p=0.61).Conclusions:1.The most important finding of this study was that patients with the remnant preserving techniques showed better clinical outcomes in Lysholm Score,IKDC Score,KT-2000,Pivot Shift and Signal-to-noise quotient when compared to those with the remnant sacrificing surgical procedures.2.In addition,the remnant preserving techniques showed no significant difference in terms of proprioceptive function of the knee,cyclops lesion,range of motion of knee,and Lachman test compare with remnant sacrificing. |
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