Department of Orthopaedic Surgery, University Hospitals, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH, 44106, USA.
Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA.
Eur J Orthop Surg Traumatol. 2024 Dec;34(8):3827-3845. doi: 10.1007/s00590-024-04078-3. Epub 2024 Aug 30.
This systematic review aims to delineate the various methods to repair or reconstruct the patellar tendon using the available literature.
MEDLINE and PubMed electronic databases were searched for English language clinical studies involving patellar tendon rupture repair or reconstruction that reported patient-reported outcome scores (PROS) between January 1st, 1953 and June 17th, 2021. Data was extracted on full text articles to collect functional outcome scores and rupture category, including acute, chronic, post-total knee arthroplasty (TKA) and post-anterior cruciate ligament reconstruction (ACLR).
Twenty-three studies with a total of 738 patients were included. Of the 14 studies including acute repairs, mean postoperative Lvsholm scores ranged from 84 to 99.5. Knee Society Score (KSS) and knee range of motion (ROM) measurement were the most widely reported outcomes in the chronic setting. The average postoperative KSS scores ranged from 70 to 87.7. Of the six studies that included patellar tendon repairs/reconstructions in the setting of prior TKA, the most frequently reported outcomes were KSS scores and knee ROM measurements. The average postoperative KSS scores for the three cohorts reporting reconstruction with allograft ranged from 79 to 88 as compared to the average postoperative KSS score for reconstruction with autograft of 70.
Despite this heterogeneity, we concluded: (1) in the primary setting, cerclage augmentation yields the lowest lysholm scores and should not be considered, although primary repairs with and without augmentation yield comparable postoperative lysholm scores, (2) in the chronic setting, repair with augmentation and reconstruction yielded similar results aside from in post-TKA patients where allograft reconstruction yielded superior KSS scores.
本系统评价旨在通过现有文献阐明修复或重建髌腱的各种方法。
检索 MEDLINE 和 PubMed 电子数据库中涉及髌腱断裂修复或重建的英文临床研究，这些研究报告了 1953 年 1 月 1 日至 2021 年 6 月 17 日之间的患者报告结局评分（PROS）。提取全文文章的数据以收集功能结局评分和断裂分类，包括急性、慢性、全膝关节置换术（TKA）后和前交叉韧带重建（ACLR）后。
共纳入 23 项研究，总计 738 例患者。在包括急性修复的 14 项研究中，术后 Lvsholm 评分的平均值范围为 84 至 99.5。膝关节学会评分（KSS）和膝关节活动范围（ROM）测量是慢性情况下最广泛报道的结局。术后平均 KSS 评分范围为 70 至 87.7。在包括 TKA 前髌腱修复/重建的 6 项研究中，最常报道的结局是 KSS 评分和膝关节 ROM 测量。报告同种异体移植物重建的三个队列的术后平均 KSS 评分范围为 79 至 88，而自体移植物重建的术后平均 KSS 评分为 70。
尽管存在这种异质性，但我们得出结论：（1）在原发性髌腱断裂中，环状加强带的使用会导致最低的 Lysholm 评分，不应考虑使用，尽管使用或不使用加强带的原发性修复术后 Lysholm 评分相似；（2）在慢性髌腱断裂中，使用加强带和重建的修复方法的结果相似，除了在 TKA 后患者中，同种异体重建的 KSS 评分更高。
