Objective

Knee joint distraction (KJD) is a joint-preserving osteoarthritis treatment that may postpone a total knee arthroplasty (TKA) in younger patients. This systematic review and meta-analysis evaluates short- and long-term clinical benefit and tissue structure changes after KJD.

Design

MEDLINE, EMBASE, and Web of Science were searched for eligible clinical studies evaluating at least one of the primary parameters: WOMAC, VAS-pain, KOOS, EQ5D, radiographic joint space width or MRI cartilage thickness after KJD. Random effects models were applied on all outcome parameters and outcomes were compared with control groups found in the included studies.

Results

Eleven articles reporting on 7 different KJD cohorts with in total 127 patients and 5 control groups with multiple follow-up moments were included, of which 2 were randomized controlled trials. Significant improvements in all primary parameters were found and benefit lasted up to at least 9 years. Overall, outcomes were comparable with control groups, including high tibial osteotomy, although TKA showed better clinical response.

Conclusions

Current, still limited, evidence shows KJD causes clear benefit in clinical and structural parameters, both short- and long-term. Longer follow-up with more patients is necessary, to validate outcome and to potentially improve patient selection for this intensive treatment. Thus far, for younger knee osteoarthritis patients, KJD may be an option to consider.

中文翻译：

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膝关节牵引作为骨关节炎治疗的临床和结构益处：对有限数量的研究和可用患者的系统评价和荟萃分析。

客观的

膝关节牵引术 (KJD) 是一种保留关节的骨关节炎治疗方法，可能会推迟年轻患者的全膝关节置换术 (TKA)。该系统评价和荟萃分析评估了 KJD 后的短期和长期临床益处和组织结构变化。

设计

在 MEDLINE、EMBASE 和 Web of Science 中搜索了评估至少一项主要参数的合格临床研究：WOMAC、VAS 疼痛、KOOS、EQ5D、KJD 后的影像学关节间隙宽度或 MRI 软骨厚度。对所有结果参数应用随机效应模型，并将结果与​​纳入研究中的对照组进行比较。

结果

共纳入 11 篇报道 7 个不同 KJD 队列的文章，共 127 名患者和 5 个具有多个随访时刻的对照组，其中 2 篇为随机对照试验。发现所有主要参数都有显着改善，并且益处持续了至少 9 年。总体而言，结果与对照组相当，包括胫骨高位截骨术，尽管 TKA 显示出更好的临床反应。

结论

目前仍然有限的证据表明，KJD 在短期和长期的临床和结构参数方面具有明显的益处。有必要对更多患者进行更长时间的随访，以验证结果并可能改善患者对这种强化治疗的选择。到目前为止，对于年轻的膝关节骨性关节炎患者，KJD 可能是一个可以考虑的选择。