Genetic Variants and Anterior Cruciate Ligament Rupture: A Systematic Review
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SYSTEMATIC REVIEW
Genetic Variants and Anterior Cruciate Ligament Rupture: A Systematic Review Mustafa Kaynak1 • Frank Nijman1 • Joyce van Meurs2 • Max Reijman1 Duncan E. Meuffels1
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Ó The Author(s) 2017. This article is published with open access at Springerlink.com
Abstract Background Studies have shown a familial predisposition for anterior cruciate ligament (ACL) rupture and have been followed by genetic-association studies on polymorphisms in candidate genes in recent years. To date, no systematic review with a best-evidence synthesis has evaluated the influence of genetics on this devastating knee injury. Objective Our objective was to evaluate the association between genetic variants and ACL rupture. Methods We performed an extensive search in Embase, MEDLINE, Web of Science, Scopus, PubMed Publisher, Cochrane Register of Clinical Trials, and Google scholar up to 24 August 2015. Studies were eligible if they met the following inclusion criteria: (1) design was a case–control study, retrospective or prospective follow-up study, or a randomized controlled trial (RCT); (2) the study examined the association between a genetic variant and ACL rupture in both an ACL and a control group. We determined the risk of bias for all included studies. Results We included a total of 16 studies (eight at high risk of bias and eight with an unclear risk) that examined 33 different DNA variants. Conflicting evidence was found for the COL1A1 rs1800012 and COL3A1 rs1800255 variants, whereas limited evidence was found for no association of the COL5A1 rs12722 and rs13946 and COL12A1 rs970547 variants (all encoding collagen). Evidence was insufficient
& Mustafa Kaynak [email protected] 1
Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, ‘s-Gravendijkwal 230, 3000 CA Rotterdam, The Netherlands
2
Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
to draw conclusions as to whether any other genetic variant identified in this review had any association with ACL rupture. Conclusions More research is needed to support a clear association between ACL rupture and genetic variants. Genome-wide studies are recommended for exploring more potential genetic variants. Moreover, large prospective studies are needed to draw robust conclusions.
Key Points Anterior cruciate ligament (ACL) rupture is a very common and severe knee injury that predominantly occurs while participating in sports. It incurs high costs and has disastrous clinical consequences. Studies in recent years have suggested that genetic predisposition is an important factor in its etiology. This is the first systematic review with a bestevidence synthesis regarding associations between genetic variants and ACL rupture. We found some potential genetic variants that require further investigation, especially since we identified large heterogeneity in the broad genetic variants studied and outcome definitions. More research with large samples, phenotype homogeneity, and less bias
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