双束与单束髌骨内侧韧带重建治疗复发性髌骨脱位：荟萃分析。

IF 2 Q2 ORTHOPEDICS Journal of Experimental Orthopaedics Pub Date : 2024-12-18 DOI:10.1002/jeo2.70112

Yiheng Wu, Junran Li, Hongbo Zhao, Hongyan Zhou, Bokai Wang, Jinlong Zhang, Shengkun Zhao

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引用次数: 0

摘要

目的：比较单束与双束髌骨内侧韧带（MPFL）重建治疗复发性髌骨脱位（RPD）的临床疗效，包括膝关节功能评分、术后并发症和影像学评估。方法：计算机检索PubMed、Cochrane图书馆、Embase、中国生物医学文献数据库（CBM）、中国国家知识网（CNKI）和VIP数据库，比较单束和双束髌股内侧韧带重建治疗RPD的效果。随机对照试验（rct）采用Cochrane协作网络推荐的偏倚风险评价工具进行质量评价，队列研究（CSs）采用纽卡斯尔-渥太华量表（NOS）进行评价。采用RevMan 5.3软件和STATA 16.0进行meta分析。结果：纳入13项研究，4项随机对照研究和9项队列研究。4项随机对照研究的证据水平为Ⅰ，9项队列研究的证据水平为Ⅲ。共纳入862例（891个膝关节）患者，其中448例（465个膝关节）行双束MPFL重建，414例（426个膝关节）行单束MPFL重建。Kujala得分(MD = 2.06, 95%可信区间[CI] [0.11, 4.01], p p p p p = n),髌骨倾斜角(MD = -0.22, 95% CI [-0.54, 0.10], p = n),髌外侧转移率(MD = -0.16, 95% CI [-0.41, 0.09], p = n),同余角(MD = 0.06, 95% CI [-0.41, 0.52], p = n),术后膝关节疼痛(OR = 0.39, 95% CI [0.14, 1.11], p = n),和额外的术后外科治疗(OR = 0.20, 95% CI [0.01 - -6.25], p = n)没有显著差异。结论：双束髌股内侧韧带重建术治疗RPD在膝关节功能评分和术后复发髌骨不稳方面均优于单束重建术，双束髌股内侧韧带重建术治疗RPD临床效果更好。证据级别：Ⅲ、Ⅰ和Ⅲ级研究。

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Double-bundle versus single-bundle medial patellofemoral ligament reconstruction for recurrent patellar dislocation: A meta-analysis

Purpose

To compare the clinical efficacy of single-bundle versus double-bundle reconstruction of the medial patellofemoral ligament (MPFL) for recurrent patellar dislocation (RPD) regarding knee function scores, postoperative complications, and imaging assessments.

Methods

A computerized search of PubMed, Cochrane Library, Embase, China Biomedical Literature Database (CBM), China National Knowledge Network (CNKI), and VIP Database was performed for single-bundle versus double-bundle reconstruction of the medial patellofemoral ligament for treatment of RPD. Randomized controlled trials (RCTs) were evaluated for quality using the risk-of-bias evaluation tool recommended by the Cochrane Collaboration Network, and Cohort studies (CSs) were assessed using the Newcastle-Ottawa Scale (NOS) scale. Meta-analysis was performed using RevMan 5.3 software and STATA 16.0.

Results

Thirteen studies were included, four randomized controlled studies, and nine cohort studies. The level of evidence for the four randomized controlled studies was Ⅰ, and the nine cohort studies were Ⅲ. A total of 862 (891 knees) patients were included, of which 448 (465 knees) underwent double-bundle MPFL reconstruction and 414 (426 knees) underwent single-bundle MPFL reconstruction. Kujala score (MD = 2.06, 95% confidence interval [CI] [0.11, 4.01], p < 0.05), Tegner score (MD = 0.39, 95% CI [0.11, 0.68], p < 0.05), International Knee Documentation Committee (IKDC) score (MD = 4.88, 95% CI [1.46, 8.31], p < 0.05), and postoperative recurrence instability (odds ratio [OR] = 0.12, 95% CI [0.04, 0.44], p < 0.05) were better in the double-bundle group than in the single-bundle group. Lysholm score (MD = 0.86, 95% CI [−0.76, 2.48], p = n.s), patellar tilt angle (MD = −0.22, 95% CI [−0.54, 0.10], p = n.s), patellar lateral shift rate (MD = −0.16, 95% CI [−0.41, 0.09], p = n.s), congruence angle (MD = 0.06, 95% CI [−0.41, 0.52], p = n.s), postoperative knee pain (OR = 0.39, 95% CI [0.14, 1.11], p = n.s), and additional postoperative surgical treatment (OR = 0.20, 95% CI [0.01−6.25], p = n.s) had no statistically significant differences.

Conclusions

Double-bundle reconstruction of the medial patellofemoral ligament for RPD was superior to single-bundle reconstruction in both knee function scores and postoperative recurrent patellar instability, and double-bundle reconstruction of the medial patellofemoral ligament for RPD had better clinical outcomes.