DataSheet3_Anterior cruciate ligament deficiency versus intactness for outcomes in patients after unicompartmental knee arthroplasty: a systematic review and meta-analysis.docx

Objective: The unicondylar knee arthroplasty (UKA) procedure is primarily indicated for osteoarthritis of the knee. Anterior cruciate ligament (ACL) defects have long been considered a contraindication to UKA. However, recent clinical studies have found that ACL defects do not affect postoperative outcomes in UKA. To elucidate whether ACL defects affect postoperative outcomes in UKA, we performed a systematic review and Meta-analysis of observational cohort studies comparing the effects of ACL defects and intactness on surgical outcomes in UKA.Methods: In this study, we used “Anterior Cruciate Ligament”, “Anterior Cruciate Ligament Injuries” and “Arthroplasty, Replacement, Knee” as the subject terms according to PICOS principles. These subject terms and the corresponding free texts were used to conduct a systematic search in the three major databases PubMed, Embase and Cochrane on December 9, 2021. The main study variables included age, gender, region, definition of ACL defect and diagnosed diseases. The study used a random effect model to pool the effect of 95% CIs. To explore the sources of heterogeneity and to test the stability of the results, a sensitivity analysis was performed.Results: The systematic review found no significant differences in postoperative clinical outcomes in the elderly population when unicondylar replacement was performed in the setting of multiple factors such as injury, defects, longitudinal tear, and synovial bursa injury defined as ACL deficiency. The primary clinical outcomes included postoperative revision, Tegner activity score, and Oxford Knee Score (OKS). After statistical meta-analysis, postoperative outcomes such as postoperative revision (OR, 1.174; 95% CIs, 0.758–1.817) and Tegner activity score (OR, -0.084; 95% CIs, -0.320–0.151) were not statistically different.Conclusion: There was no difference in postoperative revision rates and functional outcomes such as Tegner activity score between the ACL-deficient group compared with the ACL-intact group. For the present results, it is not advisable to consider ACL deficiency as a contraindication of UKA.

研究目的：单髁膝关节置换术（UKA）主要用于治疗膝关节骨关节炎。长期以来，前交叉韧带（ACL）损伤被视为UKA的禁忌症。然而，近期临床研究表明，ACL损伤并不影响UKA术后疗效。为了阐明ACL损伤是否会影响UKA术后疗效，本研究对比较ACL损伤与完整性的观察性队列研究进行了系统综述和Meta分析。研究方法：本研究根据PICOS原则，以“前交叉韧带”、“前交叉韧带损伤”和“膝关节置换术”作为主题词。这些主题词及其对应文本用于在2021年12月9日的PubMed、Embase和Cochrane三大数据库中进行系统检索。主要研究变量包括年龄、性别、地区、ACL损伤的定义以及诊断的疾病。研究采用随机效应模型对95%置信区间内的效应进行汇总。为了探究异质性的来源并检验结果的稳定性，进行了敏感性分析。研究结果：系统综述发现，在老年人群中，在存在损伤、缺陷、纵向撕裂和定义为ACL缺陷的滑膜囊损伤等多因素情况下进行单髁置换术，术后临床结局并无显著差异。主要临床结局包括术后翻修、Tegner活动评分和牛津膝关节评分（OKS）。经过统计分析的Meta分析，术后结局如术后翻修（OR，1.174；95%置信区间，0.758–1.817）和Tegner活动评分（OR，-0.084；95%置信区间，-0.320–0.151）在统计学上并无差异。结论：与ACL完整组相比，ACL缺陷组的术后翻修率和功能结局如Tegner活动评分无显著差异。对于当前研究结果，将ACL缺陷视为UKA的禁忌症并不可取。