Department of Orthopaedic Surgery, Armed Forces Daegu Hospital, Gyeongsan, Republic of Korea.
Department of Orthopaedic Surgery, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea.
Arthroscopy. 2018 Nov;34(11):3082-3093.e1. doi: 10.1016/j.arthro.2018.06.052. Epub 2018 Oct 6.
To clarify the discrepancy in surgical options and present evidence to treat patellar dislocation by evaluating which of the techniques yields better improvement in stability and functional recovery for patellar dislocation.
The MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus electronic databases were searched for relevant articles comparing the outcomes of medial patellofemoral ligament (MPFL) treatment published up until August 2017. Data searching, extraction, analysis, and quality assessment were performed based on The Cochrane Collaboration guidelines. Clinical outcomes were evaluated using various outcome values in various techniques. For results with high heterogeneity, 95% prediction intervals (PIs) were also investigated.
Eleven clinical studies were investigated. In patients with primary patellar dislocation, there were no significant differences in all evaluated outcomes between the conservative and surgical treatment groups. For patients with recurrent patellar dislocation, MPFL reconstruction was associated with a favorable Kujala score (mean difference, -8.91; 95% confidence interval, -14.05 to -3.77; I = 94%; 95% PI, -9.64 to -8.1) and Lysholm score (mean difference, -13.51; 95% confidence interval, -21.35 to -5.68; I = 96%; 95% PI, -14.86 to -12.16) when compared with soft tissue realignment surgery.
Although surgical treatment of the MPFL for primary patellar dislocation is not superior to conservative treatment in restoring knee function and clinical outcomes, MPFL reconstruction is associated with more favorable clinical outcomes compared with medial soft tissue realignment surgery in patients with recurrent patellar dislocation. Double-bundle MPFL reconstruction seems to provide more favorable outcomes than single-bundle MPFL reconstruction, but this finding should be interpreted with caution because the evidence levels were low and were from only a few studies.
Level III, meta-analysis.
通过评估哪种技术能更好地提高髌骨脱位的稳定性和功能恢复，阐明手术选择的差异，并为髌骨脱位提供治疗证据。
检索 MEDLINE、Embase、Cochrane 中央对照试验注册库、Web of Science 和 Scopus 电子数据库，查找截至 2017 年 8 月比较内侧髌股韧带（MPFL）治疗结果的相关文章。根据 Cochrane 协作网指南进行数据检索、提取、分析和质量评估。使用各种技术中的不同结果值评估临床结果。对于具有高度异质性的结果，还调查了 95%预测区间（PI）。
共纳入 11 项临床研究。对于初次髌骨脱位患者，保守治疗和手术治疗组在所有评估结果上均无显著差异。对于复发性髌骨脱位患者，MPFL 重建与更好的 Kujala 评分（平均差异，-8.91；95%置信区间，-14.05 至-3.77；I=94%；95%PI，-9.64 至-8.1）和 Lysholm 评分（平均差异，-13.51；95%置信区间，-21.35 至-5.68；I=96%；95%PI，-14.86 至-12.16）相关，与软组织重新排列手术相比。
尽管 MPFL 治疗初次髌骨脱位的手术治疗在恢复膝关节功能和临床结果方面并不优于保守治疗，但对于复发性髌骨脱位患者，MPFL 重建与内侧软组织重新排列手术相比，具有更有利的临床结果。双束 MPFL 重建似乎比单束 MPFL 重建提供更有利的结果，但这一发现应谨慎解释，因为证据水平较低，且仅来自少数几项研究。
III 级，荟萃分析。
