Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.
Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany.
J Orthop Surg Res. 2022 Feb 22;17(1):121. doi: 10.1186/s13018-022-03008-5.
This systematic review evaluated the clinical outcomes of hardware-free MPFL reconstruction techniques in patients with recurrent patellofemoral instability, focusing on patient-reported outcome measures (PROMs), redislocation rate, and complications. The hypothesis was that hardware-free MPFL reconstruction in patients with recurrent patellofemoral instability is safe and effective.
This systematic review was conducted following the PRISMA guidelines. PubMed, Scopus, and Virtual Health Library databases were accessed in October 2021. All the clinical studies investigating the efficacy and feasibility of hardware-free MPFL reconstruction were screened for inclusion. Only studies with a minimum 24-month follow-up were considered eligible. Kujala Anterior Knee Pain Scale improvement and redislocation rate after surgical treatment were evaluated as primary outcomes. The rate of postoperative complications was evaluated as a secondary outcome. The quality of the methodological assessment was assessed using the Modified Coleman Methodology Score.
Eight studies were included in the present systematic review. The quality of the methodological assessment was moderate. Short- to long-term improvement of Kujala score was observed in all included studies. Mean score improvement ranged from + 13.2/100 to + 54/100, with mean postoperative scores ranging from 82/100 to 94/100. Patellar redislocation was observed in 8.33% (8 of 96) patients.
Hardware-free MPFL reconstruction with or without associated soft-tissue or bony realignment procedures provided reliable clinical improvements and was associated with a low rate of redislocation in patients with recurrent patellofemoral instability. Advantages such as safety, femoral physis preservation, and comparable complication profiles with implant-based techniques endorse its implementation. Orthopedic surgeons in cost-sensitive environments may also benefit their patients with lower costs, no need for implants, lack of implant-related complications, or surgery for implant removal.
Level IV.
本系统评价评估了无内固定物 MPFL 重建技术在复发性髌股关节不稳定患者中的临床效果，重点关注患者报告的结局指标（PROMs）、再脱位率和并发症。假设是，无内固定物 MPFL 重建治疗复发性髌股关节不稳定是安全有效的。
本系统评价按照 PRISMA 指南进行。于 2021 年 10 月检索 PubMed、Scopus 和虚拟健康图书馆数据库。筛选纳入所有研究无内固定物 MPFL 重建疗效和可行性的临床研究。仅纳入随访时间至少 24 个月的研究。手术治疗后 Kujala 膝关节前痛量表（Kujala Anterior Knee Pain Scale）改善和再脱位率作为主要结局，术后并发症发生率作为次要结局。使用改良 Coleman 方法学评分评估方法学评估质量。
本系统评价纳入了 8 项研究。方法学评估质量为中等。所有纳入研究均观察到 Kujala 评分的短期至长期改善。平均评分改善范围为+13.2/100 至+54/100，平均术后评分范围为 82/100 至 94/100。8.33%（96 例中的 8 例）患者出现髌骨再脱位。
对于复发性髌股关节不稳定患者，无内固定物 MPFL 重建联合或不联合软组织或骨矫正手术可提供可靠的临床改善效果，并降低再脱位率。该方法具有安全性高、保护股骨骨骺、与植入物技术相比并发症谱相似等优点，支持其应用。在成本敏感环境中的骨科医生也可以使患者受益，降低成本，无需植入物，避免植入物相关并发症，或无需进行植入物取出手术。
IV 级。
