Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.
Department of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada.
Arthroscopy. 2019 Jun;35(6):1893-1904. doi: 10.1016/j.arthro.2018.11.071. Epub 2019 Apr 4.
To determine the effect of knee flexion angle during graft fixation on outcomes and complications following medial patellofemoral ligament (MPFL) reconstruction.
Three databases (PubMed, EMBASE, and MEDLINE) were searched from database inception to January 2018. After screening based on inclusion and exclusion criteria, patient demographics, fixation technique, graft selection, outcomes, and complications were extracted from the included studies. The studies were grouped based on flexion angle used during graft fixation: low (0°-30°) and high (45°-90°) flexion angle group. Methodological Index for Non-Randomized Studies criteria were used to assess the quality of each included study. Descriptive statistics are presented.
Seventeen studies (of 3,399) were included and were either cohort (n = 1) or case series (n = 17) study designs. A total of 556 patients with a mean age of 23.6 years (range, 10-60 years) underwent MPFL reconstructions, with 458 patients in the 0° to 30° fixation group and 98 in the 45° to 90° fixation group. The mean Kujala score improved from 45 to 72.9 (365 patients) preoperatively to 83 to 94.5 (460 patients) postoperatively for the 0° to 30° fixation group and from 53.3 to 72 preoperatively to 92.2 to 95.2 postoperatively for the 45° to 90° fixation group (98 patients).
The knee flexion angle during MPFL graft fixation ranges from 20° to 90°. Graft fixation at low and high knee flexion angles during MPFL reconstruction showed excellent patient-reported outcomes and low patellar redislocation rates overall, with no clear differences between the 2 groups based on the currently available data.
Level IV, systematic review of Level III-IV studies.
确定在进行内侧髌股韧带（MPFL）重建时，移植物固定时的膝关节弯曲角度对结果和并发症的影响。
从数据库建立之初到 2018 年 1 月，我们在三个数据库（PubMed、EMBASE 和 MEDLINE）中进行了搜索。根据纳入和排除标准筛选后，从纳入的研究中提取患者人口统计学资料、固定技术、移植物选择、结果和并发症。根据移植物固定时使用的弯曲角度将研究分为两组：低（0°-30°）和高（45°-90°）弯曲角度组。使用非随机研究方法学指数（Methodological Index for Non-Randomized Studies，MINORS）标准评估每个纳入研究的质量。呈现描述性统计数据。
纳入了 17 项研究（共 3399 项），均为队列（n=1）或病例系列（n=17）研究设计。共有 556 名平均年龄为 23.6 岁（范围 10-60 岁）的患者接受了 MPFL 重建，其中 458 名患者在 0°至 30°固定组，98 名患者在 45°至 90°固定组。0°至 30°固定组的 Kujala 评分从术前的 45 分（365 例）提高到术后的 83 分至 94.5 分（460 例），45°至 90°固定组的 Kujala 评分从术前的 53.3 分提高到术后的 92.2 分至 95.2 分（98 例）。
MPFL 移植物固定时的膝关节弯曲角度范围为 20°至 90°。在 MPFL 重建时，在低和高膝关节弯曲角度下固定移植物，总体上显示出极好的患者报告结果和低髌骨再脱位率，根据目前可用的数据，两组之间没有明显差异。
四级，对三级和四级研究的系统评价。
