Midwest Orthopaedics at Rush University, Chicago, Illinois, USA.
Rush University School of Medicine, Chicago, Illinois, USA.
Am J Sports Med. 2022 Jun;50(7):2042-2051. doi: 10.1177/03635465211012371. Epub 2021 May 26.
Patella alta is a known risk factor for patellar instability and, in the setting of recurrent patellar instability with significant patella alta, correction of patellar height with a tibial tubercle osteotomy (TTO) may help decrease the failure of soft tissue-based stabilization.
To perform a systematic review and meta-analysis of radiographic and clinical outcomes after TTO for patella alta.
Systematic review and meta-analysis; Level of evidence, 4.
PubMed, OVID/Medline, and Cochrane databases were queried in June 2020 for studies reporting outcomes of TTO for patella alta. Data pertaining to study characteristics and design, radiographic and clinical outcome values, and incidence of complications and reoperations were extracted. DerSimonian-Laird continuous and binary random-effects models were constructed to (1) perform subgroup-based analysis of mean changes in radiographic indices after TTO and (2) quantify the pooled incidence of complications and reoperations.
Eight studies including 340 patients (420 knees) with a mean age of 24.7 ± 8.4 years were included. The mean follow-up was 53.1 months (range, 3-120 months), with 1 study reporting a mean follow-up of less than 2 years. The pooled mean anterior transfer was 5.6 mm; the mean medial transfer was 8.7 ± 1.3 mm; and the pooled mean distalization of the tibial tubercle was 12.2 ± 4.5 mm. Continuous random-effects meta-analysis determined that significant reductions in the mean Insall-Salvati ratio (1.40 vs 0.98, < .001), Caton-Deschamps index (1.26 vs 0.97, < .001), and tibial tubercle to trochlear groove ratio (18.27 vs 10.69, < .001) were observed after TTO. The overall incidence of complications was 7.6% (95% CI, 4.8%-10.5%), while the overall incidence of reoperations was 14.3% (95% CI 6.2%-22.4%).
TTO for patellar instability in the setting of patella alta results in a significant decrease in patellar height with varying degrees of medialization depending on the utilized technique. A mean postoperative complication rate of 7.6% was reported with a reoperation incidence of 14.3%, related primarily to hardware removal.
高位髌骨是髌骨不稳定的已知危险因素，对于高位髌骨合并复发性髌骨不稳定的患者，通过胫骨结节截骨术（TTO）来矫正髌骨高度有助于降低软组织固定失败的风险。
对 TTO 治疗高位髌骨的影像学和临床结果进行系统回顾和荟萃分析。
系统回顾和荟萃分析；证据水平，4 级。
2020 年 6 月，检索 PubMed、OVID/Medline 和 Cochrane 数据库，以获取报道 TTO 治疗高位髌骨的研究结果。提取研究特征和设计、影像学和临床结果值以及并发症和再次手术的发生率等数据。采用 DerSimonian-Laird 连续和二项随机效应模型，（1）对 TTO 后影像学指标的平均变化进行亚组分析；（2）量化并发症和再次手术的总发生率。
纳入 8 项研究，共 340 例患者（420 膝），平均年龄 24.7±8.4 岁。平均随访时间为 53.1 个月（范围 3-120 个月），1 项研究的平均随访时间少于 2 年。荟萃分析结果显示，胫骨结节的平均前向移位为 5.6mm，平均内侧移位为 8.7±1.3mm，平均远端移位为 12.2±4.5mm。连续随机效应荟萃分析确定，TTO 后 Insall-Salvati 比值（1.40 比 0.98， <.001）、Caton-Deschamps 指数（1.26 比 0.97， <.001）和胫骨结节-滑车沟比值（18.27 比 10.69， <.001）均显著降低。总的并发症发生率为 7.6%（95%CI，4.8%-10.5%），总的再次手术发生率为 14.3%（95%CI，6.2%-22.4%）。
TTO 治疗高位髌骨合并髌骨不稳定可显著降低髌骨高度，根据所使用的技术，髌骨会出现不同程度的内移。报道的平均术后并发症发生率为 7.6%，再次手术发生率为 14.3%，主要与内固定取出有关。
