Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, 1200 Main St West, Hamilton, ON, 4E14L8N 3Z5, Canada.
Department of Medicine, McMaster University, Hamilton, ON, Canada.
Knee Surg Sports Traumatol Arthrosc. 2022 Nov;30(11):3784-3795. doi: 10.1007/s00167-022-07003-5. Epub 2022 May 26.
To determine the effect of early MPFL reconstruction versus rehabilitation on the rate of recurrent patellar dislocations and functional outcomes in skeletally mature patients with traumatic, first-time patellar dislocation.
Three online databases MEDLINE, PubMed and EMBASE were searched from database inception (1946, 1966, and 1974, respectively) to August 20th, 2021 for literature addressing the management of patients sustaining acute first-time patellar dislocations. Data on redislocation rates, functional outcomes using the Kujala score, and complication rates were recorded. A meta-analysis was used to pool the mean postoperative Kujala score, as well as calculate the proportion of patients sustaining redislocation episodes using a random effects model. Quality assessment of included studies was performed for all included studies using the MINORS and Detsky scores.
A total of 19 studies and 1,165 patients were included in this review. The pooled mean redislocation rate in 14 studies comprising 734 patients in the rehabilitation group was 30% (95% CI 25-36%, I = 67%). Moreover, the pooled mean redislocation rate in 5 studies comprising 318 patients undergoing early MPFL reconstruction was 7% (95% CI 2-17%, I = 70%). The pooled mean postoperative Kujala anterior knee pain score in 7 studies comprising 332 patients in the rehabilitation group was 81 (95% CI 78-85, I = 78%), compared to a score of 87 (95% CI 85-89, I = 0%, Fig. 4) in 3 studies comprising 54 patients in the reconstruction group.
Management of acute first-time patellar dislocations with MPFL reconstruction resulted in a lower rate of redislocation of 7% in the reconstruction group vs 30% in the rehabilitation group and a higher Kujala score compared to the rehabilitation group. The information this review provides will help surgeons guide their decision to choose early MPFL reconstruction versus rehabilitation when treating patients with first-time patellar dislocations and may guide future studies on the topic.
IV.
确定在成熟骨骼患者中，初次创伤性髌骨脱位后早期行 MPFL 重建与康复治疗对复发性髌骨脱位率和功能结果的影响。
从 MEDLINE、PubMed 和 EMBASE 这三个在线数据库中检索文献，检索时间截至 2021 年 8 月 20 日，检索词为“处理急性初次髌骨脱位患者”。记录再脱位率、使用 Kujala 评分评估的功能结果和并发症发生率的数据。使用随机效应模型对术后平均 Kujala 评分进行荟萃分析，并计算使用 MPFL 重建的患者发生再脱位的比例。使用 MINORS 和 Detsky 评分对所有纳入研究进行质量评估。
本综述共纳入 19 项研究和 1165 名患者。在 14 项研究（康复组 734 名患者）中，再脱位率的汇总平均值为 30%（95%CI 25%-36%，I=67%）。此外，在 5 项研究（早期 MPFL 重建组 318 名患者）中，再脱位率的汇总平均值为 7%（95%CI 2%-17%，I=70%）。在康复组的 7 项研究（332 名患者）中，术后 Kujala 膝关节前痛评分的汇总平均值为 81（95%CI 78%-85%，I=78%），而在重建组的 3 项研究（54 名患者）中，Kujala 评分则为 87（95%CI 85%-89%，I=0%，图 4）。
与康复治疗相比，MPFL 重建治疗急性初次髌骨脱位的再脱位率较低（重建组为 7%，康复组为 30%），且 Kujala 评分较高。本综述提供的信息将有助于指导外科医生在治疗初次髌骨脱位患者时选择早期 MPFL 重建与康复治疗，并可能指导该主题的未来研究。
IV 级。
