An Vincent Vg, Sivakumar Brahman S, Phan Kevin, Fritsch Brett A, Sher Doron
1 Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia.
2 Department of Orthopaedics, Royal North Shore Hospital, St Leonards, New South Wales, Australia.
J Orthop Surg (Hong Kong). 2019 Jan-Apr;27(1):2309499018820698. doi: 10.1177/2309499018820698.
Medial patellofemoral ligament reconstruction (MPFLR) is regularly combined with a tibial tuberosity transfer (TTT) in cases of recurrent patellar instability with underlying structural deformity. However, these indications for a TTT have recently come into question. This study aimed to assess the traditional indications by comparing the outcomes of isolated and combined MPFLR for the treatment of recurrent lateral patellar dislocation.
A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Included studies were those which reported the outcomes of either isolated or combined or both MPFLR. Studies were required to report at least one of the following: redislocation rate, revision due to instability, or the Kujala score.
We found no difference between isolated and combined MPFLR in terms of redislocation ( p = 0.48), revisions due to instability ( p = 0.36), positive apprehension tests ( p = 0.25), or the Kujala score ( p = 0.58). Combined reconstruction presented more complications compared to isolated procedures ( p = 0.05). Subgroup analysis revealed no significant difference between studies investigating isolated medial patellofemoral ligament reconstruction MPFLR performed in patients with normal tibial tuberosity-trochlear groove (TT-TG) distances only or in patients with both normal and elevated TT-TG distances.
According to the published data, there is no difference in outcomes between isolated and combined MPFLR. Underlying structural deformity did not demonstrate any significant effect on the success of the isolated MPFLR. Although there are definite indications for combined reconstruction, the current evidence suggests that our inclusion criteria may not be entirely correct. Further study is required to clarify and refine the true indications for combined MPFLR.
III, meta-analysis of nonrandomized studies.
在伴有潜在结构畸形的复发性髌骨不稳病例中，内侧髌股韧带重建术（MPFLR）常与胫骨结节移位术（TTT）联合进行。然而，最近TTT的这些适应证受到了质疑。本研究旨在通过比较单纯MPFLR和联合MPFLR治疗复发性髌骨外侧脱位的疗效，评估传统适应证。
按照系统评价和Meta分析的首选报告项目指南进行系统评价。纳入的研究为报告单纯MPFLR、联合MPFLR或两者疗效的研究。研究需报告以下至少一项：再脱位率、因不稳进行的翻修手术或Kujala评分。
我们发现，单纯MPFLR和联合MPFLR在再脱位（p = 0.48）、因不稳进行的翻修手术（p = 0.36）、阳性恐惧试验（p = 0.25）或Kujala评分（p = 0.58）方面无差异。与单纯手术相比，联合重建出现的并发症更多（p = 0.05）。亚组分析显示，仅在胫骨结节-滑车沟（TT-TG）距离正常的患者中或在TT-TG距离正常和升高的患者中进行单纯内侧髌股韧带重建MPFLR的研究之间无显著差异。
根据已发表的数据，单纯MPFLR和联合MPFLR的疗效无差异。潜在的结构畸形对单纯MPFLR的成功率未显示出任何显著影响。虽然联合重建有明确的适应证，但目前的证据表明我们的纳入标准可能不完全正确。需要进一步研究以明确和完善联合MPFLR的真正适应证。
III，非随机研究的Meta分析。
