American Hip Institute Research Foundation, Chicago, U.S.A.
American Hip Institute Research Foundation, Chicago, U.S.A.; AMITA Health St. Alexius Medical Center, Hoffman Estates, U.S.A.
Arthroscopy. 2021 Jun;37(6):1811-1819.e1. doi: 10.1016/j.arthro.2021.01.022. Epub 2021 Jan 27.
To present the indications, surgical technique, outcomes, and complications for patients undergoing arthroscopic reconstruction of the ligamentum teres (LT).
Articles were included if they had postoperative patient-reported outcomes (PROs) for arthroscopic LT reconstruction. Studies were analyzed for patient demographics, clinical assessment and indications, radiographic and magnetic resonance imaging data, concomitant procedures performed, PROs, surgical techniques, intra-articular classifications, complications, and need for follow-up surgeries. For PROs, the standard mean difference was calculated. The proportion of patients achieving patient acceptable symptomatic state for postoperative modified Harris Hip Score (≥74) was recorded. The number of patients achieving minimal clinically important difference for modified Harris Hip Score (Δ ≥8) was calculated.
The majority of the cases were revision arthroscopies. Of the 3 studies reporting on patients undergoing LT reconstruction due to microinstability, 4, 9, and 11 patients demonstrated a mean improvement of 25.7, 35.2, and 27.7 in modified Harris Hip, respectively. In addition, one of the studies reported a mean improvement of 31.1 and 4.2 in Nonarthritic Hip Score and visual analog scale, respectively. Of the 3 studies, the percentile of patients surpassing minimal clinically important difference and patient acceptable symptomatic state ranged between 50% and 100% and 33.3% and 88.8%, respectively. Overall, 5 patients underwent revision hip arthroscopy due to adhesions, iliopsoas impingement, and persistent microinstability, and 3 patients underwent a secondary hip arthroplasty due to refractory pain and radiographic evidence of hip osteoarthritis.
Reconstruction of the LT may be considered in surgical management for patients with symptomatic hip instability due to soft-tissue causes. Current evidence supports for LT reconstruction predominantly for patients experiencing refractory instability following previous hip preservation procedures. Patients' expectations as well as the relatively high reoperation rate (i.e., 33%) should be discussed before the procedure.
Level IV, systematic review of Level IV studies.
介绍关节镜下修复圆韧带（LT）的适应证、手术技术、结果和并发症。
纳入的研究必须有术后患者报告的结局（PROs）数据。分析患者的人口统计学、临床评估和适应证、影像学和磁共振成像数据、同时进行的手术、PROs、手术技术、关节内分类、并发症以及是否需要随访手术。对于 PROs，计算标准均数差。记录术后改良 Harris 髋关节评分（≥74 分为可接受的症状状态）达到患者可接受症状状态的患者比例。计算改良 Harris 髋关节评分（Δ≥8 为最小临床重要差异）达到最小临床重要差异的患者数量。
大多数病例为关节镜翻修术。在 3 项报告因微不稳定而行 LT 重建的研究中，4、9 和 11 例患者的改良 Harris 髋关节评分分别平均改善 25.7、35.2 和 27.7。此外，其中一项研究报告非关节炎髋关节评分和视觉模拟评分分别平均改善 31.1 和 4.2。在这 3 项研究中，达到最小临床重要差异和患者可接受症状状态的患者百分比范围为 50%100%和 33.3%88.8%。总的来说，5 例患者因粘连、髂腰肌撞击和持续微不稳定而行翻修髋关节镜手术，3 例患者因顽固性疼痛和髋关节骨关节炎的放射学证据而行二期髋关节置换术。
对于因软组织原因导致的有症状髋关节不稳定的患者，LT 重建可作为手术治疗的选择。目前的证据支持 LT 重建主要用于经历先前髋关节保留手术后难治性不稳定的患者。在手术前，应与患者讨论其预期以及相对较高的再次手术率（即 33%）。
IV 级，对 IV 级研究的系统评价。
