Cimino Addison, Wall Kevin C, Elphingstone Joseph, Paul Kyle, Arguello Alexandra M, Casp Aaron, Brabston Eugene, Ponce Brent, Momaya Amit
From the Department of Orthopaedics, University of Alabama at Birmingham, Birmingham.
Mayo Clinic Orthopedic Surgery, Rochester, Minnesota.
South Med J. 2023 Feb;116(2):208-214. doi: 10.14423/SMJ.0000000000001515.
Reconstruction for a chronic patellar tendon rupture in a native knee is an uncommon surgical procedure. Although there have been case series investigating patient-reported outcomes, there is no systematic review of these studies to date. The purpose of this review is to synthesize the literature on this procedure to better understand its outcomes, complications, and surgical technique options.
A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify studies that reported outcomes and techniques of patellar tendon reconstruction for chronic disruption in native knees. Searches were conducted through MEDLINE using PubMed, Cochrane Database of Systematic Reviews, and clinicaltrials.gov.
Ten studies with 103 patients and 105 knees were included. Results for nonnative (arthroplasty) knees were excluded. The mean patient age was 40.3 years, and the mean postsurgical follow-up time was 53.8 months. Of the 105 knees, 75% received a hamstring tendon graft, whereas 13% received a bone-tendon-bone graft and 7% received a whole extensor mechanism allograft. The mean preoperative range of motion was 113.8°, which improved to 126.0° postoperatively. The mean preoperative Lysholm score was 58.6, which improved to 86.0 postoperatively; 100% of patients returned to their normal work activities and 76% returned to their prior level of physical activity. There were no major complications reported in any of the included studies.
Chronic patellar tendon disruption in a native knee is an uncommon injury that can result in significant limitations for patients. Although more research is needed to better elucidate which graft is best, outcomes after patellar tendon reconstruction for chronic tears appear to be satisfactory with current techniques.
在原膝关节中重建慢性髌腱断裂是一种不常见的外科手术。尽管已有病例系列研究患者报告的结局，但迄今为止尚无对这些研究的系统评价。本综述的目的是综合有关该手术的文献，以更好地了解其结局、并发症和手术技术选择。
按照系统评价和Meta分析的首选报告项目指南进行系统评价，以确定报告原膝关节慢性断裂髌腱重建结局和技术的研究。通过使用PubMed的MEDLINE、Cochrane系统评价数据库和clinicaltrials.gov进行检索。
纳入了10项研究，共103例患者和105个膝关节。非原（关节置换）膝关节的结果被排除。患者平均年龄为40.3岁，术后平均随访时间为53.8个月。在105个膝关节中，75%接受了腘绳肌腱移植，13%接受了骨-腱-骨移植，7%接受了全伸肌机制同种异体移植。术前平均活动范围为113.8°，术后改善至126.0°。术前平均Lysholm评分为58.6，术后改善至86.0；100%的患者恢复了正常工作活动，76%的患者恢复到了之前的体力活动水平。纳入的任何研究均未报告重大并发症。
原膝关节慢性髌腱断裂是一种不常见的损伤，可给患者带来严重限制。尽管需要更多研究以更好地阐明哪种移植物最佳，但目前技术下慢性撕裂的髌腱重建术后结局似乎令人满意。
