Ribeiro Ricardo, Gomes Eluana, Ferreira Bárbara, Figueiredo Inês, Valente Cristina, Delgado Diego, Sánchez Mikel, Andrade Renato, Espregueira-Mendes João
School of Medicine, Minho University, Braga, Portugal.
Clínica Espregueira-FIFA Medical Centre of Excellence, Porto, Portugal.
Knee Surg Sports Traumatol Arthrosc. 2024 Mar;32(3):713-724. doi: 10.1002/ksa.12097. Epub 2024 Feb 22.
Patellofemoral instability (PFI) is a common condition that can be caused from multiple factors, including lower limb rotational malalignments. Determining precise criteria for performing corrective torsional osteotomy can be a daunting task due to the lack of consensus on normal and excessive values and the limited evidence-based data in the postoperative results. The purpose was to assess the clinical, functional and imaging outcomes following derotational distal femoral osteotomy (DDFO) in patients with PFI and/or anterior knee pain (AKP) associated with lower limb rotational malalignments.
Searches were conducted on PubMed, EMBASE and Web of Science databases up to October 2023. Studies reporting outcomes after DDFO in patients with PFI and/or AKP were eligible for the systematic review. The primary outcome was imaging metrics, especially femoral anteversion. Secondary outcomes included the patient-reported outcome measures (PROMs) (clinical and functional). Quantitative synthesis involved the use of weighted averages to calculate pre- to postoperative mean differences (MD) and compare them against the minimal clinically important difference (MCID).
Ten studies (309 knees) were included with a mean follow-up of 36.1 ± 11.7 months. Imaging outcomes consistently indicated the correction of femoral anteversion (MD = -19.4 degrees, 95% confidence interval: -20.1 to -18.7) following DDFO. PROMs showed significant improvements in most studies, exceeding the MCID. Patient satisfaction with the DDFO was high (93.3%).
The DDFO was an effective treatment option for correcting excessive femoral anteversion in patients with PFI associated with clinically relevant functional and clinical improvement and a high satisfaction rate.
Level IV, systematic review of level II-IV studies.
髌股关节不稳定（PFI）是一种常见病症，可由多种因素引起，包括下肢旋转排列不齐。由于对于正常和过度值缺乏共识，且术后结果的循证数据有限，确定进行矫正扭转截骨术的精确标准可能是一项艰巨的任务。本研究旨在评估股骨远端旋转截骨术（DDFO）治疗伴有下肢旋转排列不齐的PFI和/或前膝痛（AKP）患者后的临床、功能和影像学结果。
截至2023年10月，在PubMed、EMBASE和科学网数据库进行检索。报告DDFO治疗PFI和/或AKP患者后结果的研究符合系统评价的纳入标准。主要结果是影像学指标，尤其是股骨前倾角度。次要结果包括患者报告的结局指标（PROMs）（临床和功能方面）。定量综合分析采用加权平均值来计算术前至术后的平均差值（MD），并将其与最小临床重要差异（MCID）进行比较。
纳入10项研究（共309例膝关节），平均随访时间为36.1±11.7个月。影像学结果一致表明，DDFO术后股骨前倾得到矫正（MD=-19.4度，95%置信区间：-20.1至-18.7）。大多数研究中PROMs显示出显著改善，超过了MCID。患者对DDFO的满意度较高（93.3%）。
对于伴有临床相关功能和临床改善且满意度高的PFI患者，DDFO是矫正股骨过度前倾的有效治疗选择。
IV级，对II-IV级研究的系统评价。
