股骨远端截骨术可改善髌骨外翻患者的复发性髌骨不稳：系统回顾

IF 2.7 Q1 ORTHOPEDICS Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine Pub Date : 2024-09-10 DOI:10.1016/j.jisako.2024.100318

Thomas E. Moran, Elizabeth K. Driskill, J. Brett Goodloe, Pradip Ramamurti, G. Bradley Reahl, Alyssa D. Althoff, David R. Diduch

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引用次数: 0

摘要

重要意义冠状面错位会导致复发性髌骨不稳，这是一种常见的膝关节病变，尤其是在青少年中，会对膝关节功能和稳定性产生负面影响。目的系统回顾文献，总结使用股骨远端截骨术（DFO）对膝外翻患者复发性髌骨外侧不稳进行手术治疗的临床和放射学结果。纳入标准为：为治疗复发性髌骨不稳并伴有髌骨外翻而进行的外侧开放式和内侧闭合式DFO手术的结果、至少90天的随访、英语文章和人类研究。提取的数据包括人口统计学信息、截骨术类型和伴随手术、放射学结果、患者报告结果评分以及并发症发生率。所有纳入的研究均为回顾性病例系列，加权平均随访时间为（2.75 ± 0.75）年。147 个膝关节中有 6 个（4.08%）显示出复发性髌骨不稳。所有研究均报告了良好至极佳的术后患者报告结果，与术前相比有所改善。所有研究均报告术后机械轴和/或股骨远端外侧角（LDFA）的测量结果相对正常。147个膝关节中有63个（42.86%）接受了再次手术，其中最常进行的手术是硬件移除[147个膝关节中有53个（36.05%）]。为了更好地了解针对该适应症的屈曲产生型DFO的临床和放射学结果，应进行更多的高证据级别研究，利用匹配的对照组，如接受保守治疗的患者，并对结果进行标准化报告。

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Distal femoral osteotomies improves recurrent patellar instability in patients with genu valgum: A systematic review

Importance

Coronal plane malalignment can contribute to recurrent patellar instability, a common knee pathology, particularly in adolescents that can negatively impact knee function and stability.

Objective

To systematically review the literature in order to summarize the clinical and radiologic outcomes of the surgical treatment of recurrent lateral patellar instability in patients with genu valgum using varus-producing distal femoral osteotomies (DFOs).

Evidence review

A systematic review was conducted using PubMed, Cochrane Library, and OVID Medline databases from 1990 to present. Inclusion criteria were: outcomes of lateral opening- and medial closing-DFOs performed for treatment of recurrent patellar instability with associated genu valgum, minimum 90-day follow-up, English language articles, and human studies. Data extracted included demographic information, type of osteotomy and concomitant procedures, radiological outcomes, patient reported outcome scores, and incidence of complications.

Findings

Nine studies, with a total of 147 knees were available for review. All included studies were retrospective case series, with a weighted mean follow-up of 2.75 ± 0.75 years. 6 of 147 (4.08%) knees demonstrated recurrent patellar instability. All studies reported good to excellent patient-reported outcomes postoperatively, with improvement from pre-operative measures. All studies reported relative normalization of measurements of mechanical axis and/or lateral distal femoral angle (LDFA) postoperatively. 63 of 147 (42.86%) knees underwent re-operation, with hardware removal [53 of 147 (36.05%) knees] being the most commonly performed procedure.

Conclusions

Varus-producing DFOs are an efficacious procedure to improve functionality and radiographic malalignment and address recurrent patellar instability in patients with associated valgus deformity. Additional higher-level of evidence studies utilizing matched control groups, such as patients undergoing conservative treatment, with standardized reporting of outcomes should be performed in order to better understand clinical and radiographic outcomes of varus-producing DFOs for this indication.