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Cochrane Database of Systematic Reviews

One‐incision versus two‐incision techniques for arthroscopically assisted anterior cruciate ligament reconstruction in adults

Information

DOI:
https://doi.org/10.1002/14651858.CD010875.pub2Copy DOI
Database:
  1. Cochrane Database of Systematic Reviews
Version published:
  1. 15 December 2017see what's new
Type:
  1. Intervention
Stage:
  1. Review
Cochrane Editorial Group:
  1. Cochrane Bone, Joint and Muscle Trauma Group

Copyright:
  1. Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Authors

  • Fernando C Rezende

    Correspondence to: Department of Orthopaedics and Traumatology, Universidade Federal de São Paulo, São Paulo, Brazil

    [email protected]

    [email protected]

  • Vinícius Y Moraes

    Department of Orthopaedics and Traumatology, Universidade Federal de São Paulo, São Paulo, Brazil

  • Carlos ES Franciozi

    Department of Orthopaedics and Traumatology, Universidade Federal de São Paulo, São Paulo, Brazil

  • Pedro Debieux

    Department of Orthopaedics and Traumatology, Universidade Federal de São Paulo, São Paulo, Brazil

  • Marcus V Luzo

    Department of Orthopaedics and Traumatology, Universidade Federal de São Paulo, São Paulo, Brazil

  • João Carlos Belloti

    Department of Orthopaedics and Traumatology, Universidade Federal de São Paulo, São Paulo, Brazil

Contributions of authors

Fernando Cury Rezende, Vinícius de Moraes, and Carlos Franciozi conceived and drafted the protocol and review. Vinícius de Moraes and João Carlos Belloti provided input on methodological issues. All authors revised and approved the final version of the review.

Fernando Cury Rezende is the guarantor of this review.

Sources of support

Internal sources

  • Escola Paulista de Medicina ‐ Universidade Federal de São Paulo, Brazil.

External sources

  • No sources of support supplied

Declarations of interest

Fernando C Rezende: none known
Vinícius Y Moraes: none known
Carlos ES Franciozi: none known
Pedro Debieux: none known
Marcus V Luzo: none known
João Carlos Belloti: none known

Acknowledgements

We would like to thank Helen Handoll, Zipporah Iheozor‐ejiofor, and Guanghua Lei for feedback on drafts of the review, and Lindsey Elstub and Joanne Elliott for editorial support.

We also thank Helen Handoll, Guanghua Lei, and Ana Luiza Cabrera Martimbianco for feedback on drafts of the protocol, and Joanne Elliott, Lindsey Elstub, and Laura MacDonald for editorial assistance on the protocol.

This project was supported by the National Institute for Health Research (NIHR) via Cochrane Infrastructure funding to the Cochrane Bone, Joint and Muscle Trauma Group. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Systematic Reviews Programme, NIHR, National Health Service (NHS), or the Department of Health.

Version history

Published

Title

Stage

Authors

Version

2017 Dec 15

One‐incision versus two‐incision techniques for arthroscopically assisted anterior cruciate ligament reconstruction in adults

Review

Fernando C Rezende, Vinícius Y Moraes, Carlos ES Franciozi, Pedro Debieux, Marcus V Luzo, João Carlos Belloti

https://doi.org/10.1002/14651858.CD010875.pub2

2013 Dec 17

One‐incision versus two‐incision techniques for arthroscopically‐assisted anterior cruciate ligament reconstruction in adults

Protocol

Fernando C Rezende, Vinícius Y Moraes, Carlos ES Franciozi, Pedro Debieux, Marcus V Luzo, João Carlos Belloti

https://doi.org/10.1002/14651858.CD010875

Differences between protocol and review

Types of interventions

We clarified that the same grafts, fixation devices, and other techniques needed to be used for both intervention groups to ensure that the comparison was strictly one‐incision versus two‐incision techniques.

Types of outcome measures

In our protocol, we omitted to include composite clinical (clinician‐rated) scores, specifically the objective part of the International Knee Documentation Committee (IKDC). The IKDC results are categorised as normal (level A), nearly normal (level B), abnormal (level C), and severely abnormal (level D). In our analyses, as recommended by Irrgang 2001, we opted to pool the first two groups (A and B) to compare data of participants with normal or nearly normal results with participants of the other two groups (C and D), allowing meta‐analyses of dichotomous outcomes.

In the protocol, we set the threshold for distinguishing between intermediate‐ and long‐term follow‐up at three years. In the review we changed this to two years, which was consistent with follow‐up times of the contributing trials and a related Cochrane Review (Mohtadi 2011). Additionally, based on data availability, we presented long‐term data separately for two to five years and six years and above.

Furthermore, we made a post hoc decision to report outcome of longer duration if an outcome was reported at different time points classed under the same follow‐up period (short, intermediate, or long term). Thus if data for two different time points belonging to the same period were available, we reported the longer‐duration data.

'Risk of bias' assessment

We decided against performing separate analyses of subjective and objective outcomes of the following 'Risk of bias' domains: blinding of participants and personnel, blinding of outcome assessment, and incomplete outcome data, because we considered that the judgements for the two categories of outcome would be comparable.

'Summary of findings' table

We adjusted the list of outcomes stipulated for inclusion in the 'Summary of findings' table to make clear the time frames selected for subjective assessment of function, quality of life, and activity level outcomes. We added objective functional knee assessments (IKDC) at intermediate‐term follow‐up.

Keywords

MeSH

PICOs

Population
Intervention
Comparison
Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.

Study flow diagram.
Figures and Tables -
Figure 1

Study flow diagram.

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figures and Tables -
Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figures and Tables -
Figure 3

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Comparison 1 One‐incision versus two‐incision anterior cruciate ligament reconstruction techniques, Outcome 1 Subjectively rated knee function: Lysholm scores (0 to 100: best function).
Figures and Tables -
Analysis 1.1

Comparison 1 One‐incision versus two‐incision anterior cruciate ligament reconstruction techniques, Outcome 1 Subjectively rated knee function: Lysholm scores (0 to 100: best function).

Comparison 1 One‐incision versus two‐incision anterior cruciate ligament reconstruction techniques, Outcome 2 Subjectively rated knee function: Lysholm scores 90 or more.
Figures and Tables -
Analysis 1.2

Comparison 1 One‐incision versus two‐incision anterior cruciate ligament reconstruction techniques, Outcome 2 Subjectively rated knee function: Lysholm scores 90 or more.

Comparison 1 One‐incision versus two‐incision anterior cruciate ligament reconstruction techniques, Outcome 3 Adverse events.
Figures and Tables -
Analysis 1.3

Comparison 1 One‐incision versus two‐incision anterior cruciate ligament reconstruction techniques, Outcome 3 Adverse events.

Comparison 1 One‐incision versus two‐incision anterior cruciate ligament reconstruction techniques, Outcome 4 Tegner activity score (0 to 10: top activity) at 24 months.
Figures and Tables -
Analysis 1.4

Comparison 1 One‐incision versus two‐incision anterior cruciate ligament reconstruction techniques, Outcome 4 Tegner activity score (0 to 10: top activity) at 24 months.

Comparison 1 One‐incision versus two‐incision anterior cruciate ligament reconstruction techniques, Outcome 5 Return to previous activity level (2 to 5 years).
Figures and Tables -
Analysis 1.5

Comparison 1 One‐incision versus two‐incision anterior cruciate ligament reconstruction techniques, Outcome 5 Return to previous activity level (2 to 5 years).

Comparison 1 One‐incision versus two‐incision anterior cruciate ligament reconstruction techniques, Outcome 6 IKDC objective assessment: normal or nearly normal.
Figures and Tables -
Analysis 1.6

Comparison 1 One‐incision versus two‐incision anterior cruciate ligament reconstruction techniques, Outcome 6 IKDC objective assessment: normal or nearly normal.

Comparison 1 One‐incision versus two‐incision anterior cruciate ligament reconstruction techniques, Outcome 7 Objective function tests: one‐leg hop quotient (% of other leg) (24 months).
Figures and Tables -
Analysis 1.7

Comparison 1 One‐incision versus two‐incision anterior cruciate ligament reconstruction techniques, Outcome 7 Objective function tests: one‐leg hop quotient (% of other leg) (24 months).

Comparison 1 One‐incision versus two‐incision anterior cruciate ligament reconstruction techniques, Outcome 8 Objective function tests: one‐leg hop > 90% contralateral (2 to 5 years).
Figures and Tables -
Analysis 1.8

Comparison 1 One‐incision versus two‐incision anterior cruciate ligament reconstruction techniques, Outcome 8 Objective function tests: one‐leg hop > 90% contralateral (2 to 5 years).

Comparison 1 One‐incision versus two‐incision anterior cruciate ligament reconstruction techniques, Outcome 9 Static stability measures ‐ anterior translation, difference between sides (injured ‐ healthy knee).
Figures and Tables -
Analysis 1.9

Comparison 1 One‐incision versus two‐incision anterior cruciate ligament reconstruction techniques, Outcome 9 Static stability measures ‐ anterior translation, difference between sides (injured ‐ healthy knee).

Comparison 1 One‐incision versus two‐incision anterior cruciate ligament reconstruction techniques, Outcome 10 Static stability measures ‐ anterior translation side‐to‐side difference < 3 mm.
Figures and Tables -
Analysis 1.10

Comparison 1 One‐incision versus two‐incision anterior cruciate ligament reconstruction techniques, Outcome 10 Static stability measures ‐ anterior translation side‐to‐side difference < 3 mm.

Comparison 1 One‐incision versus two‐incision anterior cruciate ligament reconstruction techniques, Outcome 11 Static stability measures ‐ various.
Figures and Tables -
Analysis 1.11

Comparison 1 One‐incision versus two‐incision anterior cruciate ligament reconstruction techniques, Outcome 11 Static stability measures ‐ various.

Comparison 1 One‐incision versus two‐incision anterior cruciate ligament reconstruction techniques, Outcome 12 Patellofemoral pain score (0 to 20: best outcome).
Figures and Tables -
Analysis 1.12

Comparison 1 One‐incision versus two‐incision anterior cruciate ligament reconstruction techniques, Outcome 12 Patellofemoral pain score (0 to 20: best outcome).

Comparison 1 One‐incision versus two‐incision anterior cruciate ligament reconstruction techniques, Outcome 13 Pain (early and late postoperative pain).
Figures and Tables -
Analysis 1.13

Comparison 1 One‐incision versus two‐incision anterior cruciate ligament reconstruction techniques, Outcome 13 Pain (early and late postoperative pain).

Comparison 1 One‐incision versus two‐incision anterior cruciate ligament reconstruction techniques, Outcome 14 Knee range of motion (degrees).
Figures and Tables -
Analysis 1.14

Comparison 1 One‐incision versus two‐incision anterior cruciate ligament reconstruction techniques, Outcome 14 Knee range of motion (degrees).

Study

Variable (degrees)

One‐incision n = 15

Two‐incision n = 12

Mean difference

Reat 1997

Extension

‐4°

‐2°

‐2°

Reat 1997

Flexion

135°

134°

Reat 1997

Range of motion

139°

136°

Figures and Tables -
Analysis 1.15

Comparison 1 One‐incision versus two‐incision anterior cruciate ligament reconstruction techniques, Outcome 15 Range of motion at mean 15 months follow‐up (range 5 to 28 months).

Study

Muscle and conditions

One‐incision

n = 10

Two‐incision

n = 10

MD

Reported P

3 months

Hess 2002

Extensor, 60 deg/sec, concentric

65.8

52.3

13.5

0.05

Hess 2002

Extensor, 180 deg/sec, concentric

80.3

57.7

22.6

0.01

Hess 2002

Extensor, 60 deg/sec, eccentric

67.1

51

16.1

> 0.05

Hess 2002

Extensor, 180 deg/sec, eccentric

68.8

51.7

17.1

> 0.05

Hess 2002

Flexor, 60 deg/sec, concentric

110.4

82.7

27.7

0.02

Hess 2002

Flexor, 180 deg/sec, concentric

118.3

91.5

26.8

> 0.05

Hess 2002

Flexor, 60 deg/sec, eccentric

82.3

67.7

14.6

> 0.05

Hess 2002

Flexor, 180 deg/sec, eccentric

92.2

75.7

16.5

> 0.05

6 months

Hess 2002

Extensor, 60 deg/sec, concentric

79.3

61.1

18.2

0.03

Hess 2002

Extensor, 180 deg/sec, concentric

82.2

78.3

3.9

> 0.05

Hess 2002

Extensor, 60 deg/sec, eccentric

92.5

55

37.5

0.02

Hess 2002

Extensor, 180 deg/sec, eccentric

77.9

65

12.9

0.05

Hess 2002

Flexor, 60 deg/sec, concentric

108.1

91.5

16.6

0.03

Hess 2002

Flexor, 180 deg/sec, concentric

100.6

99.9

0.7

> 0.05

Hess 2002

Flexor, 60 deg/sec, eccentric

94.5

79.8

14.7

> 0.05

Hess 2002

Flexor, 180 deg/sec, eccentric

107.8

87.9

19.9

> 0.05

Figures and Tables -
Analysis 1.16

Comparison 1 One‐incision versus two‐incision anterior cruciate ligament reconstruction techniques, Outcome 16 Peak torque forces (% contralateral side) at 3 and 6 months.

Comparison 1 One‐incision versus two‐incision anterior cruciate ligament reconstruction techniques, Outcome 17 Muscle strength (peak torque forces) at 12 months.
Figures and Tables -
Analysis 1.17

Comparison 1 One‐incision versus two‐incision anterior cruciate ligament reconstruction techniques, Outcome 17 Muscle strength (peak torque forces) at 12 months.

Comparison 1 One‐incision versus two‐incision anterior cruciate ligament reconstruction techniques, Outcome 18 Deficits in isokinetic muscle strength (6 to 11 years).
Figures and Tables -
Analysis 1.18

Comparison 1 One‐incision versus two‐incision anterior cruciate ligament reconstruction techniques, Outcome 18 Deficits in isokinetic muscle strength (6 to 11 years).

Summary of findings for the main comparison. One‐incision compared to two‐incision techniques for arthroscopically assisted anterior cruciate ligament reconstruction in adults

One‐incision compared to two‐incision techniques for arthroscopically assisted anterior cruciate ligament (ACL) reconstruction in adults

Patient or population: adults undergoing arthroscopically assisted ACL reconstruction1
Setting: hospital operating theatre

Intervention: one‐incision technique
Comparison: two‐incision technique

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No. of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Two‐incision technique (control)

One‐incision technique (intervention)

Subjective function (short term)2: Lysholm knee score (0 to 100: higher scores = better function)
Follow‐up: 3 months

The mean Lysholm score in the two‐incision groups ranged from 84 to 90.

The mean Lysholm score in the one‐incision groups was 2.73 higher (2.70 lower to 8.15 higher).

79
(2 studies)

⊕⊝⊝⊝
VERY LOW3

The 95% CI are unlikely to include a clinically important difference.4

Subjective function (intermediate term)2: Lysholm knee score (0 to 100: higher scores = better function)
Follow‐up: 12 months

The mean Lysholm score in the two‐incision groups ranged from 94 to 97.

The mean Lysholm score in the one‐incision groups was 3.68 lower (0.75 to 6.61 lower).

79
(2 studies)

⊕⊝⊝⊝
VERY LOW3

The 95% CI are unlikely to include a clinically important difference.4

A similar lack of differences was found in 2 studies at 24 months (very low‐quality evidence).5

Subjective function (long term)2: Lysholm knee score (0 to 100: higher scores = better function)
Excellent score (90 or above)

Follow‐up: mean 43 months; range 2 to 5 years

900 per 10006

936 per 1000
(819 to 1000)

RR 1.04
(0.91 to 1.18)

85
(1 study)

⊕⊝⊝⊝
VERY LOW7

Quality of life(intermediate term)2

See comment

See comment

See comment

No quality of life measures were reported.

Adverse events (overall)

See comment

See comment

See comment

4 studies reported on specific complications but not overall numbers. There was very low‐quality evidence of little between‐group differences.8

Activity level (intermediate term)

Tegner activity score (0 to 10: highest sport activity)
Follow‐up: 24 months

The mean Tegner activity score in the two‐incision group was 5.7.

The mean Tegner activity score in the one‐incision group was 0.8 lower (1.9 lower to 0.3 higher)

59
(1 study)

⊕⊝⊝⊝
VERY LOW9

Objective functional knee assessments using IKDC10

(intermediate term)(normal or nearly normal assessment)
Follow‐up: 12 to 28 months

698 per 100011

705 per 1000
(594 to 845)

RR 1.01

(0.85 to 1.21)

167
(4 studies)

⊕⊝⊝⊝
VERY
LOW 12

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: confidence interval; IKDC: International Knee Documentation Committee; MD: mean difference; RR: risk ratio

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of the effect.
Moderate quality: We are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.
Low quality: Our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect.
Very low quality: We have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.

1All grafts used in the five included trials were patellar tendons. The participants were mainly in their 20s.
2We defined short term as less than six months, intermediate term as six months to two years, and long term as two years or longer after ACL reconstruction.
3We downgraded the quality of the evidence two levels for very serious risk of bias (in particular high risk of selection and performance bias), and one level for imprecision, primarily reflecting the small sample size.
4The minimum detectable change (the minimum difference in an outcome score below which cannot be distinguished from random error in the measurement) for the Lysholm score has been estimated as 8.9.
5One study (59 participants) reported a 1‐point difference (MD ‐1.00 favouring one‐incision group, 95% CI ‐7.34 to 5.34), and the other study (61 participants) found a 2‐point difference (one‐incision group: 96.81 versus two‐incision group: 94.65; reported not statistically significant).
6The assumed control risk is that of the study reporting this outcome.
7We downgraded the quality of the evidence two levels for very serious risk of bias (in particular high risk of selection, performance, and selective reporting bias), and one level for serious imprecision, reflecting the small sample size and wide confidence interval.
8Reported adverse events were infection, nerve palsy, haemarthrosis requiring treatment, knee stiffness, recurrent knee instability, persistent knee swelling, reoperation (for meniscal and cartilage lesions, removal of deep hardware, etc.), and graft failure.
9We downgraded the quality of the evidence two levels for very serious risk of bias (in particular high risk of selection and performance bias), and one level for serious imprecision, reflecting the small sample size.
10Objective assessment included that of symptoms, range of motion, one‐leg hop test, and ligament examination categorised into four groups: A (normal), B (nearly normal), C (abnormal), and D (severely abnormal).
11The assumed risk is the median control risk across studies.
12We downgraded the quality of the evidence two levels for very serious risk of bias (in particular high risk of selection and performance bias), and one level for imprecision, primarily reflecting the small sample size.

Figures and Tables -
Summary of findings for the main comparison. One‐incision compared to two‐incision techniques for arthroscopically assisted anterior cruciate ligament reconstruction in adults
Comparison 1. One‐incision versus two‐incision anterior cruciate ligament reconstruction techniques

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Subjectively rated knee function: Lysholm scores (0 to 100: best function) Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

1.1 At 3 months

2

79

Mean Difference (IV, Fixed, 95% CI)

2.73 [‐2.70, 8.15]

1.2 At 12 months

2

79

Mean Difference (IV, Fixed, 95% CI)

‐3.68 [‐6.61, ‐0.75]

1.3 At 24 months

1

59

Mean Difference (IV, Fixed, 95% CI)

‐1.0 [‐7.34, 5.34]

2 Subjectively rated knee function: Lysholm scores 90 or more Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

2.1 Long term: mean 43 months

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 Adverse events Show forest plot

4

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 Infection

2

89

Risk Ratio (M‐H, Fixed, 95% CI)

1.03 [0.07, 15.77]

3.2 Nerve palsy

1

59

Risk Ratio (M‐H, Fixed, 95% CI)

0.34 [0.01, 8.13]

3.3 Haemarthrosis requiring joint aspiration

1

59

Risk Ratio (M‐H, Fixed, 95% CI)

0.34 [0.04, 3.13]

3.4 Deep vein thrombosis

1

30

Risk Ratio (M‐H, Fixed, 95% CI)

3.0 [0.13, 68.26]

3.5 Knee stiffness (loss of terminal extension) (2 to 5 years)

2

144

Risk Ratio (M‐H, Fixed, 95% CI)

1.77 [0.40, 7.79]

3.6 Knee stiffness (loss of terminal flexion) (2 to 5 years)

2

144

Risk Ratio (M‐H, Fixed, 95% CI)

0.50 [0.14, 1.72]

3.7 Recurrent instability (giving way)

1

27

Risk Ratio (M‐H, Fixed, 95% CI)

2.44 [0.11, 54.97]

3.8 Knee swelling at final follow‐up

1

27

Risk Ratio (M‐H, Fixed, 95% CI)

1.12 [0.47, 2.65]

3.9 Reoperations

3

205

Risk Ratio (M‐H, Fixed, 95% CI)

0.89 [0.37, 2.14]

3.10 Graft failure (6 to 11 years)

1

150

Risk Ratio (M‐H, Fixed, 95% CI)

1.25 [0.35, 4.47]

4 Tegner activity score (0 to 10: top activity) at 24 months Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

5 Return to previous activity level (2 to 5 years) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

6 IKDC objective assessment: normal or nearly normal Show forest plot

5

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

6.1 At 3 to 6 months

2

43

Risk Ratio (M‐H, Fixed, 95% CI)

0.59 [0.33, 1.03]

6.2 At 12 to 28 months

4

167

Risk Ratio (M‐H, Fixed, 95% CI)

1.01 [0.85, 1.21]

6.3 At 6 to 11 years

1

150

Risk Ratio (M‐H, Fixed, 95% CI)

0.99 [0.91, 1.07]

7 Objective function tests: one‐leg hop quotient (% of other leg) (24 months) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

8 Objective function tests: one‐leg hop > 90% contralateral (2 to 5 years) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

9 Static stability measures ‐ anterior translation, difference between sides (injured ‐ healthy knee) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

9.1 Difference (mm) measured by KT‐1000 arthrometer at 89 N (3 months)

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

9.2 Difference (mm) measured by KT‐1000 arthrometer at 135 N (3 months)

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

9.3 Difference (mm) measured by KT‐1000 arthrometer at 89 N (24 months)

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

9.4 Difference (mm) measured by KT‐1000 arthrometer at 135 N (12 months)

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

10 Static stability measures ‐ anterior translation side‐to‐side difference < 3 mm Show forest plot

4

297

Risk Ratio (M‐H, Fixed, 95% CI)

0.96 [0.85, 1.09]

10.1 Measured by KT‐1000 arthrometer (12 to 24 months)

2

86

Risk Ratio (M‐H, Fixed, 95% CI)

0.95 [0.78, 1.15]

10.2 Measured by KT‐2000 arthrometer (2 to 5 years)

2

211

Risk Ratio (M‐H, Fixed, 95% CI)

0.97 [0.83, 1.14]

11 Static stability measures ‐ various Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

11.1 Pivot‐Shift (normal or nearly normal) (3 months)

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

11.2 Lachman (normal or nearly normal) (3 months)

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

11.3 Pivot‐Shift (normal or nearly normal) (12 months)

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

11.4 Lachman (normal or nearly normal) (12 months)

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

11.5 Lachman (normal or nearly normal) (2 to 5 years)

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

12 Patellofemoral pain score (0 to 20: best outcome) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

12.1 Patellofemoral pain score (3 months)

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

12.2 Patellofemoral pain score (12 months)

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

12.3 Patellofemoral pain score (24 months)

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

13 Pain (early and late postoperative pain) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

13.1 Pain (6 weeks)

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

13.2 Late pain (mean 15 months)

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

14 Knee range of motion (degrees) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

14.1 Flexion (3 months)

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

14.2 Flexion (6 months)

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

14.3 Flexion (12 months)

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

14.4 Extension (3 months)

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

14.5 Extension (6 months)

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

14.6 Extension (12 months)

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

15 Range of motion at mean 15 months follow‐up (range 5 to 28 months) Show forest plot

Other data

No numeric data

16 Peak torque forces (% contralateral side) at 3 and 6 months Show forest plot

Other data

No numeric data

16.1 3 months

Other data

No numeric data

16.2 6 months

Other data

No numeric data

17 Muscle strength (peak torque forces) at 12 months Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

17.1 Extensors (60º) under concentric isokinetic movement

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

17.2 Extensors (180º) under concentric isokinetic movement

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

17.3 Extensors (60º) under eccentric isokinetic movement

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

17.4 Extensors (180º) under eccentric isokinetic movement

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

17.5 Flexors (60º) under concentric isokinetic movement

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

17.6 Flexors (180º) under concentric isokinetic movement

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

17.7 Flexors (60º) under eccentric isokinetic movement

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

17.8 Flexors (180º) under eccentric isokinetic movement

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

18 Deficits in isokinetic muscle strength (6 to 11 years) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

18.1 Quadriceps deficit > or = 10%

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

18.2 Hamstrings deficit > or = 10%

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 1. One‐incision versus two‐incision anterior cruciate ligament reconstruction techniques