Functional outcomes of paediatric medial patellofemoral ligament (MPFL) reconstruction surgery with or without patella distalisation and medialisation for recurrent patella instability

Q4 Medicine
Andrew Hannah , Timothy Pigott , Fazal Ali , Nicolas Nicolaou
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引用次数: 0

Abstract

Background

No studies to date have compared the outcome of isolated medial patellofemoral ligament reconstruction (MPFLR) surgery with MPFLR plus re-alignment procedures (MPFLR+) in the paediatric population, making it unclear when additional re-alignment procedures are required.

By retrospectively reviewing and comparing our MPFLR patient cohorts’ we aim to generate guidance to aid surgical planning.

Methods

University of Salford ethical approval was secured and theatre records were retrospectively reviewed, identifying all patients less than 18 years-of-age who received MPFLR surgery between October 01, 2015 and October 01, 2019.

All patients were contacted for documented consent. Pre-operative and post-operative outcome questionnaires were reviewed in conjunction with patient’s medical records and radiological imaging.

Results

A total of 75 MPFLR surgeries were identified and 33 patients (40 knees) consented for inclusion in the study; 23 MPFLR and 17 MPFLR+. Mean improvement in outcome scores achieved statistical significance (P < 0.05) in almost all questionnaire subtypes for both groups. A greater improvement in Quality of life (QoL) correlated with an increased tibial tuberosity–trochlear groove distance (TT-TG) in the MPFLR group 0.557 (P = 0.025) and a lower Patellotrochlear index (PTI) - 0.549 (P = 0.034) in the MPFLR + group.

Increased Body Mass Index (BMI) correlated with worse outcomes in numerous questionnaire subtypes (P = 0.05 and P = 0.01) for the MPFLR + group.

Increased Trochlear dysplasia correlated – 0.541 (P = 0.03) with less improvement in symptoms following MPFLR + surgery and an increased need for revision surgery 0.312 (P = 0.053) in both groups.

Conclusions

Both groups achieved good outcomes and statistically significant improvements in almost all mean outcome scores following MPFLR surgery, suggesting that our current described selection criteria are appropriate. While we were unable to identify any absolute radiological cut off figures in this diverse population with changing anatomy, we recommend additional procedures be considered for high TT-TG distances and or significant patella alta.

Patients with a high BMI should be supported in losing weight prior to surgery and patients with trochlear dysplasia need counselling with regard to potential lesser improvements in symptoms, a higher risk of failure and need for revision surgery. Additional realignment procedures did not appear to offer any improved outcome in the presence of trochlear dysplasia.

Level of Evidence IV: Case series.

小儿髌股内侧韧带(MPFL)重建手术治疗复发性髌骨不稳时髌骨远端和内侧化的功能结果
到目前为止,还没有研究比较孤立的髌股内侧韧带重建术(MPFLR)与MPFLR+重新对准手术(MPFLR+)在儿科人群中的结果,因此不清楚何时需要额外的重新对准手术。通过回顾性回顾和比较我们的MPFLR患者队列,我们旨在为辅助手术计划提供指导。方法获得了索尔福德大学的伦理批准,回顾性审查了所有在2015年10月1日至2019年10月1日期间接受MPFLR手术的18岁以下患者的手术室记录。与所有患者取得书面同意。结合患者的医疗记录和放射成像,对术前和术后结果问卷进行了审查。结果共发现75例MPFLR手术,33例患者(40个膝关节)同意纳入研究;23 MPFLR和17 MPFLR+。结果评分的平均改善具有统计学意义(P <两组几乎所有问卷类型的差异均为0.05)。生活质量(QoL)的改善与MPFLR组胫骨结节-滑车沟距离(TT-TG)增加(0.557)(P = 0.025)和MPFLR +组髌骨滑车指数(PTI)降低(0.549)(P = 0.034)相关。在MPFLR +组中,体重指数(BMI)的增加与许多问卷亚型的较差结果相关(P = 0.05和P = 0.01)。滑车发育不良的增加与MPFLR +手术后症状改善较少相关0.541 (P = 0.03),两组患者对翻修手术的需求增加相关0.312 (P = 0.053)。结论两组在MPFLR手术后均获得了良好的预后,几乎所有平均预后评分均有统计学上的显著改善,表明我们目前描述的选择标准是合适的。虽然我们无法在这种不同的人群中确定任何绝对的放射切线,但我们建议对高TT-TG距离和或显著的髌骨上缘考虑额外的手术。应支持高BMI患者在手术前减肥,滑车发育不良患者需要咨询有关症状改善可能较小、失败风险较高和需要翻修手术的问题。在滑车发育不良的情况下,额外的调整程序似乎没有提供任何改善的结果。证据级别IV:案例系列。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Arthroscopy and Joint Surgery
Journal of Arthroscopy and Joint Surgery Medicine-Orthopedics and Sports Medicine
CiteScore
0.60
自引率
0.00%
发文量
1
期刊介绍: Journal of Arthroscopy and Joint Surgery (JAJS) is committed to bring forth scientific manuscripts in the form of original research articles, current concept reviews, meta-analyses, case reports and letters to the editor. The focus of the Journal is to present wide-ranging, multi-disciplinary perspectives on the problems of the joints that are amenable with Arthroscopy and Arthroplasty. Though Arthroscopy and Arthroplasty entail surgical procedures, the Journal shall not restrict itself to these purely surgical procedures and will also encompass pharmacological, rehabilitative and physical measures that can prevent or postpone the execution of a surgical procedure. The Journal will also publish scientific research related to tissues other than joints that would ultimately have an effect on the joint function.
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