Stupay Kristen L, Swart Eric, Shubin Stein Beth E
Tulane University School of Medicine, New Orleans, Louisiana, U.S.A..
Columbia University Medical Center, New York, New York, U.S.A.
Arthroscopy. 2015 Jul;31(7):1372-80. doi: 10.1016/j.arthro.2014.12.029. Epub 2015 Feb 19.
Our primary purpose was to evaluate whether complications have increased or functional outcomes have changed as medial patellofemoral ligament (MPFL) reconstruction has been adopted by more surgeons at more institutions over recent years. Our secondary purpose was to further define the complication profile of MPFL reconstruction.
A systematic review of the literature was performed on January 12, 2014, using the keywords "medial patellofemoral ligament reconstruction," "patellar instability reconstruction," "patellofemoral ligament reconstruction," and "MPFL." Articles meeting our inclusion criteria were reviewed. Outcome measures, functional failures, complications, graft choice, and surgical technique were recorded and analyzed.
Thirty-four articles met our exclusion and inclusion criteria and were reviewed. Nineteen articles were "new" additions to the literature, whereas 15 had previously been reported on in prior analyses ("old"). The 19 new articles reported a statistically significant decrease in functional failure rates, from 9.55% in older studies to 4.77% in more recent studies (P < .001). The major complication rate dropped from 2.01% to 0.46% in the newer studies (P = .005), and the minor complication rate decreased from 6.53% to 4.00% (P = .06). Postoperative Kujala scores did not show a statistically significant change between newer and older publications (89.0 [SD, 3.7] and 89.4 [SD, 4.9], respectively; P = .55). Comparing results by fixation type, as well as by graft choice, showed no statistically significant differences in terms of outcomes or complication profile.
With nearly twice the number of medical centers performing reconstruction of the MPFL and outcomes reported on nearly double the number of patients in recent years, functional outcomes remain favorable as complication and failure profiles are improving. Furthermore, despite a wide array of fixation techniques, as well as multiple options for graft constructs, there are no statistically or clinically significant differences in functional outcomes over time. This finding highlights the efficacy and adoptability of MPFL reconstruction for the treatment of recurrent patellar instability.
Level IV, systematic review of mixed-level studies.
我们的主要目的是评估近年来随着越来越多的外科医生在更多机构采用内侧髌股韧带（MPFL）重建术，并发症是否增加或功能结果是否发生变化。我们的次要目的是进一步明确MPFL重建术的并发症情况。
2014年1月12日对文献进行了系统回顾，使用关键词“内侧髌股韧带重建”“髌骨不稳定重建”“髌股韧带重建”和“MPFL”。对符合我们纳入标准的文章进行了综述。记录并分析了结果指标、功能失败情况、并发症、移植物选择和手术技术。
34篇文章符合我们的排除和纳入标准并进行了综述。19篇文章是文献中的“新增”内容，而15篇曾在之前的分析中报道过（“旧”文章）。19篇新文章报道功能失败率有统计学显著下降，从早期研究中的9.55%降至近期研究中的4.77%（P <.001）。在较新的研究中，主要并发症发生率从2.01%降至0.46%（P =.005），次要并发症发生率从6.53%降至4.00%（P =.06）。较新和较早出版物之间的术后库贾拉评分没有显示出统计学显著变化（分别为89.0[标准差，3.7]和89.4[标准差，4.9]；P =.55）。按固定类型以及移植物选择比较结果，在结果或并发症情况方面没有显示出统计学显著差异。
近年来进行MPFL重建的医疗中心数量几乎增加了一倍，报告结果的患者数量也几乎增加了一倍，随着并发症和失败情况的改善，功能结果仍然良好。此外，尽管有多种固定技术以及移植物构建的多种选择，但随着时间推移，功能结果在统计学或临床上没有显著差异。这一发现突出了MPFL重建术治疗复发性髌骨不稳定的有效性和可采用性。
IV级，对混合水平研究的系统回顾。
