在孤立的髌股内侧韧带重建中，升高的不稳定分辨角预测较差的患者报告结果

Q3 Medicine

Arthroscopy Sports Medicine and Rehabilitation Pub Date : 2025-04-01 DOI:10.1016/j.asmr.2024.101066

Zachary Wang B.S., Daniel Kaplan M.D., Navya Dandu M.D., Erik Haneberg B.S., Kevin Credille M.D., M.S., Tristan Elias M.D., Nikhil Verma M.D., Brian J. Cole M.D., M.B.A., Adam B. Yanke M.D., Ph.D.

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During the EUA the instability resolution angle (IRA) was identified by applying a lateral force on the patella through increasing knee flexion and defined by the degree of flexion the patella ceased lateral translation. PROs, including International Knee Documentation Committee (IKDC), Knee Injury and Osteoarthritis Outcome Score Jr, and Kujala, were collected at 1-year and 2-year minimum after surgery. In addition, MPFLR failure was recorded and defined by patellar redislocation.</div></div><div><h3>Results</h3><div>In total, 94 patients met inclusion criteria, with 42 patients having an IRA <60° and 52 patients with an IRA ≥60° of knee flexion. At 2-year minimum follow-up, IKDC and Kujala PROs were significantly lower in patients with IRA ≥60° compared with patients with IRA <60° for both final and delta PROs. Mean tibial tubercle-trochlear groove distance examined on preoperative magnetic resonance imaging was 17.21 ± 5.00 mm for the IRA ≥60° cohort and 14.36 ± 4.89 mm for the IRA <60° cohort (<em>P <</em> .01). Four patients redislocated their patella, and all 4 had an IRA ≥60° (<em>P =</em> .07).</div></div><div><h3>Conclusions</h3><div>Patients who underwent isolated MPFLR with an IRA ≥60° had significantly lower IKDC and Kujala scores than similar patients with IRA <60° of knee flexion at 2-year minimum follow-up. 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引用次数: 0

摘要

目的探讨麻醉下检查（EUA）的预后价值，通过评估患者报告的结果评分（PROs）和接受原发性、孤立性髌股内侧韧带重建（MPFLR）的患者的失败率与EUA结果的关系。方法回顾性分析2015年8月至2021年8月期间接受原发性孤立性MPFLR的患者。在EUA期间，通过增加膝关节屈曲对髌骨施加侧向力来确定不稳定分解角（IRA），并通过屈曲程度来确定髌骨停止侧向平移。包括国际膝关节文献委员会（IKDC）、膝关节损伤和骨关节炎结局评分Jr和Kujala在内的PROs在手术后至少1年和2年收集。此外，MPFLR失败记录和定义为髌骨脱位。结果94例患者符合纳入标准，其中IRA≥60°的患者42例，IRA≥60°的患者52例。在最少2年的随访中，与IRA≥60°的患者相比，IRA≥60°的患者的最终和delta pro的IKDC和Kujala pro均显著降低。术前磁共振成像显示，IRA≥60°组平均胫骨结节-滑车沟距离为17.21±5.00 mm， IRA≥60°组平均为14.36±4.89 mm (P <；. 01)。4例患者髌骨再脱位，IRA≥60°（P = 0.07）。结论在至少2年的随访中，IRA≥60°的孤立性MPFLR患者的IKDC和Kujala评分明显低于IRA≥60°的膝关节屈曲患者。IRA≥60°的患者有4例（7.7%）髌骨再脱位，而IRA≥60°的患者没有发生再脱位。证据水平：III级，回顾性队列研究。

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Elevated Instability Resolution Angle Predicts Inferior Patient-Reported Outcomes in Isolated Medial Patellofemoral Ligament Reconstruction

Purpose

To investigate the prognostic utility of an examination under anesthesia (EUA) by evaluating the patient-reported outcome scores (PROs) and failure rates of patients undergoing primary, isolated medial patellofemoral ligament reconstruction (MPFLR) relative to their EUA findings.

Methods

A retrospective review was performed on patients who underwent primary, isolated MPFLR between August 2015 and August 2021. During the EUA the instability resolution angle (IRA) was identified by applying a lateral force on the patella through increasing knee flexion and defined by the degree of flexion the patella ceased lateral translation. PROs, including International Knee Documentation Committee (IKDC), Knee Injury and Osteoarthritis Outcome Score Jr, and Kujala, were collected at 1-year and 2-year minimum after surgery. In addition, MPFLR failure was recorded and defined by patellar redislocation.

Results

In total, 94 patients met inclusion criteria, with 42 patients having an IRA <60° and 52 patients with an IRA ≥60° of knee flexion. At 2-year minimum follow-up, IKDC and Kujala PROs were significantly lower in patients with IRA ≥60° compared with patients with IRA <60° for both final and delta PROs. Mean tibial tubercle-trochlear groove distance examined on preoperative magnetic resonance imaging was 17.21 ± 5.00 mm for the IRA ≥60° cohort and 14.36 ± 4.89 mm for the IRA <60° cohort (P < .01). Four patients redislocated their patella, and all 4 had an IRA ≥60° (P = .07).

Conclusions

Patients who underwent isolated MPFLR with an IRA ≥60° had significantly lower IKDC and Kujala scores than similar patients with IRA <60° of knee flexion at 2-year minimum follow-up. Four (7.7%) patients with IRA ≥60° redislocated their patella, whereas zero patients with IRA <60° experienced redislocation.