Walker Madison, Maini Larissa, Kay Jeffrey, Siddiqui Ali, Almasri Mahmoud, de Sa Darren
Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, 1200 Main St West 4E14, Hamilton, ON, L8N 3Z5, Canada.
Knee Surg Sports Traumatol Arthrosc. 2022 Apr;30(4):1352-1361. doi: 10.1007/s00167-021-06603-x. Epub 2021 May 8.
The purpose of this study was to identify the causes of failure of previous medial patellofemoral ligament reconstruction (MPFL-R), and to furthermore report the surgical techniques available for MPFL revision surgery.
Four databases [PubMed, Ovid (MEDLINE), Cochrane Database, and EMBASE] were searched until September 29, 2020 for human studies pertaining to revision MPFL. Two reviewers screened the literature independently and in duplicate. Methodological quality of the included studies was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria, or the CAse REport guidelines (CARE), where appropriate.
Fourteen studies (one level II, one level III, two level IV, ten level V) were identified. This search resulted in a total of 76 patients with a mean age (range) of 22 (14-39) years. The patients were 75% female with a mean (range) time to revision of 24.1 (1-60) months and mean (range) follow-up of 36.2 (2-48) months. The most common indication for revision surgery was malpositioning of the femoral tunnel (38.1%), unaddressed trochlear dysplasia (18.4%), patellar fracture (11.8%). Femoral tunnel malposition was typically treated via revision MPFL-R with quadriceps tendon or semitendinosus autograft and may retain the primary graft if fixation points were altered. Unaddressed trochlear dysplasia was treated with deepening trochleoplasty with or without revision MPFL-R, and patella fracture according to the nature of the fracture pattern and bone quality. Though generally, outcomes in the revision scenario across all indications were inferior to those post-primary procedure, overall, revision patients demonstrated positive improvements in pain and instability symptoms. Transverse patella fractures treated with debridement and filling with demineralized bone matrix if required with further fixation according to the fracture pattern.
The most common causes of MPFL failure in literature published to date, in order of decreasing frequency, are: malposition of the femoral tunnel, unaddressed trochlear dysplasia, and patellar fracture. Although surgical techniques of revision MPFL-R to manage these failures were varied, promising outcomes have been reported to date. Larger prospective comparative studies would be useful to clarify optimal surgical management of MPFL-R failure at long-term follow-up.
IV.
本研究旨在确定既往髌股内侧韧带重建术（MPFL-R）失败的原因，并进一步报告可用于MPFL翻修手术的手术技术。
检索了四个数据库[PubMed、Ovid（MEDLINE）、Cochrane数据库和EMBASE]，直至2020年9月29日，以查找与MPFL翻修相关的人体研究。两名审阅者独立且重复地筛选文献。纳入研究的方法学质量在适当情况下使用非随机研究方法学指数（MINORS）标准或病例报告指南（CARE）进行评估。
确定了14项研究（1项II级、1项III级、2项IV级、10项V级）。此次检索共纳入76例患者，平均年龄（范围）为22（14-39）岁。患者中75%为女性，翻修的平均（范围）时间为24.1（1-60）个月，平均（范围）随访时间为36.2（2-48）个月。翻修手术最常见的指征是股骨隧道位置不当（38.1%）、未处理的滑车发育不良（18.4%）、髌骨骨折（11.8%）。股骨隧道位置不当通常通过使用股四头肌腱或半腱肌自体移植物进行MPFL-R翻修来治疗，如果固定点改变，可保留原移植物。未处理的滑车发育不良通过加深滑车成形术治疗，可联合或不联合MPFL-R翻修，髌骨骨折则根据骨折类型和骨质情况进行治疗。尽管总体而言，所有指征的翻修情况的结果均不如初次手术，但总体上，翻修患者在疼痛和不稳定症状方面有积极改善。横行髌骨骨折采用清创术治疗，必要时用脱矿骨基质填充，并根据骨折类型进一步固定。
在迄今为止发表的文献中，MPFL失败最常见的原因按频率递减顺序为：股骨隧道位置不当、未处理的滑车发育不良和髌骨骨折。尽管用于处理这些失败情况的MPFL-R翻修手术技术各不相同，但迄今为止已有报道显示出良好的结果。更大规模的前瞻性比较研究将有助于明确MPFL-R失败的最佳手术管理方案，以便进行长期随访。
IV级
Zotero 插件