背景:伸肌机制破裂是全膝关节置换术(TKA)后的严重并发症,发生率为0.1-2.5%。TKA手术中的跟腱同种异体移植(ATA)和伸肌机制同种异体移植(EMA)产生了混合的临床结果。我们的系统评价旨在确定使用同种异体移植的TKA后伸肌机制重建失败的比例,并评估临床和功能结果以及最常见的并发症。此外,我们在处理孤立髌腱断裂的研究中进行了荟萃分析,以评估失败率,手术并发症,以及使用ATA或EMA移植物重建伸肌机构的临床发现(伸肌滞后和膝关节运动范围)。
方法:根据PRISMA指南对文献进行了系统综述,包括使用EMA和ATA治疗TKA后伸肌机制断裂的研究。Coleman方法评分和MINORS评分用于评估研究质量。进行了荟萃分析以评估故障率,并发症,ATA和EMA治疗在孤立性髌腱断裂中的临床发现(伸肌滞后和膝关节活动范围)。
结果:共有238例患者(245膝),平均年龄从54岁到74岁,在纳入的18项研究中,确定了使用同种异体移植物进行伸肌机制重建的人。我们分析了166例髌腱断裂,29股四头肌腱断裂,和29髌骨骨折的分析。在大多数纳入病例中描述了慢性损伤。ATA和全EMA分别用于89例(92膝)和149例(153膝),分别。总体故障百分比为23%,而EMA和ATA分别为23%和24%。最常见的并发症是伸肌滞后(≥20°)。术后感染的总发生率为7%。14篇论文中有11篇报道了术后平均膝关节屈曲超过100°。在ATA和EMA中,需要助行器的患者比例为55%和34.5%,分别。孤立性髌腱断裂的伸肌机制重建后的失败结果为27%,EMA和ATA在失败率和临床结局方面无统计学差异。
结论:在全膝关节置换术后急性或慢性破裂患者中,同种异体移植重建伸肌机制是一种有效的治疗选择。持续的伸肌滞后是最常见的并发症。EMA与在最后一次随访时需要助行器的患者频率较低有关,尽管它具有与ATA相似的临床和功能结局。髌腱断裂,ATA具有与EMA相当的成功率。
方法:四级,治疗性研究。
背景:PROSPERO2019CRD42019141574。
BACKGROUND: Extensor mechanism rupture is a severe complication with an incidence of 0.1-2.5% after total knee arthroplasty (TKA). Achilles tendon allograft (ATA) and extensor mechanism allograft (EMA) in TKA surgery have yielded mixed clinical results. Our systematic
review aims to identify the proportion of failure in extensor mechanism reconstruction after TKA using allograft and evaluate clinical and functional outcomes and the most common complications. Furthermore, we performed a meta-analysis among studies dealing with isolated patellar tendon ruptures to assess the failure rate, surgical complications, and clinical findings (extensor lag and knee range of motion) of extensor mechanism reconstruction using either ATA or EMA grafts.
METHODS: A systematic
review of the literature was performed following the PRISMA guidelines, including the studies dealing with the use of EMA and ATA for extensor mechanism rupture following TKA. Coleman Methodology Score and the MINORS score were used to assess the quality of the studies. A meta-analysis was performed to evaluate the failure rate, complications, and clinical findings (extensor lag and knee range of motion) of the ATA and EMA treatments in isolated patellar tendon ruptures.
RESULTS: A total of 238 patients (245 knees), with a mean age ranging from 54 to 74 years, who underwent extensor mechanism reconstruction with an allograft were identified in the 18 included studies. We analysed 166 patellar tendon ruptures, 29 quadriceps tendon ruptures, and 29 patellar fractures in the analysis. A chronic injury was described in the majority of included cases. ATA and whole EMA were used in 89 patients (92 knees) and 149 patients (153 knees), respectively. The overall failure percentage was 23%, while EMA and ATA were 23 and 24%. The most common complication was extensor lag (≥ 20°). The overall incidence of postoperative infection was 7%. Eleven of 14 included papers reported more than 100° of the mean postoperative knee flexion. The percentage of patients requiring walking aids is 55 and 34.5% in ATA and EMA, respectively. The failure outcome after extensor mechanism reconstruction in isolated patellar tendon ruptures was 27%, with no statistical difference between EMA and ATA in terms of failure rate and clinical outcomes.
CONCLUSIONS: Extensor mechanism reconstruction with allograft represents a valid treatment option in patients with acute or chronic rupture following total knee arthroplasty. Persistent extensor lag represents the most common complication. EMA is associated with a lower frequency of patients requiring walking aids at last follow-up, although it has similar clinical and functional outcomes to ATA. In patellar tendon ruptures, ATA has a comparable success rate with EMA.
METHODS: Level IV, therapeutic study.
BACKGROUND: PROSPERO 2019 CRD42019141574.