PDF(Pubmed)
Abstract：
The purpose of this systematic review is to report outcomes and complications following the reconstruction of chronic patellar tendon ruptures. Four databases (Cochrane Database of Systematic Reviews, PubMed, Embase, MEDLINE) were searched from inception to July 2021. Inclusion criteria included articles that (1) analyzed outcomes and complications following chronic patellar tendon reconstruction (>4 weeks from injury to repair), (2) were written in English, (3) greater than five patients, and (4) a minimum 2-year follow-up. Exclusion criteria included (1) non-original research and (2) patellar tendon repair/reconstruction with prior total knee arthroplasty. Data on outcome metrics and complications were extracted from the included studies and reported in a qualitative manner. Nine studies (number of patients = 96) were included after screening. Seven studies analyzed autograft reconstruction, and three of those seven studies analyzed reconstructions with additional augmentation. The remaining two studies evaluated reconstruction utilizing a bone-tendon-bone (BTB) allograft. Four of the autograft studies (n=40 patients) showed a range of post-operative mean Lysholm scores of 74-94. Additionally, four studies reported a post-operative extensor lag of 0-3°. Post-operative protocol for autograft studies included delayed motion and was either contained to a bivalved cast or a hinged knee brace for six weeks. The two allograft studies reported a range of mean Lysholm scores from 62 to 67, and each immobilized the leg in full extension until six weeks. While chronic patellar tendon ruptures are a rare injury of the extensor mechanism, there are viable options for reconstruction. Overall, chronic patellar tendon ruptures reconstructed with both autograft and allograft will provide fair to good outcomes with low complication rates. Following surgery, immobilization for at least six weeks should be emphasized to protect the graft and optimize patient outcomes.
摘要：
本系统评价的目的是报告慢性髌腱断裂重建后的结果和并发症。四个数据库(Cochrane系统评价数据库，PubMed,Embase,MEDLINE)从成立之初到2021年7月进行了搜索。纳入标准包括以下文章：（1）分析慢性髌腱重建（从损伤到修复>4周）后的结果和并发症，（2）用英语写的，（3）大于5名患者，（4）至少2年随访。排除标准包括（1）非原创性研究和（2）pat骨肌腱修复/重建与先前的全膝关节置换术。从纳入的研究中提取结果指标和并发症的数据，并以定性的方式报告。筛选后纳入9项研究（患者人数=96）。七项研究分析了自体移植重建，这七项研究中有三项分析了重建，并进行了额外的增强。其余两项研究评估了使用骨-腱-骨（BTB）同种异体移植的重建。四项自体移植研究（n=40例患者）显示术后平均Lysholm评分为74-94。此外,4项研究报告术后伸肌滞后0-3°.自体移植研究的术后方案包括延迟运动，并将其包含在双瓣膜石膏或铰链式膝关节支架中，持续六周。两项同种异体移植研究报告了平均Lysholm评分从62到67的范围，并且每个都将腿完全固定直到六周。虽然慢性髌腱断裂是一种罕见的伸肌机制损伤，重建有可行的选择。总的来说,自体移植和同种异体移植重建的慢性髌腱断裂将提供良好的结果，并发症发生率低。手术后,应强调固定至少6周,以保护移植物并优化患者预后.
