在中期随访中，沟深滑车成形术和髌股内侧韧带重建为解决髌骨不稳定提供了良好的临床效果：回顾性病例系列。

IF 2.7 Q1 ORTHOPEDICS

Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine Pub Date : 2025-01-09 DOI:10.1016/j.jisako.2025.100387

Thomas E. Moran, Brock J. Manley, Adam J. Tagliero, Elizabeth K. Driskill, David R. Diduch

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引用次数: 0

摘要

目的：更新先前发表的Dejour沟深滑车成形术和内侧髌股韧带重造术（MPFL-R）的中期随访的临床和影像学结果，并监测患者报告的结果评分和满意度的趋势。方法：使用我们之前发表的2年短期随访的同一队列患者，对67例（76个膝关节）严重滑车发育不良和复发性髌骨不稳患者进行了间歇随访，这些患者前瞻性地接受了Dejour沟深滑车成形术和MPFL-R联合其他髌骨稳定手术。随访时间少于2年的患者被排除在外。评估包括影像学分析、体格检查、临床随访和患者报告的结果评分。结果：本研究纳入37例患者（45个膝关节），平均术后随访6.1年（标准差[SD] 2.7年）。进行了两次间隔再手术(关节镜下粘连松解；硬件移除和关节镜剃须软骨成形术)。复发性髌骨不稳未发生再手术。患者报告的结果从早期（平均3.6年）到中期（平均6.1年）随访基本稳定，早期和中期国际膝关节文献委员会（IKDC）（P = 0.75）、Kujala （P = 0.47）或VAS（视觉模拟量表）疼痛评分（P = 0.06）之间无统计学差异。中期随访（平均6.1年），与术前膝关节评分相比，IKDC评分（49.3 vs 82.0, P < 0.001, d = 1.85）、Kujala评分（56.5 vs 89.3, P < 0.001, d = 2.03）和VAS疼痛评分（3.8 vs 1.9, P = 0.003, d = 0.33）差异有统计学意义。在最近的随访中，髌骨关节炎的平均kelgren - lawrence分级从0.56到0.52 （P = 0.511）没有统计学意义的变化。结论：在中期随访中，Dejour沟深滑车成形术和MPFL-R联合其他髌骨稳定手术，实现了持久的髌骨不稳定的解决，维持了患者报告的结果评分和满意度，并且没有临床或放射学证据表明髌骨关节炎进展。证据等级：IV，案例系列。

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Sulcus-deepening trochleoplasty and medial patellofemoral ligament reconstruction provide good clinical outcomes in addressing patellar instability at mid-term follow-up: A retrospective case series

Purpose

This study aimed to update previously published clinical and radiographic outcomes of Dejour sulcus-deepening trochleoplasty and medial patellofemoral ligament reconstruction (MPFL-R) at mid-term follow-up and monitor trends in patient-reported outcome scores and satisfaction.

Methods

Using the same cohort of patients from our previously published short-term series of 2-year follow-up, an interval follow-up was performed on 67 patients (76 knees) with severe trochlear dysplasia and recurrent patellar instability who were prospectively enrolled and underwent Dejour sulcus-deepening trochleoplasty and MPFL-R combined with other patellar stabilization procedures. Patients with less than 2 years of follow-up were excluded. Evaluation involved radiographic analysis, physical examination, clinical follow-up, and patient-reported outcome scores.

Results

A total of 37 patients (45 knees) were included in the current study, with a mean follow-up of 6.1 years postoperatively (standard deviation: 2.7 years). Two interval reoperations were performed (arthroscopic lysis of adhesions; hardware removal and arthroscopic shaving chondroplasty). There remained no occurrences of reoperation for recurrent patellar instability. Patient-reported outcomes were largely stable from early (mean: 3.6 years) to mid-term (mean: 6.1 years) follow-up, with no statistically significant difference between early and mid-term International Knee Documentation Committee (IKDC) (P = 0.75), Kujala (P = 0.47), or visual analog scale (VAS) pain (P = 0.06) scores. Compared to preoperative knee scores, there was a significant difference in IKDC (49.3 vs 82.0, P < 0.001, d = 1.85), Kujala (56.5 vs 89.3, P < 0.001, d = 2.03), and VAS pain (3.8 vs 1.9, P = 0.003, d = 0.33) scores at mid-term follow-up (mean: 6.1 years). Mean Kellgren-Lawrence grading of patellofemoral arthritis showed no statistically significant change from 0.56 to 0.52 (P = 0.511) on sunrise radiographs at the most recent follow-up.

Conclusions

At the mid-term follow-up, Dejour sulcus-deepening trochleoplasty and MPFL-R, combined with other patellar stabilization procedures, achieves durable resolution of patellar instability with maintained patient-reported outcome scores and satisfaction rates and is without interval evidence of clinical or radiographic progression of patellofemoral arthritis.