对骨骼尚未发育成熟的患者进行解剖学趾骨分离式 MPFL 重建，在至少 24 个月的随访中显示出良好的效果。

IF 2 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics Pub Date : 2024-10-22 DOI:10.1002/jeo2.70063

Panagiotis Ntagiopoulos, Pierrenzo Pozzi, Georgios Kalinterakis, Dimitris Fligkos, Triantafyllia Dimou, Riccardo Compagnoni, Paolo Ferrua, Pietro Simone Randelli

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引用次数: 0

摘要

目的：复发性髌骨脱位是活跃的儿童和青少年群体中普遍存在的骨科问题。对于生长发育中的患者，不建议进行骨性外科手术；因此，手术的重点是恢复髌骨内侧韧带，并采用不同的重建技术。这组回顾性病例主要研究了骨骼尚未发育成熟的开放性髋关节患者进行髌股关节内侧韧带（MPFL）重建手术两年后的效果：连续24例患有髌骨股骨不稳定和生长板开放的患者接受了解剖性MPFL重建术，采用了骨骺分离技术。所有受试者均发生过三次以上的髌骨真正脱位。术前放射学检查包括前胸切面和侧切面，以评估髌骨高度和肢体对齐情况。磁共振成像用于评估胫骨髁发育不良和胫骨结节-胫骨髁沟（TT-TG）距离。采用视觉模拟量表（VAS）、Kujala和儿科国际膝关节文献委员会（Pedi-IKDC）评分对患者的并发症和临床结果进行询问。采用配对 t 检验对变量进行评估，以 p 表示显著性：手术时的平均年龄为 13.04 岁（9-16 岁）。平均随访时间为 38.66 个月（24-86 个月）。从受伤到手术的平均时间为 50.45 天（16-80 天）。在整个随访期间，术后未发现生长停滞、肢体长度差异或角度畸形。在整个研究期间，没有髌骨再次脱位的记录。VAS 评分从 5.67（4-8 分）明显降低到 1.88（0-4 分）（p p p p 结论）：在儿童和青少年中进行骨膜疏松MPFL重建术可获得极佳的中期效果，使患者能够重返运动场，而不会发生髌骨再脱位。男孩术后在 VAS、Pedi-IKDC 和 Kujala 评分方面优于女孩，但这些差异无统计学意义：IV：病例系列，无对比组。

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Anatomic physeal-sparing MPFL reconstruction in skeletally immature patients shows favourable outcomes at a minimum of 24-month follow-up

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Anatomic physeal-sparing MPFL reconstruction in skeletally immature patients shows favourable outcomes at a minimum of 24-month follow-up

Purpose

Recurrent patellar dislocation is a prevalent orthopaedic issue among active paediatric and adolescent populations. Bony surgical procedures are not recommended in growing patients; therefore, the focus of surgery is on restoring the medial patellar ligaments, with different reconstructive techniques available. This retrospective case series focuses on the 2-year outcomes of medial patellofemoral ligament (MPFL) reconstruction in skeletally immature patients with open physis.

Methods

Twenty-four consecutive patients with patellofemoral instability and open growth plates underwent anatomic MPFL reconstruction with a physeal-sparing technique. All subjects have had more than three episodes of true patellar dislocations. Preoperative radiographic examination included anteroposterior and lateral views to assess patella alta and limb alignment. Magnetic resonance imaging was performed to evaluate trochlear dysplasia and tibial tubercle–trochlear groove (TT–TG) distance. The patients were questioned regarding complications and clinical outcomes using the visual analogue scale (VAS), Kujala and Paediatric International Knee Documentation Committee (Pedi-IKDC) score. Variables were evaluated using paired t test with significance at p < 0.05.

Results

The mean age at the time of operation was 13.04 years (9–16 years). The cohort was followed for a mean duration of 38.66 months (24–86 months). The mean time from injury to surgery was 50.45 days (16–80 days). No growth arrest, limb-length discrepancies or angular deformities were observed post-operatively during the whole follow-up period. No patellar re-dislocations were recorded throughout the study period. The VAS score improved significantly from 5.67 (4–8) to 1.88 (0–4) (p < 0.01). The Kujala score improved significantly from 64.67 (44–81) preoperatively to 87.58 (77–100) post-operatively (p < 0.01). The Pedi-IKDC also increased significantly from 58.81 (34.80–77.70) preoperatively to 90.64 (70.70–100) post-operatively (p < 0.01). The vast majority of patients (87.5%) returned to their pre-injury activity level. Boys scored better than girls in VAS, Pedi-IKDC and Kujala score post-operatively, but these differences were not statistically significant.

Conclusion

Physeal-sparing MPFL reconstruction in children and adolescents yields excellent midterm results and allows patients to return to sports without redislocation of the patella. Boys scored better than girls in VAS, Pedi-IKDC and Kujala score post-operatively, but these differences were not statistically significant.