Michael DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
Knee Surg Sports Traumatol Arthrosc. 2023 Jun;31(6):2433-2445. doi: 10.1007/s00167-022-07186-x. Epub 2022 Oct 10.
To determine the effect of isolated medial patellofemoral ligament reconstruction (MPFLR) versus concomitant MPFLR and tibial-tubercle osteotomy (TTO) on patient-reported functional outcomes, rate of patellar redislocation, and rate of return to sport in skeletally mature patients with recurrent patellar instability and lateralization as defined by elevated tibial-tubercle trochlear groove (TT-TG) distance.
Three databases MEDLINE, PubMed and EMBASE were searched from inception to July 10th, 2022 for literature outlining the management of patients with TT-TG indices greater than 15 mm with either isolated MPFLR or concomitant MPFLR and TTO procedures. The authors adhered to the PRISMA and R-AMSTAR guidelines as well as the Cochrane Handbook for Systematic Reviews of Interventions. Data on functional outcomes via the Kujala anterior knee pain score, redislocation rates, return to sport rates, and complications were recorded. The MINORS score was used for all studies to perform a quality assessment of included studies.
A total of 31 studies comprising 1405 patients (1452 knees) were included in this review. The mean Kujala score in 13 studies comprising 848 total patients in the isolated MPFLR group was 85.0 (range 80.9-97.5) compared to a score of 83.7 (range 77.2-94.0) in 14 studies comprising 459 patients in the concomitant group. The mean pooled redislocation rate in 19 studies examining isolated MPFLR procedures comprising 948 patients was 3.1% (95% CI 2.1-4.4%, I = 7%) as opposed to 3.2% (95% CI 1.9-5.0%, I = 0%) in 15 studies comprising 486 patients in the concomitant group. The mean pooled return to sport rate in seven studies with 472 total patients in the isolated MPFLR group was 82% (95% CI 78-86%, I = 16%) compared to a score of 92% (95% CI 78-99%, I = 58%) in four studies comprising 54 patients in the concomitant group. There were similar complication rates between both treatment groups, including range of motion deficits, fractures, infections, and graft failures.
Isolated MPFLR leads to similar anterior knee pain, similar redislocation rates and lower return to sport rates than concomitant MPFLR and TTO procedures in patients with TT-TG distances greater than 15 mm. Information from this review can aid surgeons in their decision to choose MPFLR versus concomitant procedures for this patient population, and can also guide future studies on this topic.
Level IV.
确定孤立性内侧髌股韧带重建（MPFLR）与同时行 MPFLR 和胫骨结节截骨术（TTO）治疗外侧化、胫骨结节滑车沟（TT-TG）距离升高的复发性髌股关节不稳定的骨骼成熟患者的患者报告的功能结果、髌骨再脱位率和重返运动率的影响。
从 MEDLINE、PubMed 和 EMBASE 三个数据库中检索了截至 2022 年 7 月 10 日的文献，以确定单独使用 MPFLR 或同时使用 MPFLR 和 TTO 治疗 TT-TG 指数大于 15mm 的患者的管理方法。作者遵守 PRISMA 和 R-AMSTAR 指南以及 Cochrane 干预系统评价手册。记录了通过 Kujala 前膝痛评分、再脱位率、重返运动率和并发症的功能结果数据。使用 MINORS 评分对所有研究进行质量评估。
共纳入 31 项研究，包括 1405 例患者（1452 膝）。在单独行 MPFLR 组的 13 项研究中，共有 848 例患者的平均 Kujala 评分 85.0（范围 80.9-97.5），而同时行 MPFLR 和 TTO 组的 14 项研究中，459 例患者的平均评分 83.7（范围 77.2-94.0）。在 19 项研究中，孤立性 MPFLR 术后的平均再脱位率为 948 例患者的 3.1%（95%CI 2.1-4.4%，I=7%），而同时行 MPFLR 和 TTO 组的 15 项研究中，486 例患者的平均再脱位率为 3.2%（95%CI 1.9-5.0%，I=0%）。在单独行 MPFLR 组的 7 项研究中，共有 472 例患者的平均重返运动率为 82%（95%CI 78-86%，I=16%），而同时行 MPFLR 和 TTO 组的 4 项研究中，54 例患者的平均重返运动率为 92%（95%CI 78-99%，I=58%）。两组的并发症发生率相似，包括运动范围受限、骨折、感染和移植物失败。
在 TT-TG 距离大于 15mm 的患者中，孤立性 MPFLR 导致的前膝痛相似、再脱位率相似、重返运动率低于同时行 MPFLR 和 TTO 手术。本综述中的信息可以帮助外科医生在选择 MPFLR 与同时行手术治疗这一患者群体时做出决策，也可以为该主题的未来研究提供指导。
IV 级。
