MACSports Research Program, McMaster University, Hamilton, Ontario, Canada; School of Medicine, St. George's University, True Blue, Grenada, West Indies.
MACSports Research Program, McMaster University, Hamilton, Ontario, Canada.
Arthroscopy. 2021 Oct;37(10):3187-3197. doi: 10.1016/j.arthro.2021.04.048. Epub 2021 May 5.
The purpose of this systematic review is to ascertain the reported clinical outcomes and complication profiles of medial patellofemoral ligament (MPFL) reconstruction performed using a superficial "swing-down" quadriceps tendon autograft.
Three databases (PubMed, EMBASE, and MEDLINE) were searched from January 1, 2000, to April 06, 2020. Keywords used in the search included: "medial patellofemoral ligament" and "reconstruction". After screening based on inclusion and exclusion criteria, patient demographics, graft type, outcomes, and complications were extracted. Methodological Index for Non-Randomized Studies criteria were used to assess the quality of each included study.
Eleven studies were included, comprising data from 226 patients with mean follow up ranging from 12 to 38 months. All reconstructions used a superficial "swing-down" quadriceps tendon autograft fixed at 20-30 degrees of knee flexion where reported. Eight of eleven studies reported significant improvement in patient reported outcomes such as Kujala score, Lysholm score, and Tegner score. The mean preoperative Kujala score ranged from 35.8 to 82.1 (167 patients), while the mean postoperative Kujala score ranged from 88.4 to 94.8 (197 patients). The mean of the preoperative Lysholm score ranged from 43.3 to 79.3 (77 patients), while the mean of the postoperative Lysholm score ranged from 81.9 to 90.9 (99 patients). The I statistic for Lysholm and Kujala scores was 94% and 97%, respectively. Across data reported on 194 patients, there was no incidence of patellar redislocation, patellar fracture, or graft site morbidity.
The quadriceps tendon produced improved clinical outcomes with low rates of recurrent postoperative patellar dislocation. These data suggest that the quadriceps tendon remains a suitable alternative for MPFL reconstruction and should remain part of the arsenal of knee ligament surgeons.
Systematic review of Level III and IV studies.
本系统评价旨在确定使用浅层“下挥”股四头肌腱自体移植物进行内侧髌股韧带（MPFL）重建的报告临床结果和并发症情况。
从 2000 年 1 月 1 日至 2020 年 4 月 6 日，我们在三个数据库（PubMed、EMBASE 和 MEDLINE）中进行了搜索。搜索中使用的关键词包括：“medial patellofemoral ligament”和“reconstruction”。在根据纳入和排除标准进行筛选后，提取了患者人口统计学、移植物类型、结果和并发症等数据。使用非随机研究方法学指数评估每个纳入研究的质量。
共纳入 11 项研究，包含 226 例患者的数据，平均随访时间为 12 至 38 个月。所有重建均使用浅层“下挥”股四头肌腱自体移植物，报道的固定位置在膝关节屈曲 20-30 度。11 项研究中有 8 项报道了患者报告结果的显著改善，如 Kujala 评分、Lysholm 评分和 Tegner 评分。术前 Kujala 评分的平均值范围为 35.8 至 82.1（167 例患者），术后 Kujala 评分的平均值范围为 88.4 至 94.8（197 例患者）。术前 Lysholm 评分的平均值范围为 43.3 至 79.3（77 例患者），术后 Lysholm 评分的平均值范围为 81.9 至 90.9（99 例患者）。Lysholm 和 Kujala 评分的 I 统计量分别为 94%和 97%。在 194 例患者的数据中，没有发生髌骨再脱位、髌骨骨折或移植物部位发病率。
股四头肌腱产生了改善的临床结果，且术后复发性髌骨脱位的发生率较低。这些数据表明，股四头肌腱仍然是 MPFL 重建的合适替代物，应该成为膝关节韧带外科医生的武器库的一部分。
对 III 级和 IV 级研究进行系统评价。
