Rooney A, Wahba A J, Smith T O, Donell S T
Department of Orthopaedics, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY UK.
Department of Orthopaedics, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY UK.
Orthop Traumatol Surg Res. 2015 Jun;101(4):469-75. doi: 10.1016/j.otsr.2015.01.019. Epub 2015 Apr 29.
Anterior knee pain (AKP) encompasses a range of pathologies. As a result, there are a number of therapeutic options used to treat AKP. The non-operative treatments have been analysed in a number of randomised controlled trials and systematic reviews. There is however a scarcity of such publications covering the surgical management of AKP. There are no systematic reviews that have investigated surgical interventions for AKP due to pathology of the infrapatellar fat pad (IFP). The aims of this study were to review the literature systematically, to establish which surgical procedures have been used to treat IFP disease and to determine their efficacy.
The review was conducted in accordance with the PRISMA reporting guidelines. A search of the literature was performed on 1st January 2014 using multiple databases including CENTRAL, MEDLINE, EMBASE, PubMed, and Google Scholar. The quality of the studies was assessed using Oxford Evidence-Based Medicine Levels of Evidence guidelines and the GRADE approach.
Twenty-four eligible studies were found and included. The critical appraisal identified that the current evidence-base has low methodology quality. The clinical findings indicated that there is a positive trend towards the surgical management of IFP disease for AKP symptoms. Excision of IFP tumours and resection of the IFP in Hoffa's disease can lead to improvements in symptoms and function.
Truly robust evidence to support the surgical management of IFP pathology requires randomised controlled trials; however the expenses involved to design such trials means that they are unlikely to be undertaken for this uncommon disorder. Consequently well-designed and well-reported case series need to be undertaken to improve our current understanding that includes recording quantitative measures such as range of knee motion, VAS Pain scores and a validated scoring system.
膝前痛（AKP）涵盖一系列病理情况。因此，有多种治疗AKP的方法。一些随机对照试验和系统评价对非手术治疗进行了分析。然而，关于AKP手术治疗的此类出版物却很少。目前尚无系统评价研究因髌下脂肪垫（IFP）病变导致的AKP的手术干预措施。本研究的目的是系统回顾文献，确定哪些手术方法用于治疗IFP疾病，并确定其疗效。
本综述按照PRISMA报告指南进行。2014年1月1日使用多个数据库（包括CENTRAL、MEDLINE、EMBASE、PubMed和谷歌学术）对文献进行检索。采用牛津循证医学证据水平指南和GRADE方法评估研究质量。
共纳入24项符合条件的研究。批判性评价发现，目前的证据基础在方法学质量方面较低。临床研究结果表明，针对IFP疾病进行手术治疗以缓解AKP症状呈积极趋势。切除IFP肿瘤以及在霍法病中切除IFP可改善症状和功能。
支持IFP病理手术治疗的真正有力证据需要随机对照试验；然而，设计此类试验的费用意味着不太可能针对这种罕见疾病开展此类试验。因此，需要开展设计良好且报告完善的病例系列研究，以增进我们目前的认识，包括记录膝关节活动范围、视觉模拟评分法疼痛评分等定量指标以及经过验证的评分系统。
