Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China.
Department of Hand and Foot Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.
BMC Musculoskelet Disord. 2024 Aug 14;25(1):642. doi: 10.1186/s12891-024-07722-5.
To confirm which method provides lower rate of recurrent instability and superior clinical outcomes.
We searched PubMed, Embase and Web of Science for the trials involving one intervention or both for patellar instability: medial patellofemoral ligament reconstruction (MPFLR) with and without tibial tubercle osteotomy (TTO). The postoperative Kujala score, Lysholm score, Tegner scores and the rate of recurrent instability (dislocation or subluxation) were analyzed as the primary clinical outcome parameters in a random or fixed effects meta-analysis.
In total, 43 articles met inclusion criteria after full-text review. A total of 2046 patients were analyzed. The overall mean age was 20.3 years (range, 9.5-60.0 years), with a mean follow-up time of 3.2 years (range, 1-8 years). The mean Kujala scores in MPFLR and MPFLR + TTO were 89.04 and 84.44, respectively. There was significant difference in Kujala scores between MPFLR and MPFLR + TTO (MD = 4.60, 95%CI: 1.07-8.13; P = 0.01). The mean Lysholm scores in MPFLR and MPFLR + TTO were 90.59 and 88.14, respectively. There was no significant difference in Lysholm scores between MPFLR and MPFLR + TTO (MD = 2.45, 95%CI: -3.20-8.10; P = 0.40). The mean Tegner scores in MPFLR and MPFLR + TTO were 5.30 and 4.88, respectively. There was no significant difference in Tegner scores between MPFLR and MPFLR + TTO (MD = 0.42, 95%CI: -0.39-1.23; P = 0.31). At final follow-up, the rates of recurrent instability in MPFLR and MPFLR + TTO were 3% and 4%, respectively. There was no significant difference in the rates between MPFLR and MPFLR + TTO (OR = 0.99, 95%CI: 0.96-1.02; P = 0.4848).
MPFLR and MPFLR + TTO are effective and reliable treatments in the setting of patellofemoral instability. MPFLR seems to show a better performance in functional outcomes than MPFLR + TTO. Moreover, their rates of recurrent instability are very low, and no significant difference exists.
证实哪种方法能降低复发性不稳定的发生率，并取得更好的临床效果。
我们检索了 PubMed、Embase 和 Web of Science 中涉及髌股不稳的试验，包括髌股内侧支持带重建（MPFLR）和（或）胫骨结节内移术（TTO）。术后 Kujala 评分、Lysholm 评分、Tegner 评分和复发性不稳定（脱位或半脱位）的发生率是随机或固定效应荟萃分析的主要临床结局参数。
共 43 篇全文符合纳入标准。共分析了 2046 例患者。总体平均年龄为 20.3 岁（范围，9.5-60.0 岁），平均随访时间为 3.2 年（范围，1-8 年）。MPFLR 和 MPFLR+TTO 的平均 Kujala 评分为 89.04 和 84.44。MPFLR 和 MPFLR+TTO 的 Kujala 评分有显著差异（MD=4.60，95%CI：1.07-8.13；P=0.01）。MPFLR 和 MPFLR+TTO 的平均 Lysholm 评分为 90.59 和 88.14。MPFLR 和 MPFLR+TTO 的 Lysholm 评分无显著差异（MD=2.45，95%CI：-3.20-8.10；P=0.40）。MPFLR 和 MPFLR+TTO 的平均 Tegner 评分为 5.30 和 4.88。MPFLR 和 MPFLR+TTO 的 Tegner 评分无显著差异（MD=0.42，95%CI：-0.39-1.23；P=0.31）。末次随访时，MPFLR 和 MPFLR+TTO 的复发性不稳定发生率分别为 3%和 4%。MPFLR 和 MPFLR+TTO 的发生率无显著差异（OR=0.99，95%CI：0.96-1.02；P=0.4848）。
MPFLR 和 MPFLR+TTO 是髌股不稳的有效且可靠的治疗方法。MPFLR 在功能结局方面似乎优于 MPFLR+TTO。此外，它们的复发性不稳定发生率非常低，且无显著差异。
