Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Bologna, Italy.
ASST Centro specialistico Ortopedico Traumatologico Gaetano Pini - CTO, Milano, Italy.
Knee Surg Sports Traumatol Arthrosc. 2018 Nov;26(11):3206-3218. doi: 10.1007/s00167-018-4831-8. Epub 2018 Jan 15.
The need of patellar resurfacing in total knee arthroplasty (TKA) is a subject of debate. This systematic review of overlapping meta-analyses aimed to assess and analyze current evidence regarding patellar resurfacing and non-resurfacing in TKA.
A systematic literature search was performed in March 2017 in PubMed, CINAHL and Cochrane Library. Inclusion criteria were meta-analysis of randomized controlled trials that compared TKA with and without patellar resurfacing considering as outcomes re-operations rate, complications, anterior knee pain, functional scores. The quality of meta-analyses was evaluated with AMSTAR score and the most relevant meta-analysis was determined by applying the Jadad algorithm.
Ten meta-analyses, published between 2005 and 2015, were included in the systematic review. Two studies found a significantly increased Knee Society Score in the resurfacing group. According to four meta-analyses, anterior knee pain incidence was lower in resurfacing group. Six of the included studies described a greater risk of re-intervention in the non-resurfacing groups. The overall quality of included studies was moderate. The most relevant meta-analysis reported no differences in functional scores and incidence of anterior knee pain between the groups.
Comparable outcomes were found when comparing patellar resurfacing and non-resurfacing in TKA. The higher risk of re-operations after non-resurfacing should be interpreted with caution due to the methodological limitations of the meta-analyses regarding search criteria, heterogeneity and the inherent bias of easier indication to reoperation when the patella is not resurfaced. There is no clear superiority of patellar resurfacing compared to patellar retention.
Level II, systematic review of meta-analyses.
全膝关节置换术中（TKA）是否需要行髌骨表面置换术一直存在争议。本项对重叠的荟萃分析进行系统评价的目的是评估和分析目前关于 TKA 中髌骨表面置换术和非表面置换术的证据。
2017 年 3 月，我们在 PubMed、CINAHL 和 Cochrane 图书馆中进行了系统的文献检索。纳入标准为比较 TKA 髌骨表面置换术与非表面置换术的随机对照试验的荟萃分析，将再手术率、并发症、膝关节前痛、功能评分作为结局。使用 AMSTAR 评分评估荟萃分析的质量，并应用 Jadad 算法确定最相关的荟萃分析。
本系统评价共纳入了 2005 年至 2015 年期间发表的 10 项荟萃分析。有 2 项研究发现表面置换组的膝关节学会评分显著提高。根据 4 项荟萃分析，表面置换组膝关节前痛的发生率较低。纳入的 6 项研究描述了非表面置换组再次干预的风险更高。纳入研究的总体质量为中等。最相关的荟萃分析报告两组间的功能评分和膝关节前痛发生率无差异。
在 TKA 中，髌骨表面置换术与非表面置换术的结果相当。由于荟萃分析在搜索标准、异质性以及在未行髌骨表面置换时更容易进行再手术的指示固有偏倚方面存在方法学限制，因此非表面置换后再手术风险较高的结果应谨慎解读。与髌骨保留相比，髌骨表面置换术并没有明显的优势。
II 级，荟萃分析的系统评价。
