Aliberti Gianna M, Kraeutler Matthew J, Miskimin Cadence, Scillia Anthony J, Belk John W, Mulcahey Mary K
Tulane University School of Medicine, New Orleans, Louisiana, USA.
Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, New Jersey, USA.
Orthop J Sports Med. 2021 Oct 19;9(10):23259671211046639. doi: 10.1177/23259671211046639. eCollection 2021 Oct.
Patients with recurrent lateral patellar dislocations are often treated with reconstruction of the medial patellofemoral ligament (MPFL).
To perform a systematic review to evaluate clinical outcomes and the risk of recurrent patellar dislocation after MPFL reconstruction (MPFLR) with autograft versus allograft.
Systematic review; Level of evidence, 4.
The authors conducted a search of PubMed, the Cochrane Library, and Embase to identify studies comparing outcomes of MPFLR with autograft versus allograft. The inclusion criteria were full-text studies that directly compared clinical outcomes and/or risk of recurrent patellar instability between patients undergoing MPFLR with autograft versus allograft. A quality assessment was performed using the modified Coleman Methodology Score, and risk-of-bias assessment was performed using the Risk Of Bias In Non-randomized Studies-of Interventions and the Cochrane Collaboration tools.
Seven studies (1 evidence level 2, 3 level 3, 3 level 4) that met inclusion criteria were identified and included a total of 150 patients who underwent MPFLR with autograft and 193 with MPFLR with allograft. One study found a significantly higher failure rate among patients with autograft, and another study found a trend toward a significantly higher failure rate among patients with autograft. One study demonstrated no significant difference between postoperative tibial tubercle-trochlear groove distance (measured on magnetic resonance imaging scans) in failed versus successful grafts. One study found that patellar tilt angle improved significantly from preoperatively to postoperatively ( < .001) but there was no difference between the groups. Kujala scores significantly improved for both autograft and allograft groups across studies. Two studies found significant differences in postoperative Kujala scores between the 2 groups, 1 of which found better scores in the allograft group ( = .0032) and another in which scores were better in the autograft group ( = .02).
Patients undergoing MPFLR with either autograft or allograft can expect to experience improvement in clinical outcomes. Subjective outcomes improved to a similar degree in both groups. Graft failure was more frequently observed in patients with autograft. Allograft may be a better option for MPFLR owing to lower failure rate.
复发性外侧髌股关节脱位患者常采用内侧髌股韧带（MPFL）重建术进行治疗。
进行一项系统评价，以评估自体移植物与同种异体移植物行MPFL重建术（MPFLR）后的临床疗效及复发性髌股关节脱位的风险。
系统评价；证据等级，4级。
作者检索了PubMed、Cochrane图书馆和Embase，以确定比较自体移植物与同种异体移植物行MPFLR疗效的研究。纳入标准为直接比较自体移植物与同种异体移植物行MPFLR患者的临床疗效和/或复发性髌股关节不稳定风险的全文研究。使用改良的科尔曼方法评分进行质量评估，并使用干预性非随机研究中的偏倚风险和Cochrane协作工具进行偏倚风险评估。
共纳入7项符合纳入标准的研究（1项证据等级为2级，3项为3级，3项为4级），总计150例行自体移植物MPFLR的患者和193例行同种异体移植物MPFLR的患者。一项研究发现自体移植物患者的失败率显著更高，另一项研究发现自体移植物患者有失败率显著更高的趋势。一项研究表明，失败与成功移植物术后胫骨结节 - 滑车沟距离（在磁共振成像扫描上测量）无显著差异。一项研究发现，髌股倾斜角从术前到术后显著改善（P <.001），但两组之间无差异。跨研究中，自体移植物和同种异体移植物组的库贾拉评分均显著改善。两项研究发现两组术后库贾拉评分存在显著差异，其中一项发现同种异体移植物组评分更好（P =.0032），另一项发现自体移植物组评分更好（P =.02）。
自体移植物或同种异体移植物行MPFLR的患者临床疗效均可得到改善。两组主观疗效改善程度相似。自体移植物患者更常观察到移植物失败。由于失败率较低，同种异体移植物可能是MPFLR的更好选择。
