采用股骨隧道近端而非远端位置进行 MPFL 重建，短期效果较差

IF 2.3 3区医学 Q2 ORTHOPEDICS

Orthopaedics & Traumatology-Surgery & Research Pub Date : 2024-11-01 DOI:10.1016/j.otsr.2024.103816

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引用次数: 0

摘要

背景：本研究旨在比较股骨隧道近端（靠近内收肌结节[AT]）和远端（靠近内上髁[ME]）解剖位置的髌股内侧韧带（MPFL）重建术（MPFLR）的临床和放射学结果：假设：股骨隧道近端位置的 MPFLR 比股骨隧道远端位置的 MPFLR 的临床和放射学结果更差：回顾性分析了55例接受股骨近端或远端隧道孤立性MPFLR手术且随访至少2年的患者。根据术后CT图像，28名患者被分为AT组，其余27名患者被分为ME组。对国际膝关节文献委员会、Lysholm、Tegner、Kujala 评分和并发症进行了评估。在放射学方面，对卡顿-德尚指数（CDI）、髌骨倾斜角、髌股骨关节炎（PFOA）、国际软骨修复学会（ICRS）分级的髌股软骨状况、骨挫伤和 MPFL 移植信号强度进行了评估：结果：两组患者的所有临床评分均有明显改善（p <0.01）。两组在术前人口统计学数据、术后临床评分、并发症或放射学结果（CDI、髌骨倾斜角、PFOA、骨挫伤和移植物信号强度）方面均无统计学差异。AT 组髌骨内侧面软骨状况较差（P = 0.02）。与ME组相比，AT组髌骨内侧面的ICRS分级在统计学上也有所提高（P = 0.04）：讨论：两组的临床疗效均有明显改善。然而，就髌骨内侧面而言，股骨隧道近端位置的 MPFLR 比股骨隧道远端位置的 MPFLR 的软骨状况和 ICRS 分级进展更差：证据级别：III；回顾性比较研究。

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MPFL reconstruction with proximal rather than distal femoral tunnel position leads to less favorable short-term results

Background

This study aimed to compare the clinical and radiological outcomes of medial patellofemoral ligament (MPFL) reconstruction (MPFLR) between anatomic femoral tunnel positions: proximal (near adductor tubercle [AT]) and distal (near medial epicondyle [ME]).

Hypothesis

MPFLR with the proximal femoral tunnel position has worse clinical and radiological outcomes than those with the distal femoral tunnel position.

Patients and methods

Fifty-five patients who underwent isolated MPFLR with proximal or distal femoral tunnels with at least 2 years of follow-up were retrospectively analyzed. Based on postoperative CT images, 28 patients were classified as group AT and the remaining 27 patients were classified as group ME. The International Knee Documentation Committee, Lysholm, Tegner, Kujala scores, and complications were evaluated. Radiologically, the Caton-Deschamps Index (CDI), patellar tilt angle, patellofemoral osteoarthritis (PFOA), patellofemoral cartilage status by the International Cartilage Repair Society (ICRS) grade, bone contusion, and MPFL graft signal intensity were evaluated.

Results

All clinical scores significantly improved in both groups (p < 0.01). No statistically significant difference was noted between the two groups in regards to their preoperative demographic data, postoperative clinical scores, complications, or radiological findings (CDI, patellar tilt angle, PFOA, bone contusion, and graft signal intensity). The group AT had worse cartilage status on the medial facet of the patella (p = 0.02). The ICRS grade for the medial facet of the patella statistically progressed in group AT compared to group ME (p = 0.04) as well.

Discussion

Both groups showed significantly improved clinical outcomes. However, for the medial facet of the patella, MPFLR with the proximal femoral tunnel position had worse cartilage status and ICRS grade progression than those with the distal femoral tunnel position.

Level of evidence

III; retrospective comparative study.

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来源期刊

Orthopaedics & Traumatology-Surgery & Research 医学-外科

CiteScore

5.10

自引率

26.10%

发文量

329

审稿时长

12.5 weeks

期刊介绍： Orthopaedics & Traumatology: Surgery & Research (OTSR) publishes original scientific work in English related to all domains of orthopaedics. Original articles, Reviews, Technical notes and Concise follow-up of a former OTSR study are published in English in electronic form only and indexed in the main international databases.