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      Femoral fixation methods for hamstring graft in anterior cruciate ligament reconstruction: A network meta-analysis of controlled clinical trials

      research-article
      Author(s): 1 , 2 , 3 , 1 , 2 , * ,
      Editor(s):
      Publication date (Electronic):
      Journal: PLoS ONE
      Publisher: Public Library of Science

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          Abstract

          Objective

          To compare the clinical effectiveness of cortical button (CB), cross-pin (CP) and compression with interference screws (IS) fixation techniques in anterior cruciate ligament (ACL) reconstruction using hamstring graft.

          Methods

          Studies were systematically retrieved from PubMed, Embase, Cochrane Library and Web of Science up to May 20, 2021. Primary outcomes were KT-1000 assessment, International Knee Documentation Committee (IKDC) score A or B, Lachman’s test, pivot-shift test, visual analogue scale (VAS) score, Lysholm score, Tegner score, and Cincinnati Knee Score. Secondary outcomes included reconstruction failures and synovitis. League tables, rank probabilities and forest plots were drawn for efficacy comparison.

          Results

          Twenty-six controlled clinical trials (CCTs) with 1,824 patients undergoing ACL reconstruction with hamstring graft were included. No significant differences were found among CB, CP and IS fixation methods regarding the 10 outcomes. For KT-1000 assessment, IKDC score A or B, Lachman’s test, VAS score and pivot-shift test, CP had the greatest probability of becoming the best method, and IS may be the suboptimal method in 4 out of these 5 outcomes except pivot-shift test.

          Conclusions

          CP, CB and IS fixations have comparable clinical performance, while CP fixation is most likely to be the optimum fixation technique for hamstring graft in ACL reconstruction. Future larger-sample studies of high quality comparing these techniques in more clinical outcomes are required.

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          Most cited references62

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          The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials

          Julian P. T. Higgins, Douglas G. Altman, Peter C. Gøtzsche … (2014)
          Flaws in the design, conduct, analysis, and reporting of randomised trials can cause the effect of an intervention to be underestimated or overestimated. The Cochrane Collaboration’s tool for assessing risk of bias aims to make the process clearer and more accurate
          Article 0 comments Cited 8502 times – based on 0 reviews     Review now
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            Rating systems in the evaluation of knee ligament injuries.

            Y Tegner, J Lysholm (1985)
            Many different methods of evaluating disability after knee ligament injury exist. Most of them differ in design. Some are based on only patients' symptoms. Other include patients' symptoms, activity grading, performance in a test, and clinical findings. The rating in these evaluating systems can be either numerical, as in a score, or binary, with yes/no answers. Comparison between a symptom-related score and a score of more complex design showed that the symptom-related score gave a more differentiated picture of the disability. It was also shown that the binary rating system gave less detailed information than a score and that differences in a binary rating can depend on at what level the symptoms are regarded as "significant." A new activity grading scale, where work and sport activities were graded numerically, was constructed as complement to the functional score. When evaluating knee ligament injuries, stability testing, functional knee score, performance test, and activity grading are all important. However, the relative importance varies during the course of treatment, and therefore they should not all be included in one and the same score.
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              Evaluating the Quality of Evidence from a Network Meta-Analysis

              Georgia Salanti, Cinzia Del Giovane, Anna Chaimani … (2014)
              Systematic reviews that collate data about the relative effects of multiple interventions via network meta-analysis are highly informative for decision-making purposes. A network meta-analysis provides two types of findings for a specific outcome: the relative treatment effect for all pairwise comparisons, and a ranking of the treatments. It is important to consider the confidence with which these two types of results can enable clinicians, policy makers and patients to make informed decisions. We propose an approach to determining confidence in the output of a network meta-analysis. Our proposed approach is based on methodology developed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group for pairwise meta-analyses. The suggested framework for evaluating a network meta-analysis acknowledges (i) the key role of indirect comparisons (ii) the contributions of each piece of direct evidence to the network meta-analysis estimates of effect size; (iii) the importance of the transitivity assumption to the validity of network meta-analysis; and (iv) the possibility of disagreement between direct evidence and indirect evidence. We apply our proposed strategy to a systematic review comparing topical antibiotics without steroids for chronically discharging ears with underlying eardrum perforations. The proposed framework can be used to determine confidence in the results from a network meta-analysis. Judgements about evidence from a network meta-analysis can be different from those made about evidence from pairwise meta-analyses.
              Article 0 comments Cited 402 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Shixin Nie: Role: ConceptualizationRole: Writing – original draftRole: Writing – review & editing
                Shuqing Zhou: Role: Data curationRole: Formal analysisRole: InvestigationRole: Methodology
                Wei Huang:
                ORCID: https://orcid.org/0000-0001-9116-2985
                Role: ConceptualizationRole: Writing – review & editing
                Osama Farouk: Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS One
                Journal ID (publisher-id): plos
                Title: PLoS ONE
                Publisher: Public Library of Science (San Francisco, CA USA )
                ISSN (Electronic): 1932-6203
                Publication date (Electronic): 22 September 2022
                Publication date Collection: 2022
                Volume: 17
                Issue: 9
                Electronic Location Identifier: e0275097
                Affiliations
                [1 ] Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
                [2 ] Orthopedic Laboratory of Chongqing Medical University, Chongqing, China
                [3 ] Department of Orthopedics, The Centre Hospital of Jiangjin, Chongqing, China
                Assiut University Faculty of Medicine, EGYPT
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                https://orcid.org/0000-0001-9116-2985
                Article
                Publisher ID: PONE-D-21-35863
                DOI: 10.1371/journal.pone.0275097
                PMC ID: 9499312
                PubMed ID: 36137116
                SO-VID: b3d953c2-1eee-4191-a8c1-7a2eafeda1a8
                Copyright © © 2022 Nie et al
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 26 November 2021
                Date accepted : 11 September 2022
                Page count
                Figures: 3, Tables: 9, Pages: 20
                Funding
                The author(s) received no specific funding for this work.
                Categories
                Subject: Research Article
                Subject: Biology and Life Sciences
                Subject: Anatomy
                Subject: Musculoskeletal System
                Subject: Skeleton
                Subject: Skeletal Joints
                Subject: Knees
                Subject: Medicine and Health Sciences
                Subject: Anatomy
                Subject: Musculoskeletal System
                Subject: Skeleton
                Subject: Skeletal Joints
                Subject: Knees
                Subject: Biology and Life Sciences
                Subject: Anatomy
                Subject: Body Limbs
                Subject: Legs
                Subject: Knees
                Subject: Medicine and Health Sciences
                Subject: Anatomy
                Subject: Body Limbs
                Subject: Legs
                Subject: Knees
                Subject: Medicine and Health Sciences
                Subject: Surgical and Invasive Medical Procedures
                Subject: Musculoskeletal System Procedures
                Subject: Anterior Cruciate Ligament Reconstruction
                Subject: Research and Analysis Methods
                Subject: Mathematical and Statistical Techniques
                Subject: Statistical Methods
                Subject: Metaanalysis
                Subject: Physical Sciences
                Subject: Mathematics
                Subject: Statistics
                Subject: Statistical Methods
                Subject: Metaanalysis
                Subject: Biology and Life Sciences
                Subject: Anatomy
                Subject: Biological Tissue
                Subject: Connective Tissue
                Subject: Ligaments
                Subject: Medicine and Health Sciences
                Subject: Anatomy
                Subject: Biological Tissue
                Subject: Connective Tissue
                Subject: Ligaments
                Subject: Medicine and Health Sciences
                Subject: Epidemiology
                Subject: Medical Risk Factors
                Subject: Biology and Life Sciences
                Subject: Bioengineering
                Subject: Biotechnology
                Subject: Medical Devices and Equipment
                Subject: Engineering and Technology
                Subject: Bioengineering
                Subject: Biotechnology
                Subject: Medical Devices and Equipment
                Subject: Medicine and Health Sciences
                Subject: Medical Devices and Equipment
                Subject: Medicine and Health Sciences
                Subject: Surgical and Invasive Medical Procedures
                Subject: Plastic Surgery and Reconstructive Techniques
                Subject: Medicine and Health Sciences
                Subject: Clinical Medicine
                Subject: Clinical Trials
                Subject: Medicine and Health Sciences
                Subject: Pharmacology
                Subject: Drug Research and Development
                Subject: Clinical Trials
                Subject: Research and Analysis Methods
                Subject: Clinical Trials
                Custom metadata
                Data Availability All relevant data are within the manuscript and its Supporting Information files.

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