PDF(Sci-hub)
Abstract：
UNASSIGNED: Patella alta is a known risk factor for patellar instability and, in the setting of recurrent patellar instability with significant patella alta, correction of patellar height with a tibial tubercle osteotomy (TTO) may help decrease the failure of soft tissue-based stabilization.
UNASSIGNED: To perform a systematic review and meta-analysis of radiographic and clinical outcomes after TTO for patella alta.
UNASSIGNED: Systematic review and meta-analysis; Level of evidence, 4.
UNASSIGNED: PubMed, OVID/Medline, and Cochrane databases were queried in June 2020 for studies reporting outcomes of TTO for patella alta. Data pertaining to study characteristics and design, radiographic and clinical outcome values, and incidence of complications and reoperations were extracted. DerSimonian-Laird continuous and binary random-effects models were constructed to (1) perform subgroup-based analysis of mean changes in radiographic indices after TTO and (2) quantify the pooled incidence of complications and reoperations.
UNASSIGNED: Eight studies including 340 patients (420 knees) with a mean age of 24.7 ± 8.4 years were included. The mean follow-up was 53.1 months (range, 3-120 months), with 1 study reporting a mean follow-up of less than 2 years. The pooled mean anterior transfer was 5.6 mm; the mean medial transfer was 8.7 ± 1.3 mm; and the pooled mean distalization of the tibial tubercle was 12.2 ± 4.5 mm. Continuous random-effects meta-analysis determined that significant reductions in the mean Insall-Salvati ratio (1.40 vs 0.98, P < .001), Caton-Deschamps index (1.26 vs 0.97, P < .001), and tibial tubercle to trochlear groove ratio (18.27 vs 10.69, P < .001) were observed after TTO. The overall incidence of complications was 7.6% (95% CI, 4.8%-10.5%), while the overall incidence of reoperations was 14.3% (95% CI 6.2%-22.4%).
UNASSIGNED: TTO for patellar instability in the setting of patella alta results in a significant decrease in patellar height with varying degrees of medialization depending on the utilized technique. A mean postoperative complication rate of 7.6% was reported with a reoperation incidence of 14.3%, related primarily to hardware removal.
UNASSIGNED: To perform a systematic review and meta-analysis of radiographic and clinical outcomes after TTO for patella alta.
UNASSIGNED: Systematic review and meta-analysis; Level of evidence, 4.
UNASSIGNED: PubMed, OVID/Medline, and Cochrane databases were queried in June 2020 for studies reporting outcomes of TTO for patella alta. Data pertaining to study characteristics and design, radiographic and clinical outcome values, and incidence of complications and reoperations were extracted. DerSimonian-Laird continuous and binary random-effects models were constructed to (1) perform subgroup-based analysis of mean changes in radiographic indices after TTO and (2) quantify the pooled incidence of complications and reoperations.
UNASSIGNED: Eight studies including 340 patients (420 knees) with a mean age of 24.7 ± 8.4 years were included. The mean follow-up was 53.1 months (range, 3-120 months), with 1 study reporting a mean follow-up of less than 2 years. The pooled mean anterior transfer was 5.6 mm; the mean medial transfer was 8.7 ± 1.3 mm; and the pooled mean distalization of the tibial tubercle was 12.2 ± 4.5 mm. Continuous random-effects meta-analysis determined that significant reductions in the mean Insall-Salvati ratio (1.40 vs 0.98, P < .001), Caton-Deschamps index (1.26 vs 0.97, P < .001), and tibial tubercle to trochlear groove ratio (18.27 vs 10.69, P < .001) were observed after TTO. The overall incidence of complications was 7.6% (95% CI, 4.8%-10.5%), while the overall incidence of reoperations was 14.3% (95% CI 6.2%-22.4%).
UNASSIGNED: TTO for patellar instability in the setting of patella alta results in a significant decrease in patellar height with varying degrees of medialization depending on the utilized technique. A mean postoperative complication rate of 7.6% was reported with a reoperation incidence of 14.3%, related primarily to hardware removal.
摘要：
■髌骨是髌骨不稳定的已知危险因素，在复发性髌骨不稳定伴有显著髌骨的情况下，胫骨结节截骨术（TTO）矫正髌骨高度可能有助于减少软组织稳定的失败。
■对髌骨TTO术后的影像学和临床结果进行系统评价和荟萃分析。
■系统评价和荟萃分析；证据水平，4.
■PubMed,OVID/Medline,和Cochrane数据库于2020年6月查询了报告TTO对髌骨的结局的研究。与研究特征和设计有关的数据，放射学和临床结果值，并提取并发症发生率和再次手术。构建了DerSimonian-Laird连续和二元随机效应模型，以（1）对TTO后影像学指标的平均变化进行基于亚组的分析，以及（2）量化并发症和再次手术的合并发生率。
■纳入了8项研究，包括340名患者（420膝），平均年龄为24.7±8.4岁。平均随访53.1个月(范围，3-120个月），1项研究报告平均随访时间少于2年。合并平均前转移为5.6毫米；平均内侧转移为8.7±1.3毫米；胫骨结节的合并平均扩张为12.2±4.5毫米。连续随机效应荟萃分析确定平均Insall-Salvati比率显着降低（1.40vs0.98，P<.001），卡顿-德尚指数（1.26vs0.97，P<.001），TTO后观察到胫骨结节与滑车沟的比率（18.27vs10.69，P<.001）。并发症的总发生率为7.6％（95％CI，4.8％-10.5％），而再次手术的总发生率为14.3%(95%CI6.2%-22.4%).
■TTO在髌骨阿尔塔设置中的髌骨不稳定性导致髌骨高度显着降低，并具有不同程度的中介化，具体取决于所使用的技术。术后平均并发症发生率为7.6%，再次手术发生率为14.3%，主要与硬件拆卸有关。
■对髌骨TTO术后的影像学和临床结果进行系统评价和荟萃分析。
■系统评价和荟萃分析；证据水平，4.
■PubMed,OVID/Medline,和Cochrane数据库于2020年6月查询了报告TTO对髌骨的结局的研究。与研究特征和设计有关的数据，放射学和临床结果值，并提取并发症发生率和再次手术。构建了DerSimonian-Laird连续和二元随机效应模型，以（1）对TTO后影像学指标的平均变化进行基于亚组的分析，以及（2）量化并发症和再次手术的合并发生率。
■纳入了8项研究，包括340名患者（420膝），平均年龄为24.7±8.4岁。平均随访53.1个月(范围，3-120个月），1项研究报告平均随访时间少于2年。合并平均前转移为5.6毫米；平均内侧转移为8.7±1.3毫米；胫骨结节的合并平均扩张为12.2±4.5毫米。连续随机效应荟萃分析确定平均Insall-Salvati比率显着降低（1.40vs0.98，P<.001），卡顿-德尚指数（1.26vs0.97，P<.001），TTO后观察到胫骨结节与滑车沟的比率（18.27vs10.69，P<.001）。并发症的总发生率为7.6％（95％CI，4.8％-10.5％），而再次手术的总发生率为14.3%(95%CI6.2%-22.4%).
■TTO在髌骨阿尔塔设置中的髌骨不稳定性导致髌骨高度显着降低，并具有不同程度的中介化，具体取决于所使用的技术。术后平均并发症发生率为7.6%，再次手术发生率为14.3%，主要与硬件拆卸有关。
