PDF(Pubmed)
Abstract：
UNASSIGNED: Hypermobility describes the movement of joints beyond normal limits. Whether hypermobility predisposes to patellar instability is yet to be established. We aimed to determine if joint hypermobility leads to an increased risk of patellar instability, and to evaluate outcomes of treatment for patellar instability in those who exhibit hypermobility.
UNASSIGNED: Published and unpublished literature databases were searched to September 7, 2023. Studies comparing prevalence of patellar dislocation/differences in treatment outcomes in patients with and without hypermobility were included.
UNASSIGNED: We identified 18 eligible studies (4,391 patients). The evidence was low in quality. A case series on 82 patients found that there was a relationship between generalised joint laxity and patellar instability. This was corroborated by a study comparing 104 patients with patellar dislocation to 110 patients without. Prevalence of generalised joint laxity was six time higher in the former (64.4% vs 10.9%, p < 0.001).Five studies found surgical intervention aimed at correcting patellar dislocation in patients with idiopathic hypermobility led to satisfactory outcomes. There was conflicting evidence regarding if hypermobile patients have worse outcomes than non-hypermobile patients following medial patellofemoral ligament reconstruction (MPFLR) in two studies. In addition, this procedure had a 19.1% failure rate in patients with Ehlers Danlos Syndrome (EDS), with hypermobility associated with a higher failure rate (p = 0.03). One study showed the type of graft used made no difference in outcome scores or re-dislocation rates (p > 0.5). Another study had 7/31 (22.6%) autografts which failed, compared to 2/16 allografts (12.5%) (p = 0.69).
UNASSIGNED: Joint hypermobility is a risk factor for patellar instability. Identification of at-risk groups may aid prevention of dislocations and allow for appropriate treatment. Patients with EDS experience poor outcomes following patellar stabilization surgery, with post-operative monitoring required.
UNASSIGNED: Published and unpublished literature databases were searched to September 7, 2023. Studies comparing prevalence of patellar dislocation/differences in treatment outcomes in patients with and without hypermobility were included.
UNASSIGNED: We identified 18 eligible studies (4,391 patients). The evidence was low in quality. A case series on 82 patients found that there was a relationship between generalised joint laxity and patellar instability. This was corroborated by a study comparing 104 patients with patellar dislocation to 110 patients without. Prevalence of generalised joint laxity was six time higher in the former (64.4% vs 10.9%, p < 0.001).Five studies found surgical intervention aimed at correcting patellar dislocation in patients with idiopathic hypermobility led to satisfactory outcomes. There was conflicting evidence regarding if hypermobile patients have worse outcomes than non-hypermobile patients following medial patellofemoral ligament reconstruction (MPFLR) in two studies. In addition, this procedure had a 19.1% failure rate in patients with Ehlers Danlos Syndrome (EDS), with hypermobility associated with a higher failure rate (p = 0.03). One study showed the type of graft used made no difference in outcome scores or re-dislocation rates (p > 0.5). Another study had 7/31 (22.6%) autografts which failed, compared to 2/16 allografts (12.5%) (p = 0.69).
UNASSIGNED: Joint hypermobility is a risk factor for patellar instability. Identification of at-risk groups may aid prevention of dislocations and allow for appropriate treatment. Patients with EDS experience poor outcomes following patellar stabilization surgery, with post-operative monitoring required.
摘要：
■超移动性描述了关节超出正常范围的运动。活动过度是否容易导致髌骨不稳定尚待确定。我们的目的是确定关节过度活动是否会导致髌骨不稳定的风险增加，并评估表现出活动过度的患者髌骨不稳定的治疗结果。
■检索已发布和未发布的文献数据库至2023年9月7日。包括比较有和没有过度活动的患者髌骨脱位的患病率/治疗结果差异的研究。
■我们确定了18项符合条件的研究（4,391名患者）。证据质量很低。一项针对82例患者的病例系列发现，广泛性关节松弛与髌骨不稳定之间存在关系。一项研究将104例髌骨脱位患者与110例无髌骨脱位患者进行了比较，证实了这一点。前者普遍关节松弛的患病率高6倍(64.4%vs10.9%,p<0.001)。五项研究发现，旨在纠正特发性活动过度患者髌骨脱位的手术干预可获得令人满意的结果。在两项研究中，关于内侧髌股韧带重建（MPFLR）后，高流动性患者的预后是否比非高流动性患者差的证据相互矛盾。此外,在EhlersDanlos综合征（EDS）患者中，该手术的失败率为19.1％，高流动性与较高的故障率相关(p=0.03)。一项研究表明，使用的移植物类型在结果评分或再脱位率方面没有差异（p>0.5）。另一项研究有7/31（22.6％）的自体移植物失败，与2/16同种异体移植物（12.5％）相比（p=0.69）。
■关节过度活动是髌骨不稳定的危险因素。确定高危人群可能有助于预防脱臼并进行适当的治疗。EDS患者髌骨稳定手术后预后较差，需要术后监测。
■检索已发布和未发布的文献数据库至2023年9月7日。包括比较有和没有过度活动的患者髌骨脱位的患病率/治疗结果差异的研究。
■我们确定了18项符合条件的研究（4,391名患者）。证据质量很低。一项针对82例患者的病例系列发现，广泛性关节松弛与髌骨不稳定之间存在关系。一项研究将104例髌骨脱位患者与110例无髌骨脱位患者进行了比较，证实了这一点。前者普遍关节松弛的患病率高6倍(64.4%vs10.9%,p<0.001)。五项研究发现，旨在纠正特发性活动过度患者髌骨脱位的手术干预可获得令人满意的结果。在两项研究中，关于内侧髌股韧带重建（MPFLR）后，高流动性患者的预后是否比非高流动性患者差的证据相互矛盾。此外,在EhlersDanlos综合征（EDS）患者中，该手术的失败率为19.1％，高流动性与较高的故障率相关(p=0.03)。一项研究表明，使用的移植物类型在结果评分或再脱位率方面没有差异（p>0.5）。另一项研究有7/31（22.6％）的自体移植物失败，与2/16同种异体移植物（12.5％）相比（p=0.69）。
■关节过度活动是髌骨不稳定的危险因素。确定高危人群可能有助于预防脱臼并进行适当的治疗。EDS患者髌骨稳定手术后预后较差，需要术后监测。
