Kalinterakis Georgios, Vlastos Iakovos, Gianzina Elina, Dimitriadis Savvas, Mastrantonakis Konstantinos, Chronopoulos Efstathios, Yiannakopoulos Christos K
School of Physical Education and Sport Science, National and Kapodistrian University of Athens, 17237 Athens, Greece.
Laboratory for Research of the Musculoskeletal System "Th. Garofalidis", Medical School, National and Kapodistrian University of Athens, KAT General Hospital, Kifissia, 14561 Athens, Greece.
Children (Basel). 2024 Oct 22;11(11):1275. doi: 10.3390/children11111275.
MPFL reconstruction in children with open physis may be challenging, as a major concern during the surgery is to preserve the distal femoral physis. The purpose of this study was to compare the complication rate and the patient-reported outcomes in skeletally immature patients who underwent MPFL reconstruction using an anatomic (A) or non- anatomic (NA) surgical technique.
For this systematic review, the authors adhered to the PRISMA guidelines. The literature search was conducted from inception to 31 May 2024. Three databases were used: Pubmed, Scopus and Cochrane library. We included skeletally immature patients who underwent MPFL reconstruction for chronic or recurrent patellar instability. The included studies should describe the surgical technique, report clinical outcomes and complications. Patients with closed physis, prior ipsilateral knee surgery, concomitant surgical procedures except for lateral retinacular release, multiligament knee injury, congenital or acute patellofemoral instability, hyperlaxity or less than 12 months follow up were excluded. Risk of bias was assessed using ROBINS-I, MINORS and MCMS scores.
Data from 304 procedures were collected, of which 208 were performed using an anatomic technique and 96 using a non-anatomic technique. Patient age at the time of surgery ranged from 8 to 17 years. The follow-up time ranged between 12 and 116.4 months. Postoperative Kujala (-0.73, = 0.55) and Tegner (-0.70, = 0.80) scores were better in the anatomic group compared to the non-anatomic one. Higher rates of recurrent instability (OR 0.91; 95%CI 0.44-1.86, = 0.85), redislocation (OR 1.21; 95%CI 0.42-3.51, = 0.8), subluxation (OR 0.73; 95%CI 0.29-1.83, = 0.62), a positive apprehension test (OR 0.92; 95%CI 0.27-3.13, = 0.89), stiffness (decreased ROM) (OR 1.63; 95%CI 0.33-1.72, = 0.54) and reoperation (OR 1.16; 95%CI 0.35-3.80, = 0.8) were reported in papers using the anatomic technique.
The findings of this systematic review reveal that there is no significant difference between anatomic and non-anatomic MPFL reconstruction techniques in terms of patient-reported outcomes and complications. Thus, the choice of surgical technique might be left up to surgeon's preference. Further high-quality, pediatric-oriented studies with long-term follow-up are needed to better guide clinical decision-making.
对于骨骺未闭的儿童进行内侧髌股韧带（MPFL）重建可能具有挑战性，因为手术期间的一个主要关注点是保留股骨远端骨骺。本研究的目的是比较采用解剖学（A）或非解剖学（NA）手术技术进行MPFL重建的骨骼未成熟患者的并发症发生率和患者报告的结局。
对于本系统评价，作者遵循PRISMA指南。文献检索从开始至2024年5月31日进行。使用了三个数据库：PubMed、Scopus和Cochrane图书馆。我们纳入了因慢性或复发性髌股关节不稳定而接受MPFL重建的骨骼未成熟患者。纳入的研究应描述手术技术，报告临床结局和并发症。排除骨骺已闭合、同侧膝关节既往手术史、除外侧支持带松解外的同期手术、多韧带膝关节损伤、先天性或急性髌股关节不稳定、关节过度松弛或随访时间少于12个月的患者。使用ROBINS-I、MINORS和MCMS评分评估偏倚风险。
收集了304例手术的数据，其中208例采用解剖学技术，96例采用非解剖学技术。手术时患者年龄在8至17岁之间。随访时间在12至116.4个月之间。与非解剖学组相比解剖学组术后的库贾拉（-0.73，P = 0.55）和特格纳（-0.70，P = 0.80）评分更好。采用解剖学技术的论文报告了更高的复发性不稳定率（OR 0.91；95%CI 0.44 - 1.86，P = 0.85）、再脱位率（OR 1.21；95%CI 0.42 - 3.51，P = 0.8）、半脱位率（OR 0.73；95%CI 0.29 - 1.83，P = 0.62）、阳性恐惧试验率（OR 0.92；95%CI 0.27 - 3.13，P = 0.89）、僵硬（ROM降低）率（OR 1.63；95%CI 0.33 - 1.72，P = 0.54）和再次手术率（OR 1.16；95%CI 0.35 - 3.80，P = 0.8）。
本系统评价的结果表明，在患者报告的结局和并发症方面，解剖学和非解剖学MPFL重建技术之间没有显著差异。因此，手术技术的选择可能取决于外科医生的偏好。需要进一步开展高质量、以儿科为导向的长期随访研究，以更好地指导临床决策。
