Texas Tech University Health Science Center, Paul Foster School of Medicine, El Paso, TX, USA.
Department of Orthopedic Surgery & Rehabilitation, The University of Texas Medical Branch, Galveston, TX, USA.
Knee. 2023 Oct;44:59-71. doi: 10.1016/j.knee.2023.07.003. Epub 2023 Jul 31.
Treatment of patellar instability remains up for debate, and a combination of tibial tubercle osteotomy and medial patellofemoral ligament reconstruction (MPFLr) of the medial patellofemoral ligament (MPFL) has become the mainstay treatment for recurrent lateral patellar dislocation. Due to limited small studies, there remains a variety of surgical techniques still being practiced. The use of MPFL reconstruction, in isolation, has demonstrated promise.
The purpose of this systematic review and meta-analysis is to investigate if isolated medial patellofemoral ligament reconstruction (iMPFLr) can safely and efficaciously restore knee stability and to present the patient demographics, surgical techniques, graft choices, clinical outcomes, and complications after iMPFLr for recurrent patellar dislocation (RPD).
A review of the current literature according to Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, yielded 299 abstracts. Twenty-seven articles met the inclusion/exclusion criteria accounting for 1200 patients. Data was pooled and analyzed focusing on patient demographics, graft type used, Kujala, International Knee Documentation Committee (IKDC), Lysholm, Tegner, and complications.
Across all studies the weighted mean age was found to be an average of 24.5 years, BMI was 24.9 kg/m, follow-up was 47.3 months, as 67% were female, TT-TG distance was 15.3 mm, and Caton Deschamps index 1.11. The pooled effect size difference of pre versus post assessment of Kujala was -2.8, IKDC was -4.5, Lysholm was -6.4, and Tegner was -0.74. The pooled complication rate was found to be 8% across all included studies. A subgroup analysis was also performed, specifically looking at how single bundle, double bundle, gracilis, semitendinosus and knee angle during fixation effect outcome data.
This systematic review and meta-analysis demonstrates that isolated MPFL reconstruction is a safe and effective treatment for recurrent patellar dislocations. Given the efficacy of isolated MPFL reconstruction, future investigations should aim to uncover the exact TT-TG distance, trochlear dysplasia, and patella alta grade for selecting patients to undergo this procedure. Furthermore, more primary research needs to be conducted on this topic due to the overall lack of published data from randomized controlled studies and no broad standardization of outcome measurements.
(4) Systematic Review and Meta-Analysis.
髌股不稳定的治疗仍存在争议，胫骨结节截骨术和内侧髌股韧带（MPFL）重建的联合应用已成为复发性外侧髌骨脱位的主要治疗方法。由于有限的小样本研究，仍有多种手术技术在应用。单独使用 MPFL 重建已经显示出了一定的效果。
本系统回顾和荟萃分析的目的是研究孤立性内侧髌股韧带重建（iMPFLr）是否能安全有效地恢复膝关节稳定性，并介绍复发性髌骨脱位（RPD）患者的人口统计学、手术技术、移植物选择、临床结果和并发症。
根据系统评价和荟萃分析的首选报告项目（PRISMA）指南对当前文献进行综述，共获得 299 篇摘要。27 篇文章符合纳入/排除标准，共纳入 1200 例患者。数据汇总并分析，重点关注患者人口统计学、使用的移植物类型、Kujala、国际膝关节文献委员会（IKDC）、Lysholm、Tegner 和并发症。
所有研究的加权平均年龄为 24.5 岁，BMI 为 24.9kg/m，随访时间为 47.3 个月，其中 67%为女性，TT-TG 距离为 15.3mm，Caton Deschamps 指数为 1.11。Kujala 术前与术后评估的合并效应大小差异为-2.8，IKDC 为-4.5，Lysholm 为-6.4，Tegner 为-0.74。所有纳入研究的并发症发生率为 8%。还进行了亚组分析，专门研究单束、双束、股薄肌、半腱肌和固定时的膝关节角度如何影响结果数据。
本系统回顾和荟萃分析表明，孤立性 MPFL 重建是复发性髌骨脱位的一种安全有效的治疗方法。鉴于孤立性 MPFL 重建的疗效，未来的研究应该旨在确定 TT-TG 距离、滑车发育不良和髌骨高位的具体程度，以便选择适合进行该手术的患者。此外，由于缺乏随机对照研究的广泛发表数据和缺乏对结果测量的广泛标准化，需要对这一主题进行更多的基础研究。
（4）系统评价和荟萃分析。
