Phillips Andrew R, Singh Harmanjeet, Haneberg Erik C, Danilkowicz Richard M, Yanke Adam B
Department of Orthopaedics, Rush University Medical Center, Chicago, Illinois, U.S.A.
Department of Orthopaedics, Rush University Medical Center, Chicago, Illinois, U.S.A..
Arthroscopy. 2025 May;41(5):1582-1604. doi: 10.1016/j.arthro.2024.05.019. Epub 2024 Jun 4.
To evaluate outcomes and complications of isolated medial patellofemoral ligament reconstruction (MPFLR), tibial tubercle osteotomy (TTO), and trochleoplasty for management of patellar instability.
A query of Scopus, PubMed, Google Scholar, Cochrane CENTRAL Register of Controlled Trials, and the Cochrane Database of Systematic Reviews was performed in accordance with 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Included studies reported clinical outcome data after isolated MPFLR, TTO, or trochleoplasty for patellar instability with a minimum 12-month follow-up. Meta-analysis and data aggregation was not performed.
Thirty-six studies (5 trochleoplasty, 14 TTO, and 18 MPFLR) consisting of 1,389 patients (114 trochleoplasty, 374 TTO, and 1,001 MPFLR) were included. Risk of bias was assessed with the Methodological Index for Non-Randomized Studies score, which ranged from 11 to 12 in trochleoplasty, 10 to 18 in TTO, and 8 to 18 in MPFLR studies. Patient-reported outcome measures, including Lysholm score (trochleoplasty: 51.1-71 to 71-95; TTO: 57-63.3 to 84-98; MPFLR: 37.4-59.1 to 74-92.5), Kujala score (trochleoplasty: 56-71 to 78-92; TTO: 48.6-68 to 78-92; MPFLR: 53.3-60 to 81.5-92), visual analog scale for pain (trochleoplasty: 52-25; TTO: 54-76 to 14-27; MPFLR: 29 to 17, out of 100), and Tegner score (TTO: 3-4 to 3-4; MPFLR: 2.5-6 to 4.9-5), improved after all surgeries. Failure rates ranged from 0% to 33.3% after MPFLR, 0% to 30.8% after TTO, and 5.3% to 40% after trochleoplasty. Complication rates ranged from 0% to 14.7% after MPFLR, 1.6% to 58.3% after TTO, and 8% to 26.3% after trochleoplasty.
Isolated MPFLR, TTO, or trochleoplasty may be effective treatment options for patellar stabilization. Although failure rates were highest after isolated trochleoplasty and complication rates were highest after TTO, these procedures are not interchangeable as each addresses a specific pathology.
Level IV, systematic review of Level II to IV studies.
评估单纯内侧髌股韧带重建术（MPFLR）、胫骨结节截骨术（TTO）和滑车成形术治疗髌骨不稳的疗效及并发症。
按照2020年系统评价和Meta分析的首选报告项目指南，对Scopus、PubMed、谷歌学术、Cochrane对照试验中央注册库和Cochrane系统评价数据库进行检索。纳入研究报告了单纯MPFLR、TTO或滑车成形术治疗髌骨不稳且随访至少12个月后的临床结局数据。未进行Meta分析和数据汇总。
纳入36项研究（5项滑车成形术、14项TTO和18项MPFLR），共1389例患者（114例滑车成形术、374例TTO和1001例MPFLR）。采用非随机研究方法学指数评分评估偏倚风险，滑车成形术研究的评分为11至12分，TTO研究为10至18分，MPFLR研究为8至18分。所有手术治疗后，患者报告的结局指标均有所改善，包括Lysholm评分（滑车成形术：51.1 - 71至71 - 95；TTO：57 - 63.3至84 - 98；MPFLR：37.4 - 59.1至74 - 92.5）、Kujala评分（滑车成形术：56 - 71至78 - 92；TTO：48.6 - 68至78 - 92；MPFLR：53.3 - 60至81. – 92）、疼痛视觉模拟量表评分（滑车成形术：52 - 25；TTO：54 - 76至14 - 27；MPFLR：29至17，满分100）和Tegner评分（TTO：3 - 4至3 - 4；MPFLR：2.5 - 6至4.9 - 5）。MPFLR术后失败率为0%至33.3%，TTO术后为0%至30.8%，滑车成形术后为5.3%至40%。MPFLR术后并发症发生率为0%至14.7%，TTO术后为1.6%至58.3%，滑车成形术后为8%至26.3%。
单纯MPFLR、TTO或滑车成形术可能是稳定髌骨的有效治疗选择。虽然单纯滑车成形术后失败率最高，TTO术后并发症发生率最高，但这些手术不可相互替代，因为每种手术针对的是特定的病理情况。
IV级，对II至IV级研究的系统评价。
