Macri Erin M, Stefanik Joshua J, Khan Karim K, Crossley Kay M
University of British Columbia, Vancouver, British Columbia, Canada.
Northeastern University, Boston, Massachusetts.
Arthritis Care Res (Hoboken). 2016 Oct;68(10):1453-70. doi: 10.1002/acr.22842.
We conducted a systematic review to evaluate the associations of knee alignment or trochlear morphology (measured on imaging) with presence, severity, onset, and/or progression of patellofemoral osteoarthritis (PFOA).
We prospectively registered our protocol with PROSPERO (International prospective register of systematic reviews) and followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to report this review. We searched 10 electronic databases, screened citing articles, and reviewed reference lists. We extracted data and evaluated methodologic quality. Due to study design heterogeneity, we used a best-evidence synthesis to summarize the evidence.
We included 16 publications (2,892 participants, 66% women) after removing 4 papers that did not meet our threshold for methodologic quality. There were 11 cross-sectional and 5 longitudinal papers. The target population was knee OA in 11 studies, PFOA in 2 studies, and other knee conditions in 3 studies. Alignment or morphology was measured using radiographs in 8 studies, magnetic resonance imaging in 7 studies, and computed tomography in 2 papers. Limitations include substantial heterogeneity in samples and methods, short followup times in longitudinal studies, and a small number of studies that specifically recruited participants with PFOA.
There is strong evidence that PFOA is associated with both trochlear morphology and frontal plane knee alignment, while evidence is limited but consistent in the sagittal and axial planes. These findings suggest that alignment should be evaluated clinically in individuals with PFOA. Clinical interventions targeting knee alignment warrant further investigation.
我们进行了一项系统评价，以评估膝关节对线或滑车形态（通过影像学测量）与髌股关节骨关节炎（PFOA）的存在、严重程度、发病及/或进展之间的关联。
我们前瞻性地在PROSPERO（国际系统评价前瞻性注册库）注册了研究方案，并遵循PRISMA（系统评价和Meta分析的首选报告项目）指南报告本评价。我们检索了10个电子数据库，筛选引用文献，并查阅参考文献列表。我们提取数据并评估方法学质量。由于研究设计的异质性，我们采用最佳证据综合法来总结证据。
在剔除4篇不符合我们方法学质量阈值的论文后，我们纳入了16篇出版物（2892名参与者，66%为女性）。其中有11篇横断面研究论文和5篇纵向研究论文。11项研究的目标人群为膝关节骨关节炎，2项研究为PFOA，3项研究为其他膝关节疾病。8项研究使用X线片测量对线或形态，7项研究使用磁共振成像，2篇论文使用计算机断层扫描。局限性包括样本和方法存在大量异质性、纵向研究的随访时间短，以及专门招募PFOA患者的研究数量较少。
有强有力的证据表明，PFOA与滑车形态和膝关节额状面的对线均相关，而在矢状面和轴面的证据有限但一致。这些发现表明，对于PFOA患者应进行临床对线评估。针对膝关节对线的临床干预值得进一步研究。
