AO Ordine Mauriziano, Department of Orthopedics and Traumatology, Largo Turati 62, Torino, 10128, Italy.
J ISAKOS. 2022 Apr;7(2):78-86. doi: 10.1016/j.jisako.2021.10.002. Epub 2021 Nov 17.
Tibial tubercle osteotomy (TTO) is indicated to treat patellofemoral (PF) malalignment and chondral disease refractory to conservative treatment. However, there are no systematic reviews describing TTO outcomes in chondral damages without instability.
The aims of this study were to (1) assess the quality of the published studies, (2) identify indication for TTO to treat PFP with chondral disease without instability, (3) evaluate the most common TTO techniques, (4) evaluate the clinical outcomes, and (5) evaluate TTO's complication and failure rates.
In December 2020, a literature search was performed applying the following criteria: (1) peer-reviewed Level 1-4 studies; (2) English language; (3) human subjects with clinical and/or radiological outcomes; (4) TTO alone or associated with minor cartilage procedure (only drilling, no instability); (5) minimum follow-up 12 months, minimum 10 patients; and (6) no more than 20% of drop-out rate. Data from studies were collected and described with weighted averages and standard deviations.
A total of 18 Level 4 studies were included. The average Coleman Methodology Score was 61.5 points (range 48-81). A total of 851 patients (892 knees) were included, with 64.8% of female patients. The weighted average follow-up was 49.1 months (range 12-128.5). Indication for TTOs was poorly described. The main technique used was anteromedialisation (60.4%). In 27.7% of the cases, TTO was associated with lateral release. Different scoring systems were used to evaluate outcomes, with significant improvements. The average rate of good/excellent results was 78.7% (range 57%-100%). Fifteen studies described the complication rate (9.9%), whereas only four reported the failure rate (6.2%).
TTOs performed to treat PF malalignment associated with chondral disease without instability provided good clinical outcomes, with acceptable complication/failure rates. However, high-level studies are necessary because of studies' heterogeneity regarding patellofemoral malalignment and chondral disease treatment.
Systematic review.
Level IV, systematic review of Level IV studies.
胫骨结节骨切开术（TTO）适用于治疗髌股（PF）对线不良和对保守治疗有抗性的软骨疾病。然而，目前尚无系统评价描述无不稳定情况下软骨损伤的 TTO 结果。
本研究旨在：（1）评估已发表研究的质量，（2）确定 TTO 治疗无不稳定的 PF 伴软骨疾病的适应证，（3）评估最常见的 TTO 技术，（4）评估临床结果，（5）评估 TTO 的并发症和失败率。
2020 年 12 月，应用以下标准进行文献检索：（1）同行评审的 1-4 级研究；（2）英语语言；（3）具有临床和/或影像学结果的人体受试者；（4）单独 TTO 或与小范围软骨手术联合（仅钻孔，无不稳定）；（5）随访时间至少 12 个月，至少 10 例患者；（6）失访率不超过 20%。从研究中收集数据并使用加权平均值和标准偏差进行描述。
共纳入 18 项 4 级研究。平均 Coleman 方法评分 61.5 分（范围 48-81 分）。共纳入 851 例患者（892 膝），其中 64.8%为女性患者。加权平均随访时间为 49.1 个月（范围 12-128.5 个月）。TTO 的适应证描述不佳。主要采用前内侧化（60.4%）技术。64.8%的患者接受了外侧松解术。不同的评分系统用于评估结果，均有显著改善。78.7%（范围 57%-100%）的患者报告了良好/优秀结果。15 项研究描述了并发症发生率（9.9%），而仅有 4 项研究报告了失败率（6.2%）。
TTO 治疗无不稳定的 PF 对线不良伴软骨疾病可获得良好的临床结果，并发症/失败率可接受。然而，由于髌股对线不良和软骨疾病治疗方面的研究存在异质性，需要进行高质量的研究。
系统评价。
4 级，4 级研究的系统评价。
