Department of Medicine, McMaster University, Hamilton, ON, Canada.
Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
Knee Surg Sports Traumatol Arthrosc. 2023 Jul;31(7):2772-2783. doi: 10.1007/s00167-022-07222-w. Epub 2022 Nov 13.
This study aimed to explore the efficacy of medial patellofemoral ligament (MPFL) repair versus nonoperative rehabilitation treatment on the rate of patellar redislocation and functional outcomes in skeletally mature patients with traumatic, first-time patellar dislocations.
MEDLINE, PubMed and EMBASE were searched from database inception to May 2022 for studies examining the management options for acute first-time patellar dislocations. This study was conducted in accordance with PRISMA and R-AMSTAR guidelines. Data on redislocation rates, functional outcomes including the Kujala score for anterior knee pain, and complication rates were extracted. A meta-analysis was used to pool the mean postoperative Kujala score and calculate the proportion of patients sustaining redislocations using a random effects model. Quality assessment of included studies was performed for all included studies using the MINORS and Detsky scores.
This review included a total of 25 studies and 1,361 patients. The pooled mean redislocation rate in 15 studies comprising 798 patients in the rehabilitation group was 30% (95% CI 25-36%, I = 65%). Moreover, the pooled mean redislocation rate in 10 studies comprising 170 patients undergoing MPFL repair was 7% (95% CI 3-12%, I = 30%). The pooled mean postoperative Kujala score in 8 studies comprising 396 patients in the rehabilitation group was 82.5 (95% CI 78.3-86.8, I = 91%), compared to a score of 88 (95% CI 87-90, I = 76%) in 3 studies comprising 94 patients in the repair group. Range of motion deficits was reported in 3.8% of 893 patients in the rehabilitation group and 2.0% of 205 patients in the repair group.
MPFL repair resulted in a lower rate of redislocation, less knee pain, and noninferiority with respect to a range of motion deficits compared to nonoperative treatment for the management of acute first-time patellar dislocations.
IV.
本研究旨在探讨内侧髌股韧带（MPFL）修复与非手术康复治疗对初次创伤性髌骨脱位的成熟骨骼患者髌骨再脱位率和功能结局的疗效。
从数据库建立到 2022 年 5 月，在 MEDLINE、PubMed 和 EMBASE 上搜索了评估急性初次髌骨脱位治疗选择的研究。本研究符合 PRISMA 和 R-AMSTAR 指南。提取了再脱位率、包括膝关节前痛 Kujala 评分在内的功能结局以及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 修复的患者再脱位的比例。使用 MINORS 和 Detsky 评分对所有纳入研究进行纳入研究的质量评估。
本综述共纳入 25 项研究和 1361 名患者。在包括康复组 798 名患者的 15 项研究中，再脱位率的汇总平均值为 30%（95%CI 25-36%，I=65%）。此外，在包括 170 名接受 MPFL 修复的患者的 10 项研究中，再脱位率的汇总平均值为 7%（95%CI 3-12%，I=30%）。在包括康复组 396 名患者的 8 项研究中，术后平均 Kujala 评分汇总值为 82.5（95%CI 78.3-86.8，I=91%），而在包括修复组 94 名患者的 3 项研究中，该评分值为 88（95%CI 87-90，I=76%）。康复组 893 名患者中有 3.8%报告运动范围缺陷，修复组 205 名患者中有 2.0%报告运动范围缺陷。
与非手术治疗相比，MPFL 修复可降低初次创伤性髌骨脱位的再脱位率、减轻膝关节疼痛，并且在运动范围缺陷方面具有非劣效性。
IV 级。
