Chatterji Rishi, White Alex E, Hadley Christopher J, Cohen Steven B, Freedman Kevin B, Dodson Christopher C
Ascension Providence-MSU, Southfield, Michigan, USA.
Hospital for Special Surgery, New York, New York, USA.
Orthop J Sports Med. 2020 Dec 15;8(12):2325967120966134. doi: 10.1177/2325967120966134. eCollection 2020 Dec.
Recurrent patellar instability can be treated nonoperatively or surgically, and surgical management may vary based on the causative pathology in the structures surrounding the patella. Although isolated soft tissue reconstruction is among the most common operative treatments, certain patient populations require bony realignment for adequate stabilization.
To evaluate postoperative guidelines, including return to play and rehabilitation, after bony procedures involving the tibial tubercle for patellar instability.
Systematic review; Level of evidence, 4.
A systematic review on return-to-play guidelines was conducted with studies published from 1997 to 2019 that detailed procedures involving bony realignment by tibial tubercle osteotomies and tibial tubercle transfers with or without soft tissue reconstruction. Exclusion criteria included animal or cadaveric studies, basic science articles, nonsurgical rehabilitation protocols, and patients with mean age <18 years. Studies were assessed for return-to-play criteria, rehabilitation protocols, and bias.
Included in the review were 39 studies with a total of 1477 patients and 1598 knees. Mean patient age ranged from 17.5 to 34.0 years, and mean follow-up ranged from 23 to 161 months. All 39 studies described postoperative rehabilitation; however, only 16 studies specifically outlined return-to-play criteria. The most commonly cited return-to-play criterion was quadriceps strength (62.5%). Range of motion (50.0%), physical therapy protocols (18.8%), and radiographic evidence of healing (18.8%) were other cited objective criteria for return-to-play. Four of 16 (25.0%) studies described subjective criteria for return to play, including pain, swelling, and patient comfort and confidence. Of the 11 studies that described a timeline for return to play, the range was between 2 and 6 months.
The results revealed that 100% of papers evaluated lacked adequate return-to-play guidelines. Moreover, timelines significantly varied among studies. More clearly defined return-to-play guidelines after tibial tubercle transfer for patellar instability are required.
复发性髌骨不稳可采用非手术或手术治疗，手术治疗方式可能因髌骨周围结构的致病病理情况而异。尽管单纯软组织重建是最常见的手术治疗方法之一，但某些患者群体需要进行骨性重新排列以实现充分稳定。
评估涉及胫骨结节的髌骨不稳骨性手术后的术后指导原则，包括恢复运动和康复。
系统评价；证据等级，4级。
对1997年至2019年发表的研究进行系统评价，这些研究详细描述了通过胫骨结节截骨术和胫骨结节转移进行骨性重新排列的手术，无论是否进行软组织重建。排除标准包括动物或尸体研究、基础科学文章、非手术康复方案以及平均年龄<18岁的患者。对研究的恢复运动标准、康复方案和偏倚进行评估。
纳入评价的有39项研究，共1477例患者和1598个膝关节。患者平均年龄在17.5至34.0岁之间，平均随访时间在23至161个月之间。所有39项研究都描述了术后康复；然而，只有16项研究具体概述了恢复运动标准。最常被提及的恢复运动标准是股四头肌力量（62.5%）。运动范围（50.0%）、物理治疗方案（18.8%）和愈合的影像学证据（18.8%）是其他被提及的恢复运动客观标准。16项研究中有4项（25.0%）描述了恢复运动的主观标准，包括疼痛、肿胀以及患者的舒适度和信心。在描述恢复运动时间线的11项研究中，时间范围在2至6个月之间。
结果显示，所评估的论文中有100%缺乏充分的恢复运动指导原则。此外，不同研究之间的时间线差异很大。对于髌骨不稳的胫骨结节转移术后，需要更明确界定恢复运动指导原则。
