Hao Kuo, Niu Yingzhen, Feng Ao, Wang Fei
Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China.
Orthop J Sports Med. 2023 Jul 13;11(7):23259671231181601. doi: 10.1177/23259671231181601. eCollection 2023 Jul.
An increased femoral anteversion angle (FAA) is a predisposing factor for recurrent patellar dislocations (RPDs), and combined procedures including derotational distal femoral osteotomy (DDFO) have been shown to be good options.
To investigate the safety and effectiveness of combined DDFO on clinical and radiological outcomes to treat RPDs with an increased FAA.
Systematic review; Level of evidence, 4.
This review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. We searched 7 databases for articles from inception to March 10, 2023, that reported outcomes after combined DDFO in patients with an RPD and increased FAA. Two reviewers independently extracted data and assessed study quality. Outcomes evaluated were functional scores, redislocation rates, complications, satisfaction, and radiological parameters. A meta-analysis was performed to pool functional scores, with data reported as mean differences (MDs) and 95% confidence intervals (CIs).
Included were 8 studies of 189 knees from 183 patients, with a mean patient age of 22.4 years and a mean follow-up of 33.4 months. The mean preoperative FAA ranged from 31° to 42.70°, and the mean postoperative FAA ranged from 10° to 19.08°. Significant improvements were found in the Kujala score (MD, 26.96 [95% CI, 23.54 to 30.37]), Lysholm score (MD, 26.17 [95% CI, 22.13 to 30.22]), visual analog scale score for pain (MD, -2.61 [95% CI, -3.12 to -2.10]), and Tegner activity score (MD, 1.33 [95% CI, 0.86 to 1.79]). No subluxation or redislocation occurred. The overall complication rate was 10.6%, and most of the complications were pain (60%) and limited knee activity (20%). The overall satisfaction rate was 83.3%. The patellar tilt angle significantly decreased from 40.7° ± 11.9° to 20.5° ± 8.7° and from 26.35° ± 6.86° to 11.65° ± 2.85° in 2 studies.
Combined DDFO was found to be safe and effective for the treatment of RPDs and an increased FAA by addressing both patellar dislocations and torsional malalignment. However, because of the lack of comparisons, it remains to be investigated when DDFO should be combined in such patients.
股骨前倾角度（FAA）增大是复发性髌骨脱位（RPD）的一个诱发因素，包括股骨远端旋转截骨术（DDFO）在内的联合手术已被证明是很好的选择。
探讨联合DDFO治疗FAA增大的RPD对临床和影像学结果的安全性和有效性。
系统评价；证据等级，4级。
本评价按照PRISMA（系统评价和Meta分析的首选报告项目）指南进行。我们检索了7个数据库，查找从建库至2023年3月10日报道RPD且FAA增大患者接受联合DDFO治疗后结果的文章。两名评价者独立提取数据并评估研究质量。评估的结果包括功能评分、再脱位率、并发症、满意度和影像学参数。进行Meta分析以汇总功能评分，数据以平均差（MD）和95%置信区间（CI）表示。
纳入了183例患者189膝的8项研究，患者平均年龄22.4岁，平均随访33.4个月。术前FAA平均值为31°至42.70°，术后FAA平均值为10°至19.08°。发现Kujala评分（MD，26.96 [95%CI，23.54至30.37]）、Lysholm评分（MD，26.17 [95%CI，22.13至30.22]）、疼痛视觉模拟量表评分（MD，-2.61 [95%CI，-3.12至-2.10]）和Tegner活动评分（MD，1.33 [95%CI，0.86至1.79]）有显著改善。未发生半脱位或再脱位。总体并发症发生率为10.6%，大多数并发症为疼痛（60%）和膝关节活动受限（20%）。总体满意度为83.3%。在2项研究中，髌骨倾斜角从40.7°±11.9°显著降至20.5°±8.7°，从26.35°±6.86°降至11.65°±2.85°。
发现联合DDFO通过解决髌骨脱位和扭转畸形对线不良来治疗RPD和FAA增大是安全有效的。然而，由于缺乏比较，在这类患者中何时应联合DDFO仍有待研究。
