Longo Umile Giuseppe, Candela Vincenzo, Pirato Francesco, Hirschmann Michael T, Becker Roland, Denaro Vincenzo
Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del, Portillo, 200, Trigoria, 00128, Rome, Italy.
Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101, Bruderholz, Switzerland.
Knee Surg Sports Traumatol Arthrosc. 2021 Feb;29(2):370-380. doi: 10.1007/s00167-020-05909-6. Epub 2020 Mar 5.
The aim of this systematic review was to evaluate the evidence on the existence of midflexion instability in primary total knee arthroplasty and which factors might contribute to this condition.
A comprehensive search of PubMed, Medline, Cochrane, CINAHL, and Embase databases was conducted since the inception of the database to July 2019. All relevant articles were retrieved, and their bibliographies were hand searched for further references on midflexion instability in primary total knee arthroplasty. The search strategy yielded 28 articles. After duplicate removal titles, abstracts and full text were reviewed. Fifteen studies were assessed for eligibility, 8 studies were excluded because they did not fully comply with the inclusion criteria. Seven articles were finally included in this systematic review. Anteroposterior translation, total knee arthroplasty design such as posterior-stabilized or posterior-cruciate-retaining total knee arthroplasty, joint line position with posterior condylar offset and joint gaps were considered to significantly influence midflexion stability.
Based on this systematic review anteroposterior translation of ≥ 7 mm was an independent risk factor for midflexion instability at 30° knee flexion. Joint line position can be altered by up to 5 mm without measurable changes in joint stability and both an increase and a decrease in posterior condylar offset led to 30° midflexion instability.
Midflexion instability in primary total knee arthroplasty remains to be not entirely understood. Due to the low quality of available evidence, it is difficult to make any definitive conclusions. The factors which can lead to this condition were analyzed in this review, furthermore, we did not find exhaustive evidence on midflexion instability existence as an isolated entity. Nonetheless, this review will form a baseline for future research and creates awareness for the routine assessment of midflexion instability in primary total knee arthroplasty.
IV.
本系统评价旨在评估初次全膝关节置换术中存在屈膝位不稳定的证据，以及哪些因素可能导致这种情况。
自各数据库建立至2019年7月，对PubMed、Medline、Cochrane、CINAHL和Embase数据库进行了全面检索。检索了所有相关文章，并对其参考文献进行手工检索，以获取更多关于初次全膝关节置换术中屈膝位不稳定的参考文献。检索策略共获得28篇文章。去除重复文献后，对标题、摘要和全文进行了审查。评估了15项研究的 eligibility，8项研究因未完全符合纳入标准而被排除。最终7篇文章纳入本系统评价。前后向平移、全膝关节置换设计（如后稳定型或后交叉韧带保留型全膝关节置换）、关节线位置与后髁偏移及关节间隙被认为对屈膝位稳定性有显著影响。
基于本系统评价，屈膝30°时，前后向平移≥7 mm是屈膝位不稳定的独立危险因素。关节线位置可改变达5 mm，而关节稳定性无明显变化，后髁偏移增加和减少均导致屈膝30°时不稳定。
初次全膝关节置换术中屈膝位不稳定仍未完全明确。由于现有证据质量较低，难以得出任何确定性结论。本综述分析了可能导致这种情况的因素，此外，我们未找到关于屈膝位不稳定作为一个独立实体存在的确凿证据。尽管如此，本综述将为未来研究奠定基础，并提高对初次全膝关节置换术中屈膝位不稳定进行常规评估的认识。
IV级。
