Ngimbang General Hospital, Lamongan, Indonesia.
Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
Knee. 2021 Jan;28:169-185. doi: 10.1016/j.knee.2020.11.020. Epub 2020 Dec 30.
The promising prospects of proximal fibular osteotomy (PFO) as an alternative treatment of knee osteoarthritis (KOA), which has gained popularity in recent years, has yet to be systematically evaluated. Hence, this meta-analysis aims to critically assess the clinical and radiological outcome of PFO in the management of medial compartment KOA.
Literature searches through PubMed, Scopus, CENTRAL, CINAHL, Google Scholar, and ProQuest databases were conducted, searching for eligible studies published from inception up to April 2020. Risk of bias assessments of randomized trials were performed via Cochrane RoB 2, while those of non-randomized studies with ROBINS-I tool. Random-effects model was utilized to estimate effect sizes.
A total of 907 patients and 1012 knees were included in this meta-analysis. PFO successfully ameliorated patients' knee function (Hedges' g 1.90; 95% confidence interval (CI) 1.62-2.18; I = 67%) and pain (visual analog scale: mean difference (MD) -4.13; 95% CI: -5.29 to -2.97), and also resulted in minimal complication rates, with peroneal nerve paresthesia being the most prevalent adverse event (5.93%; 95% CI: 2.15-11.25%), followed by peroneal nerve palsy (2.25%; 95% CI: 0.14-6.14%), fracture (0.56%; 95% CI: 0-1.74%), and recurrent deformity (0.54%; 95% CI: 0-1.74%). Furthermore, PFO was also associated with improved medial/lateral joint space ratio (MD 0.17; 95% CI: 0.15-0.19).
PFO yielded promising prospects in the management of medial compartment KOA, as shown by substantial improvements in clinical and radiological outcomes. However, considering the low quality of evidence, further studies with more diverse populations and higher quality of body evidence are required to confirm these findings.
近年来，腓骨近端截骨术（PFO）作为治疗膝关节骨关节炎（KOA）的一种替代方法，前景广阔，但其临床疗效尚未得到系统评价。因此，本荟萃分析旨在批判性评估 PFO 治疗内侧间室 KOA 的临床和影像学结果。
通过 PubMed、Scopus、CENTRAL、CINAHL、Google Scholar 和 ProQuest 数据库进行文献检索，检索从建库至 2020 年 4 月发表的合格研究。通过 Cochrane RoB 2 对随机试验进行偏倚风险评估，通过 ROBINS-I 工具对非随机试验进行偏倚风险评估。采用随机效应模型估计效应量。
共有 907 名患者和 1012 个膝关节纳入本荟萃分析。PFO 成功改善了患者的膝关节功能（Hedges' g 1.90；95%置信区间（CI）1.62-2.18；I=67%）和疼痛（视觉模拟评分：平均差值（MD）-4.13；95%CI：-5.29 至-2.97），且并发症发生率低，最常见的不良事件为腓浅神经感觉异常（5.93%；95%CI：2.15-11.25%），其次为腓总神经麻痹（2.25%；95%CI：0.14-6.14%）、骨折（0.56%；95%CI：0-1.74%）和复发性畸形（0.54%；95%CI：0-1.74%）。此外，PFO 还与内侧/外侧关节间隙比的改善相关（MD 0.17；95%CI：0.15-0.19）。
PFO 在治疗内侧间室 KOA 方面具有广阔的前景，其临床和影像学结局有显著改善。然而，考虑到证据质量较低，需要更多具有不同人群和更高证据质量的研究来证实这些发现。
