Michael J Kutschke, J Alex Albright, Julia M Winschel, Elaine W He, Aristides I Cruz, Alan H Daniels, Brett D Owens
{"title":"关节过度活动综合征患者髌骨不稳定事件和手术治疗的风险增加：一项匹配队列分析。","authors":"Michael J Kutschke, J Alex Albright, Julia M Winschel, Elaine W He, Aristides I Cruz, Alan H Daniels, Brett D Owens","doi":"10.1016/j.asmr.2024.100995","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>To compare the odds of patellofemoral instability events requiring subsequent surgery and revision surgical intervention in patients with joint hypermobility syndromes (JHS) to that of a matched cohort.</p><p><strong>Methods: </strong>This is a retrospective cohort study using the PearlDiver Mariner Database. Records were queried between 2010 and 2021 with a diagnosis of JHS, including Ehlers-Danlos syndrome (EDS) and Marfan syndrome. Propensity matching was performed with a randomly generated control cohort without a diagnosis of JHS to account for age, sex, Charlson comorbidity index, diabetes, and obesity. Multivariable logistic regression was used to compare rates of patellar dislocation over a 1- and 2-year period between the 2 cohorts while controlling for previous knee injury or surgery. Patients who sustained a patellar dislocation over the 2-year period were followed to calculate rates of surgical intervention and subsequent revision.</p><p><strong>Results: </strong>In a population of 91,747, those with JHS experienced patellofemoral instability at a significantly increased rate at both a 1-year (adjusted odds ratio [aOR] 11.40; 95% confidence interval 9.23-14.25, <i>P</i> < .001) and 2-year (aOR 8.73; 7.36-10.44, <i>P</i> < .001) periods. The greatest risk was observed in patients with EDS at 1 year (aOR 16.32; 12.54-21.67, <i>P</i> < .001). Of those with an instability event, patients with JHS experienced a significantly increased rate of surgery at 1 year (aOR 3.20; 1.61-7.28, <i>P</i> = .002) and 2 years (aOR 3.18; 1.70-6.62, <i>P</i> < .001). Of those treated with surgery, there was no significant difference in the rates of revision surgical intervention between the JHS and control cohorts.</p><p><strong>Conclusions: </strong>Patients with JHS experienced significantly increased rates of patellofemoral instability and subsequent surgery. However, of those treated with surgery, there was no difference in rates of revision surgical intervention between those with or without joint hypermobility syndromes.</p><p><strong>Level of evidence: </strong>Level III, retrospective cohort study.</p>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"6 6","pages":"100995"},"PeriodicalIF":0.0000,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11701986/pdf/","citationCount":"0","resultStr":"{\"title\":\"Increased Risk of Patellofemoral Instability Events and Surgical Management in Patients With Joint Hypermobility Syndromes: A Matched Cohort Analysis.\",\"authors\":\"Michael J Kutschke, J Alex Albright, Julia M Winschel, Elaine W He, Aristides I Cruz, Alan H Daniels, Brett D Owens\",\"doi\":\"10.1016/j.asmr.2024.100995\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>To compare the odds of patellofemoral instability events requiring subsequent surgery and revision surgical intervention in patients with joint hypermobility syndromes (JHS) to that of a matched cohort.</p><p><strong>Methods: </strong>This is a retrospective cohort study using the PearlDiver Mariner Database. Records were queried between 2010 and 2021 with a diagnosis of JHS, including Ehlers-Danlos syndrome (EDS) and Marfan syndrome. Propensity matching was performed with a randomly generated control cohort without a diagnosis of JHS to account for age, sex, Charlson comorbidity index, diabetes, and obesity. Multivariable logistic regression was used to compare rates of patellar dislocation over a 1- and 2-year period between the 2 cohorts while controlling for previous knee injury or surgery. Patients who sustained a patellar dislocation over the 2-year period were followed to calculate rates of surgical intervention and subsequent revision.</p><p><strong>Results: </strong>In a population of 91,747, those with JHS experienced patellofemoral instability at a significantly increased rate at both a 1-year (adjusted odds ratio [aOR] 11.40; 95% confidence interval 9.23-14.25, <i>P</i> < .001) and 2-year (aOR 8.73; 7.36-10.44, <i>P</i> < .001) periods. The greatest risk was observed in patients with EDS at 1 year (aOR 16.32; 12.54-21.67, <i>P</i> < .001). Of those with an instability event, patients with JHS experienced a significantly increased rate of surgery at 1 year (aOR 3.20; 1.61-7.28, <i>P</i> = .002) and 2 years (aOR 3.18; 1.70-6.62, <i>P</i> < .001). Of those treated with surgery, there was no significant difference in the rates of revision surgical intervention between the JHS and control cohorts.</p><p><strong>Conclusions: </strong>Patients with JHS experienced significantly increased rates of patellofemoral instability and subsequent surgery. However, of those treated with surgery, there was no difference in rates of revision surgical intervention between those with or without joint hypermobility syndromes.</p><p><strong>Level of evidence: </strong>Level III, retrospective cohort study.</p>\",\"PeriodicalId\":34631,\"journal\":{\"name\":\"Arthroscopy Sports Medicine and Rehabilitation\",\"volume\":\"6 6\",\"pages\":\"100995\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-09-03\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11701986/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Arthroscopy Sports Medicine and Rehabilitation\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1016/j.asmr.2024.100995\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/12/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q3\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Arthroscopy Sports Medicine and Rehabilitation","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1016/j.asmr.2024.100995","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/12/1 0:00:00","PubModel":"eCollection","JCR":"Q3","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0
摘要
目的：比较关节过度活动综合征（JHS）患者髌骨不稳定事件需要后续手术和翻修手术干预的几率与匹配队列的发生率。方法：采用PearlDiver水手数据库进行回顾性队列研究。研究人员查询了2010年至2021年间诊断为JHS的记录，包括埃勒斯-丹洛斯综合征（EDS）和马凡综合征。将年龄、性别、Charlson合并症指数、糖尿病和肥胖等因素纳入无JHS诊断的随机对照队列，进行倾向匹配。在控制既往膝关节损伤或手术的情况下，采用多变量logistic回归比较两组患者1年和2年期间髌骨脱位的发生率。对持续2年的髌骨脱位患者进行随访，计算手术干预率和随后的翻修率。结果：在91,747名患者中，JHS患者在1年内经历髌骨不稳的比例显著增加(调整优势比[aOR] 11.40；95%置信区间9.23 ~ 14.25,P < 0.001)和2年(aOR 8.73；7.36-10.44, P < 0.001)。EDS患者在1年时的风险最大(aOR为16.32；12.54 ~ 21.67, p < 0.001)。在那些有不稳定事件的患者中，JHS患者在1年后的手术率显著增加(aOR 3.20；1.61-7.28, P = .002)和2年(aOR 3.18；1.70-6.62, p < .001)。在接受手术治疗的患者中，JHS组和对照组在翻修手术干预率方面没有显著差异。结论：JHS患者髌骨不稳定和后续手术的发生率明显增加。然而，在接受手术治疗的患者中，有或没有关节过度活动综合征的患者的翻修手术干预率没有差异。证据等级：III级，回顾性队列研究。
Increased Risk of Patellofemoral Instability Events and Surgical Management in Patients With Joint Hypermobility Syndromes: A Matched Cohort Analysis.
Purpose: To compare the odds of patellofemoral instability events requiring subsequent surgery and revision surgical intervention in patients with joint hypermobility syndromes (JHS) to that of a matched cohort.
Methods: This is a retrospective cohort study using the PearlDiver Mariner Database. Records were queried between 2010 and 2021 with a diagnosis of JHS, including Ehlers-Danlos syndrome (EDS) and Marfan syndrome. Propensity matching was performed with a randomly generated control cohort without a diagnosis of JHS to account for age, sex, Charlson comorbidity index, diabetes, and obesity. Multivariable logistic regression was used to compare rates of patellar dislocation over a 1- and 2-year period between the 2 cohorts while controlling for previous knee injury or surgery. Patients who sustained a patellar dislocation over the 2-year period were followed to calculate rates of surgical intervention and subsequent revision.
Results: In a population of 91,747, those with JHS experienced patellofemoral instability at a significantly increased rate at both a 1-year (adjusted odds ratio [aOR] 11.40; 95% confidence interval 9.23-14.25, P < .001) and 2-year (aOR 8.73; 7.36-10.44, P < .001) periods. The greatest risk was observed in patients with EDS at 1 year (aOR 16.32; 12.54-21.67, P < .001). Of those with an instability event, patients with JHS experienced a significantly increased rate of surgery at 1 year (aOR 3.20; 1.61-7.28, P = .002) and 2 years (aOR 3.18; 1.70-6.62, P < .001). Of those treated with surgery, there was no significant difference in the rates of revision surgical intervention between the JHS and control cohorts.
Conclusions: Patients with JHS experienced significantly increased rates of patellofemoral instability and subsequent surgery. However, of those treated with surgery, there was no difference in rates of revision surgical intervention between those with or without joint hypermobility syndromes.
Level of evidence: Level III, retrospective cohort study.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
