Knee Surgery Department, Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China.
Knee Surgery Department, Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China.
Arthroscopy. 2021 May;37(5):1670-1679.e1. doi: 10.1016/j.arthro.2020.12.210. Epub 2020 Dec 24.
To examine the indications and outcomes of medial patellofemoral ligament reconstruction (MPFLR) with or without tibial tubercle osteotomy (TTO) in treating recurrent or habitual patellar dislocation with an increased tibial tuberosity-trochlear groove (TT-TG) distance.
We performed a literature search of the established medical databases Cochrane Central, PubMed-MEDLINE, EMBASE, and Web of Science. The inclusion criteria were as follows: skeletally mature patients with recurrent or habitual patellar dislocation and an increased TT-TG distance, treatment with MPFLR combined with a TTO procedure or isolated MPFLR, and reporting of clinical outcomes and complications. Each study was assessed for quality and the level of evidence. The general characteristics, indications, surgical techniques, TT-TG distance, clinical results, imaging evaluation findings, and complications of each study were recorded.
Nine studies consisting of 288 knees met the inclusion criteria. The average Coleman score was 71.56 (range, 55-83). The threshold for an increased TT-TG distance ranged from 16 to 20 mm in the included studies. Similar good postoperative outcomes were reported in patients with an increased TT-TG distance treated with MPFLR with versus without a TTO procedure. The mean postoperative Lysholm score ranged from 75.0 to 94.7 (I = 87.6%) in the isolated MPFLR group and from 85.0 to 87.6 (I = 16.3%) in the TTO-with-MPFLR group. Similar postoperative congruence angles were reported in both groups. The postoperative redislocation rate ranged from 0% to 4.2% in the TTO-with-MPFLR group, and no redislocation was found in the isolated MPFLR group. The postoperative apprehension sign was only reported in isolated MPFLR patients.
The outcomes of MPFLR with or without TTO to treat recurrent or habitual patellar dislocation with an increased TT-TG distance appeared similar. However, this study was limited by the considerable heterogeneity, variety of techniques, variety of TT-TG distances, and variability in patella alta and trochlear dysplasia among the included studies.
Level IV, systematic review of Level II to IV studies.
探讨内侧髌股韧带重建（MPFLR）联合或不联合胫骨结节截骨术（TTO）治疗胫骨结节滑车沟（TT-TG）距离增加的复发性或习惯性髌骨脱位的适应证和结果。
我们在 Cochrane 中央、PubMed-MEDLINE、EMBASE 和 Web of Science 等已建立的医学数据库中进行了文献检索。纳入标准如下：骨骼成熟的复发性或习惯性髌骨脱位且 TT-TG 距离增加的患者，接受 MPFLR 联合 TTO 手术或单纯 MPFLR 治疗，以及报告临床结果和并发症的研究。对每项研究进行质量和证据水平评估。记录每项研究的一般特征、适应证、手术技术、TT-TG 距离、临床结果、影像学评估结果和并发症。
纳入的 9 项研究共 288 膝。平均 Coleman 评分 71.56（范围，55-83）。纳入研究中 TT-TG 距离增加的阈值范围为 16-20mm。在接受 MPFLR 治疗且 TT-TG 距离增加的患者中，与未接受 TTO 手术的患者相比，术后结果相似。单纯 MPFLR 组的平均术后 Lysholm 评分为 75.0-94.7（I=87.6%），TTO 联合 MPFLR 组为 85.0-87.6（I=16.3%）。两组术后均报告了相似的吻合角。TTO 联合 MPFLR 组的术后再脱位率为 0%-4.2%，单纯 MPFLR 组未发现再脱位。单纯 MPFLR 患者仅报告了术后恐惧征。
MPFLR 联合或不联合 TTO 治疗 TT-TG 距离增加的复发性或习惯性髌骨脱位的结果似乎相似。然而，本研究受到相当大的异质性、手术技术多样性、TT-TG 距离多样性以及纳入研究中高位髌骨和滑车发育不良的变异性的限制。
IV 级，对 II 级至 IV 级研究的系统评价。
Zotero 插件