髌股关节置换术后恢复运动和娱乐活动：一项系统综述。

Return to sports and recreational activities after patellofemoral arthroplasty: A systematic review.

作者信息

Arteaga José, Poblete Eduardo, Martin Fernando, Domecq Gabriel, Figueroa David

机构信息

Departmento de Traumatología, Unidad de Rodilla y Artroscopía, Clínica Alemana, Av. Manquehue Nte. 1410, Vitacura, Región Metropolitana, Santiago, Chile; Facultad de Medicina, Clínica Alemana de Santiago, Universidad del Desarrollo, Av. Manquehue Nte. 1410, Vitacura, Región Metropolitana, Santiago, Chile.

Servicio de Cirugía Ortopédica y Traumatología, Hospital Virgen del Rocío, Av. Manuel Siurot, S/n, Sevilla, Spain.

出版信息

J ISAKOS. 2025 Jul 8;14:100925. doi: 10.1016/j.jisako.2025.100925.

DOI:10.1016/j.jisako.2025.100925

PMID:40633908

Abstract

IMPORTANCE

Patellofemoral arthroplasty (PFA) is an established treatment for isolated patellofemoral osteoarthritis. However, evidence regarding postoperative activity levels and return to sport (RTS) remains limited.

OBJECTIVE

The objective of this study was to evaluate RTS and recreational activity rates following PFA, identify factors influencing these outcomes, and report associated complications.

EVIDENCE REVIEW

A systematic search was conducted in June 2024 across PubMed, EMBASE, ScienceDirect, and Scopus databases, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Search terms included variations of "patellofemoral arthroplasty," "physical activity," and "return to sport." Studies were included if they reported RTS outcomes following PFA. Studies lacking RTS data or isolated PFA results were excluded. From 492 records, 7 studies met the inclusion criteria.

FINDINGS

Seven studies (2 prospective and 5 retrospective) comprising 265 patients (281 knees; 64.6% women; mean age: 48.9 years) were included, with a mean follow-up of up to 5.3 years. RTS definitions varied, with reported rates ranging from 64.7% to 91%. Low-impact sports were more commonly resumed, and 58.6% of patients returned to sport within six months. Among those who returned, 74.8% reached or exceeded their preoperative activity level. Postoperative pain improved (visual analog scale scores decreased from 6.3 to 2.7), although up to 38.6% of patients reported pain limiting activity. Conversion to total knee arthroplasty occurred in 6.3% to 13% of cases, and reoperation rates ranged from 10.4% to 25%. Limitations included inconsistent RTS definitions, heterogeneous outcome reporting, and use of non-standardized questionnaires.

CONCLUSIONS

RTS and recreational activity after PFA can be resumed by most patients, especially low-impact activities. Pain management should be actively addressed. High-quality studies with standardized RTS definitions are needed to evaluate the long-term impact of activity on implant survival.

RELEVANCE

RTS after PFA is safe and achievable. A personalized approach is essential to optimize RTS and manage patient expectations.

EVIDENCE LEVEL

III.

摘要

重要性

髌股关节置换术（PFA）是治疗孤立性髌股关节骨关节炎的既定疗法。然而，关于术后活动水平和恢复运动（RTS）的证据仍然有限。

目的

本研究的目的是评估PFA术后的RTS和娱乐活动率，确定影响这些结果的因素，并报告相关并发症。

证据综述

2024年6月，按照系统评价和Meta分析的首选报告项目指南，在PubMed、EMBASE、ScienceDirect和Scopus数据库中进行了系统检索。检索词包括“髌股关节置换术”、“身体活动”和“恢复运动”的变体。如果研究报告了PFA术后的RTS结果，则纳入研究。缺乏RTS数据或孤立的PFA结果的研究被排除。从492条记录中，7项研究符合纳入标准。

研究结果

纳入了7项研究（2项前瞻性研究和5项回顾性研究），共265例患者（281膝；64.6%为女性；平均年龄：48.9岁），平均随访时间长达5.3年。RTS的定义各不相同，报告的比率从64.7%到91%不等。低强度运动更常恢复，58.6%的患者在6个月内恢复运动。在恢复运动的患者中，74.8%达到或超过了术前活动水平。术后疼痛有所改善（视觉模拟量表评分从6.3降至2.7），尽管高达38.6%的患者报告疼痛限制了活动。6.3%至13%的病例转为全膝关节置换术，再次手术率从10.4%至25%不等。局限性包括RTS定义不一致、结果报告异质性以及使用非标准化问卷。