Bartsch Anna, Lubberts Bart, Mumme Marcus, Egloff Christian, Pagenstert Geert
Department of Orthopedics and Traumatology, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
Heidelberg University, Heidelberg, Germany.
Arch Orthop Trauma Surg. 2018 Nov;138(11):1563-1573. doi: 10.1007/s00402-018-2971-4. Epub 2018 Jun 11.
The aim of this systematic review is to determine the effect of patella height on clinical outcomes after isolated MPFL reconstruction for patella instability. Our primary hypothesis is that patients with patella alta report similar outcomes after isolated MPFL reconstruction compared to patients with normal patella height.
A review of the literature was performed according to the PRISMA guidelines. PubMed, EMBASE, and the Cochrane Library were searched from inception to January 10th 2018. Studies were identified using synonyms for "medial patellofemoral ligament", "reconstruction" and "patella alta".
The search resulted in 467 reports on PubMed, 175 on EMBASE and 3 on the Cochrane Library. We included and analyzed in detail six studies describing outcomes after isolated medial patellofemoral ligament reconstruction with regard to patellar height. We found that both patients with patella alta and normal patella height reported satisfactory outcomes after isolated medial patellofemoral ligament reconstruction. However, because of applied exclusion criteria in the included studies the total number of patients with severe patella alta was small (13/74 patients with patella alta, 18%).
Based on the current literature we suggest that additional tibial tubercle distalisation is not mandatory in patients with mild patella alta (Caton-Deschamps Index 1.2-1.4). To assess the best indications for different surgical procedures for patients with patella instability future research is needed to develop a clear and uniform definition of relevant patella alta.
III.
本系统评价的目的是确定髌骨高度对孤立性髌股内侧韧带（MPFL）重建治疗髌骨不稳术后临床疗效的影响。我们的主要假设是，与髌骨高度正常的患者相比，高位髌骨患者在孤立性MPFL重建术后的疗效相似。
根据PRISMA指南对文献进行综述。检索了PubMed、EMBASE和Cochrane图书馆，检索时间从建库至2018年1月10日。使用“髌股内侧韧带”、“重建”和“高位髌骨”的同义词来识别研究。
检索结果在PubMed上有467篇报告，在EMBASE上有175篇，在Cochrane图书馆上有3篇。我们纳入并详细分析了6项描述孤立性髌股内侧韧带重建术后与髌骨高度相关疗效的研究。我们发现，高位髌骨患者和髌骨高度正常的患者在孤立性髌股内侧韧带重建术后均报告了满意的疗效。然而，由于纳入研究中应用的排除标准，重度高位髌骨患者的总数较少（74例高位髌骨患者中有13例，占18%）。
基于目前的文献，我们建议对于轻度高位髌骨（Caton-Deschamps指数1.2-1.4）患者，额外的胫骨结节远端化并非必需。为了评估髌骨不稳患者不同手术方法的最佳适应证，未来需要开展研究以制定相关高位髌骨清晰且统一的定义。
III级
