Hahn Alexander K, Coladonato Carlo, Corvi John J, Patel Neel K, Sonnier John Hayden, Tjoumakaris Fotios, Freedman Kevin B
Orthopaedic Surgery, University of Connecticut, Farmington, USA.
Sports Medicine, Rothman Orthopaedic Institute, Philadelphia, USA.
Cureus. 2023 Jul 11;15(7):e41713. doi: 10.7759/cureus.41713. eCollection 2023 Jul.
The purpose of this systematic review is to report outcomes and complications following the reconstruction of chronic patellar tendon ruptures. Four databases (Cochrane Database of Systematic Reviews, PubMed, Embase, MEDLINE) were searched from inception to July 2021. Inclusion criteria included articles that (1) analyzed outcomes and complications following chronic patellar tendon reconstruction (>4 weeks from injury to repair), (2) were written in English, (3) greater than five patients, and (4) a minimum 2-year follow-up. Exclusion criteria included (1) non-original research and (2) patellar tendon repair/reconstruction with prior total knee arthroplasty. Data on outcome metrics and complications were extracted from the included studies and reported in a qualitative manner. Nine studies (number of patients = 96) were included after screening. Seven studies analyzed autograft reconstruction, and three of those seven studies analyzed reconstructions with additional augmentation. The remaining two studies evaluated reconstruction utilizing a bone-tendon-bone (BTB) allograft. Four of the autograft studies (n=40 patients) showed a range of post-operative mean Lysholm scores of 74-94. Additionally, four studies reported a post-operative extensor lag of 0-3°. Post-operative protocol for autograft studies included delayed motion and was either contained to a bivalved cast or a hinged knee brace for six weeks. The two allograft studies reported a range of mean Lysholm scores from 62 to 67, and each immobilized the leg in full extension until six weeks. While chronic patellar tendon ruptures are a rare injury of the extensor mechanism, there are viable options for reconstruction. Overall, chronic patellar tendon ruptures reconstructed with both autograft and allograft will provide fair to good outcomes with low complication rates. Following surgery, immobilization for at least six weeks should be emphasized to protect the graft and optimize patient outcomes.
本系统评价的目的是报告慢性髌腱断裂重建术后的结果及并发症。检索了四个数据库（Cochrane系统评价数据库、PubMed、Embase、MEDLINE），检索时间从建库至2021年7月。纳入标准包括：（1）分析慢性髌腱重建术后（从损伤到修复超过4周）的结果及并发症；（2）英文撰写；（3）患者超过5例；（4）至少2年的随访。排除标准包括：（1）非原创研究；（2）既往有全膝关节置换术的髌腱修复/重建。从纳入研究中提取结果指标和并发症的数据，并进行定性报告。筛选后纳入9项研究（患者数量=96）。7项研究分析了自体移植物重建，其中7项研究中的3项分析了额外增强的重建。其余2项研究评估了使用骨-肌腱-骨（BTB）同种异体移植物的重建。4项自体移植物研究（n = 40例患者）显示术后平均Lysholm评分范围为74 - 94。此外，4项研究报告术后伸膝滞后为0 - 3°。自体移植物研究的术后方案包括延迟活动，采用双瓣石膏或带铰链的膝关节支具固定6周。2项同种异体移植物研究报告的平均Lysholm评分范围为62至67，每项研究均将腿部固定在完全伸直位直至6周。虽然慢性髌腱断裂是伸肌机制的一种罕见损伤，但有可行的重建选择。总体而言，自体移植物和同种异体移植物重建慢性髌腱断裂均能提供较好的结果，并发症发生率较低。手术后，应强调至少固定6周以保护移植物并优化患者预后。
