Tompkins Marc A, Arendt Elizabeth A
Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA TRIA Orthopaedic Center, Minneapolis, Minnesota, USA.
Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA TRIA Orthopaedic Center, Minneapolis, Minnesota, USA
Am J Sports Med. 2015 Sep;43(9):2318-27. doi: 10.1177/0363546515571544. Epub 2015 Mar 6.
Many studies have demonstrated good results after medial patellofemoral ligament (MPFL) reconstruction for patients with patellar instability. The applicability of published studies to the clinical decision-making process for the individual patient with patellar instability, however, is not well elucidated.
There is inconsistency in the reporting of preoperative and postoperative variables, which limits the applicability of current studies to patients with patellar instability.
Systematic review.
A systematic review of the literature was conducted using the search term medial patellofemoral ligament reconstruction to identify studies with cohorts of patients with isolated MPFL reconstruction. A combination of inclusion and exclusion criteria resulted in 24 studies being reviewed for a variety of preoperative demographics, physical examination findings, and imaging findings, as well as postoperative outcomes, including redislocation and responses to subjective questionnaires.
A physical examination of lateral patellar translation was reported in 42% of studies, by reporting an apprehension sign (n = 9), reporting quadrant translation (n = 7), or both. For patellar instability factors on imaging, patellar height was reported as a preoperative variable in 75% of studies, and trochlear dysplasia was reported in 83% of studies. The tibial tubercle-trochlear groove distance was reported as a preoperative variable in 42% of studies. The rate of redislocation after index surgery was reported in 92% of studies. Patient-related outcome measures were reported in all of the studies; the Kujala score was the most common. A homogeneous population was selected as part of the authors' surgical indications for "isolated" MPFL in 67% of studies, and a heterogeneous population was selected in 33% of studies.
Current literature on MPFL reconstruction contains diverse methods of recording preoperative and postoperative variables. Most studies report on a homogeneous population, with inconsistent applicability to the broad spectrum of patients with patellar instability. Outcomes reporting in our current literature needs more clarity and consistency regarding reporting methodology to be of value for the treating clinician.
许多研究表明，内侧髌股韧带（MPFL）重建术治疗髌骨不稳患者效果良好。然而，已发表的研究对于个体髌骨不稳患者临床决策过程的适用性尚未得到充分阐明。
术前和术后变量的报告存在不一致性，这限制了当前研究对髌骨不稳患者的适用性。
系统评价。
使用搜索词“内侧髌股韧带重建”对文献进行系统评价，以确定孤立性MPFL重建患者队列的研究。纳入和排除标准相结合，共对24项研究进行了审查，涉及各种术前人口统计学、体格检查结果和影像学检查结果，以及术后结果，包括再脱位和主观问卷的回答。
42%的研究报告了髌骨外侧移位的体格检查情况，其中9项研究报告了恐惧征，7项研究报告了象限移位，或两者都有报告。对于影像学上的髌骨不稳因素，75%的研究将髌骨高度作为术前变量进行了报告，83%的研究报告了滑车发育不良。42%的研究将胫骨结节 - 滑车沟距离作为术前变量进行了报告。92%的研究报告了初次手术后的再脱位率。所有研究均报告了与患者相关的结局指标；最常用的是库贾拉评分。67%的研究选择同质人群作为作者“孤立性”MPFL手术指征的一部分，33%的研究选择了异质人群。
目前关于MPFL重建的文献包含多种记录术前和术后变量的方法。大多数研究报告的是同质人群，对广泛的髌骨不稳患者适用性不一致。当前文献中的结局报告在报告方法上需要更清晰和一致，才能对治疗临床医生有价值。
