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Abstract：
OBJECTIVE: To confirm which method provides lower rate of recurrent instability and superior clinical outcomes.
METHODS: We searched PubMed, Embase and Web of Science for the trials involving one intervention or both for patellar instability: medial patellofemoral ligament reconstruction (MPFLR) with and without tibial tubercle osteotomy (TTO). The postoperative Kujala score, Lysholm score, Tegner scores and the rate of recurrent instability (dislocation or subluxation) were analyzed as the primary clinical outcome parameters in a random or fixed effects meta-analysis.
RESULTS: In total, 43 articles met inclusion criteria after full-text review. A total of 2046 patients were analyzed. The overall mean age was 20.3 years (range, 9.5-60.0 years), with a mean follow-up time of 3.2 years (range, 1-8 years). The mean Kujala scores in MPFLR and MPFLR + TTO were 89.04 and 84.44, respectively. There was significant difference in Kujala scores between MPFLR and MPFLR + TTO (MD = 4.60, 95%CI: 1.07-8.13; P = 0.01). The mean Lysholm scores in MPFLR and MPFLR + TTO were 90.59 and 88.14, respectively. There was no significant difference in Lysholm scores between MPFLR and MPFLR + TTO (MD = 2.45, 95%CI: -3.20-8.10; P = 0.40). The mean Tegner scores in MPFLR and MPFLR + TTO were 5.30 and 4.88, respectively. There was no significant difference in Tegner scores between MPFLR and MPFLR + TTO (MD = 0.42, 95%CI: -0.39-1.23; P = 0.31). At final follow-up, the rates of recurrent instability in MPFLR and MPFLR + TTO were 3% and 4%, respectively. There was no significant difference in the rates between MPFLR and MPFLR + TTO (OR = 0.99, 95%CI: 0.96-1.02; P = 0.4848).
CONCLUSIONS: MPFLR and MPFLR + TTO are effective and reliable treatments in the setting of patellofemoral instability. MPFLR seems to show a better performance in functional outcomes than MPFLR + TTO. Moreover, their rates of recurrent instability are very low, and no significant difference exists.
METHODS: We searched PubMed, Embase and Web of Science for the trials involving one intervention or both for patellar instability: medial patellofemoral ligament reconstruction (MPFLR) with and without tibial tubercle osteotomy (TTO). The postoperative Kujala score, Lysholm score, Tegner scores and the rate of recurrent instability (dislocation or subluxation) were analyzed as the primary clinical outcome parameters in a random or fixed effects meta-analysis.
RESULTS: In total, 43 articles met inclusion criteria after full-text review. A total of 2046 patients were analyzed. The overall mean age was 20.3 years (range, 9.5-60.0 years), with a mean follow-up time of 3.2 years (range, 1-8 years). The mean Kujala scores in MPFLR and MPFLR + TTO were 89.04 and 84.44, respectively. There was significant difference in Kujala scores between MPFLR and MPFLR + TTO (MD = 4.60, 95%CI: 1.07-8.13; P = 0.01). The mean Lysholm scores in MPFLR and MPFLR + TTO were 90.59 and 88.14, respectively. There was no significant difference in Lysholm scores between MPFLR and MPFLR + TTO (MD = 2.45, 95%CI: -3.20-8.10; P = 0.40). The mean Tegner scores in MPFLR and MPFLR + TTO were 5.30 and 4.88, respectively. There was no significant difference in Tegner scores between MPFLR and MPFLR + TTO (MD = 0.42, 95%CI: -0.39-1.23; P = 0.31). At final follow-up, the rates of recurrent instability in MPFLR and MPFLR + TTO were 3% and 4%, respectively. There was no significant difference in the rates between MPFLR and MPFLR + TTO (OR = 0.99, 95%CI: 0.96-1.02; P = 0.4848).
CONCLUSIONS: MPFLR and MPFLR + TTO are effective and reliable treatments in the setting of patellofemoral instability. MPFLR seems to show a better performance in functional outcomes than MPFLR + TTO. Moreover, their rates of recurrent instability are very low, and no significant difference exists.
摘要：
目的：确认哪种方法提供较低的复发不稳定性和较好的临床结局。
方法：我们搜索了PubMed，Embase和WebofScience的试验涉及一种或两种方法治疗髌骨不稳定：带和不带胫骨结节截骨（TTO）的内侧髌股韧带重建（MPFLR）。术后Kujala评分,Lysholm得分,在随机或固定效应荟萃分析中，将Tegner评分和复发性不稳定（脱位或半脱位）的发生率作为主要临床结果参数进行分析。
结果：总计，经全文审查，43篇文章符合纳入标准。共分析2046例患者。总体平均年龄为20.3岁(范围，9.5-60.0年），平均随访时间为3.2年(范围，1-8年）。MPFLR和MPFLR+TTO的平均Kujala评分分别为89.04和84.44。MPFLR与MPFLR+TTO的Kujala评分差异有统计学意义(MD=4.60,95CI:1.07~8.13;P=0.01)。MPFLR和MPFLR+TTO的平均Lysholm评分分别为90.59和88.14。MPFLR与MPFLR+TTO的Lysholm评分差异无统计学意义(MD=2.45,95CI:-3.20～8.10;P=0.40)。MPFLR和MPFLR+TTO的平均Tegner评分分别为5.30和4.88。MPFLR与MPFLR+TTO的Tegner评分差异无统计学意义（MD=0.42，95CI：-0.39～1.23；P=0.31）。在最后的后续行动中，MPFLR和MPFLR+TTO的复发性不稳定率分别为3%和4%，分别。MPFLR与MPFLR+TTO的发生率差异无统计学意义(OR=0.99,95CI:0.96~1.02;P=0.4848)。
结论：MPFLR和MPFLR+TTO是髌股不稳定的有效和可靠的治疗方法。MPFLR在功能结局方面似乎比MPFLR+TTO表现更好。此外，他们反复不稳定的比率非常低，并且不存在显著差异。
方法：我们搜索了PubMed，Embase和WebofScience的试验涉及一种或两种方法治疗髌骨不稳定：带和不带胫骨结节截骨（TTO）的内侧髌股韧带重建（MPFLR）。术后Kujala评分,Lysholm得分,在随机或固定效应荟萃分析中，将Tegner评分和复发性不稳定（脱位或半脱位）的发生率作为主要临床结果参数进行分析。
结果：总计，经全文审查，43篇文章符合纳入标准。共分析2046例患者。总体平均年龄为20.3岁(范围，9.5-60.0年），平均随访时间为3.2年(范围，1-8年）。MPFLR和MPFLR+TTO的平均Kujala评分分别为89.04和84.44。MPFLR与MPFLR+TTO的Kujala评分差异有统计学意义(MD=4.60,95CI:1.07~8.13;P=0.01)。MPFLR和MPFLR+TTO的平均Lysholm评分分别为90.59和88.14。MPFLR与MPFLR+TTO的Lysholm评分差异无统计学意义(MD=2.45,95CI:-3.20～8.10;P=0.40)。MPFLR和MPFLR+TTO的平均Tegner评分分别为5.30和4.88。MPFLR与MPFLR+TTO的Tegner评分差异无统计学意义（MD=0.42，95CI：-0.39～1.23；P=0.31）。在最后的后续行动中，MPFLR和MPFLR+TTO的复发性不稳定率分别为3%和4%，分别。MPFLR与MPFLR+TTO的发生率差异无统计学意义(OR=0.99,95CI:0.96~1.02;P=0.4848)。
结论：MPFLR和MPFLR+TTO是髌股不稳定的有效和可靠的治疗方法。MPFLR在功能结局方面似乎比MPFLR+TTO表现更好。此外，他们反复不稳定的比率非常低，并且不存在显著差异。
