机器人辅助的二维保体髌股内侧韧带重建对骨未成熟复发性髌骨脱位患者具有良好的临床效果

IF 2 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics Pub Date : 2025-07-18 DOI:10.1002/jeo2.70294

Qiuzhen Liang, Zandong Zhao, Hongwei Zhan, Peidong Liu, Chaofan Liao, Junxuran Li, Yongchao Duan, Xin Kang, Bin Tian, Bo Ren, Jiang Zheng, Liang Zhang

{"title":"机器人辅助的二维保体髌股内侧韧带重建对骨未成熟复发性髌骨脱位患者具有良好的临床效果","authors":"Qiuzhen Liang, Zandong Zhao, Hongwei Zhan, Peidong Liu, Chaofan Liao, Junxuran Li, Yongchao Duan, Xin Kang, Bin Tian, Bo Ren, Jiang Zheng, Liang Zhang","doi":"10.1002/jeo2.70294","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Purpose</h3>\n \n <p>The surgical treatment of recurrent patellar dislocation (PRD) in adolescents faces particular difficulties, since the integrity of open growth plates may be compromised by standard surgical methods used in adults. This study aimed to review a series of adolescents with RPD who underwent robot-assisted physeal-sparing medial patellofemoral ligament (MPFL) reconstruction, compare the clinical results with those of a non-robot-assisted group, and measure the vertical distance between Schöttle point and the physis intraoperatively.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>This retrospective clinical analysis included 55 adolescents with RPD who had no significant bone deformities and underwent MPFL reconstruction using either a robot-assisted technique or a non-robot-assisted method between February 2019 to November 2023. Using a 2D intraopertive navigation system, the vertical distance between Schöttle point and the medial distal femoral physis was measured in the robot-assisted group. The operation duration, the number of fluoroscopies and guide needle punctures were recorded in both groups. The anterior and distal tilt angles of the bone tunnel, as well as the distance between Schöttle point and the femoral insertion of the bone tunnel (DST), were measured using postoperative CT imaging in both groups. In addition to CT, MRI, and radiographic evaluations, the International Knee Documentation Committee (IKDC), Lysholm and Kujala scores were used to assess the clinical outcomes.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>The mean patient age was 13.1 years (range, 11–16 years). At a mean of 35.5 ± 8.5 months postoperativel, all patients returned for evaluation. In the robot-assisted group, the mean distance from the Schöttle point to medial femoral physis was 6.97 ± 1.92 mm, with all Schöttle points positioned distal to the physis in every case. The IKDC, Lysholm and Kujala scores in the robot-assisted group were significantly higher than those in the non-robot-assisted group three months post-operatively (87.1 ± 6.1 vs. 82.9 ± 5.7, <i>p</i> = 0.011; 85.3 ± 5.7 vs. 81.1 ± 5.2, <i>p</i> = 0.007; 82.7 ± 6.0 vs. 77.5 ± 5.1, <i>p</i> = 0.001); however, at the last follow-up, there was no significant difference (<i>p</i> > 0.05). No patients experienced recurrent patellar instability or physeal invasion following surgery, and significantly improved functional scores and patellar tilt angles were noted at the final follow-up (<i>p</i> < 0.05). In the robot-assisted group, the number of fluoroscopy and guide needle punctures was significantly lower (3.7 ± 0.5 vs. 10.3 ± 1.8; 1.1 ± 0.3 vs. 5.7 ± 1.1, <i>p</i> < 0.001), with smaller anterior tilt angles (14.5 ± 1.7 vs. 16.6 ± 4.7, <i>p</i> = 0.044), larger distal tilt angles (13.8 ± 1.7 vs. 11.4 ± 1.5, <i>p</i> < 0.001) and shorter DST (2.00 ± 0.84 vs. 5.45 ± 1.74, <i>p</i> < 0.001) compared to the non-robot-assisted group.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>An anterodistal oblique bone tunnel can be safely used for anatomical MPFL reconstruction in skeletally immature patients, yielding good short-term clinical outcomes. The robot-assisted method is more accurate than the freehand method, requiring fewer intraoperative fluoroscopies and enabling faster early recovery.</p>\n </section>\n \n <section>\n \n <h3> Level of Evidence</h3>\n \n <p>Level IV.</p>\n </section>\n </div>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"12 3","pages":""},"PeriodicalIF":2.0000,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jeo2.70294","citationCount":"0","resultStr":"{\"title\":\"Two-dimensional robot-assisted physeal-sparing medial patellofemoral ligament reconstruction can achieve favourable clinical outcomes for skeletally immature patients with recurrent patellar dislocation\",\"authors\":\"Qiuzhen Liang, Zandong Zhao, Hongwei Zhan, Peidong Liu, Chaofan Liao, Junxuran Li, Yongchao Duan, Xin Kang, Bin Tian, Bo Ren, Jiang Zheng, Liang Zhang\",\"doi\":\"10.1002/jeo2.70294\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Purpose</h3>\\n \\n <p>The surgical treatment of recurrent patellar dislocation (PRD) in adolescents faces particular difficulties, since the integrity of open growth plates may be compromised by standard surgical methods used in adults. This study aimed to review a series of adolescents with RPD who underwent robot-assisted physeal-sparing medial patellofemoral ligament (MPFL) reconstruction, compare the clinical results with those of a non-robot-assisted group, and measure the vertical distance between Schöttle point and the physis intraoperatively.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>This retrospective clinical analysis included 55 adolescents with RPD who had no significant bone deformities and underwent MPFL reconstruction using either a robot-assisted technique or a non-robot-assisted method between February 2019 to November 2023. Using a 2D intraopertive navigation system, the vertical distance between Schöttle point and the medial distal femoral physis was measured in the robot-assisted group. The operation duration, the number of fluoroscopies and guide needle punctures were recorded in both groups. The anterior and distal tilt angles of the bone tunnel, as well as the distance between Schöttle point and the femoral insertion of the bone tunnel (DST), were measured using postoperative CT imaging in both groups. In addition to CT, MRI, and radiographic evaluations, the International Knee Documentation Committee (IKDC), Lysholm and Kujala scores were used to assess the clinical outcomes.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>The mean patient age was 13.1 years (range, 11–16 years). At a mean of 35.5 ± 8.5 months postoperativel, all patients returned for evaluation. In the robot-assisted group, the mean distance from the Schöttle point to medial femoral physis was 6.97 ± 1.92 mm, with all Schöttle points positioned distal to the physis in every case. The IKDC, Lysholm and Kujala scores in the robot-assisted group were significantly higher than those in the non-robot-assisted group three months post-operatively (87.1 ± 6.1 vs. 82.9 ± 5.7, <i>p</i> = 0.011; 85.3 ± 5.7 vs. 81.1 ± 5.2, <i>p</i> = 0.007; 82.7 ± 6.0 vs. 77.5 ± 5.1, <i>p</i> = 0.001); however, at the last follow-up, there was no significant difference (<i>p</i> > 0.05). No patients experienced recurrent patellar instability or physeal invasion following surgery, and significantly improved functional scores and patellar tilt angles were noted at the final follow-up (<i>p</i> < 0.05). In the robot-assisted group, the number of fluoroscopy and guide needle punctures was significantly lower (3.7 ± 0.5 vs. 10.3 ± 1.8; 1.1 ± 0.3 vs. 5.7 ± 1.1, <i>p</i> < 0.001), with smaller anterior tilt angles (14.5 ± 1.7 vs. 16.6 ± 4.7, <i>p</i> = 0.044), larger distal tilt angles (13.8 ± 1.7 vs. 11.4 ± 1.5, <i>p</i> < 0.001) and shorter DST (2.00 ± 0.84 vs. 5.45 ± 1.74, <i>p</i> < 0.001) compared to the non-robot-assisted group.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusion</h3>\\n \\n <p>An anterodistal oblique bone tunnel can be safely used for anatomical MPFL reconstruction in skeletally immature patients, yielding good short-term clinical outcomes. The robot-assisted method is more accurate than the freehand method, requiring fewer intraoperative fluoroscopies and enabling faster early recovery.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Level of Evidence</h3>\\n \\n <p>Level IV.</p>\\n </section>\\n </div>\",\"PeriodicalId\":36909,\"journal\":{\"name\":\"Journal of Experimental Orthopaedics\",\"volume\":\"12 3\",\"pages\":\"\"},\"PeriodicalIF\":2.0000,\"publicationDate\":\"2025-07-18\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jeo2.70294\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Experimental Orthopaedics\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1002/jeo2.70294\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Experimental Orthopaedics","FirstCategoryId":"1085","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/jeo2.70294","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ORTHOPEDICS","Score":null,"Total":0}

引用次数: 0

摘要

目的：青少年复发性髌骨脱位（PRD）的手术治疗面临着特殊的困难，因为成人使用的标准手术方法可能会损害开放生长板的完整性。本研究旨在回顾一系列青少年RPD患者，他们接受了机器人辅助的肢体保留内侧髌股骨韧带（MPFL）重建，比较了非机器人辅助组的临床结果，并测量了术中Schöttle点与身体之间的垂直距离。方法回顾性临床分析包括55名青少年RPD患者，他们没有明显的骨畸形，并在2019年2月至2023年11月期间使用机器人辅助技术或非机器人辅助方法进行了MPFL重建。使用2D术中导航系统，机器人辅助组测量Schöttle点与股骨内侧远端物理之间的垂直距离。记录两组手术时间、透视次数、导针穿刺次数。术后CT成像测量两组骨隧道前、远端倾斜角度，以及Schöttle点与骨隧道股骨止点（DST）之间的距离。除了CT、MRI和放射学评估外，国际膝关节文献委员会（IKDC）、Lysholm和Kujala评分被用于评估临床结果。结果患者平均年龄13.1岁（范围11 ~ 16岁）。术后平均35.5±8.5个月，所有患者返回进行评估。在机器人辅助组中，Schöttle点到股骨内侧骨骺的平均距离为6.97±1.92 mm，所有Schöttle点均位于骨骺远端。术后3个月，机器人辅助组的IKDC、Lysholm和Kujala评分显著高于非机器人辅助组(87.1±6.1比82.9±5.7,p = 0.011；85.3±5.7 vs. 81.1±5.2,p = 0.007；82.7±6.0 vs. 77.5±5.1,p = 0.001)；但末次随访时，两组间差异无统计学意义（p > 0.05）。术后无复发性髌骨不稳或骨骺侵犯，最终随访功能评分和髌骨倾斜角度均有显著改善（p < 0.05）。在机器人辅助组，透视针和引导针穿刺次数明显减少(3.7±0.5 vs. 10.3±1.8；1.1±0.3 vs. 5.7±1.1,p < 0.001)，与非机器人辅助组相比，前倾角较小（14.5±1.7 vs. 16.6±4.7,p = 0.044），远端倾角较大（13.8±1.7 vs. 11.4±1.5,p < 0.001）， DST较短（2.00±0.84 vs. 5.45±1.74,p < 0.001）。结论前远端斜骨隧道可安全用于骨未成熟患者的解剖性MPFL重建，短期临床效果良好。机器人辅助的方法比徒手方法更准确，术中需要更少的透视检查，并且能够更快地早期恢复。证据等级四级。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Two-dimensional robot-assisted physeal-sparing medial patellofemoral ligament reconstruction can achieve favourable clinical outcomes for skeletally immature patients with recurrent patellar dislocation

Purpose

The surgical treatment of recurrent patellar dislocation (PRD) in adolescents faces particular difficulties, since the integrity of open growth plates may be compromised by standard surgical methods used in adults. This study aimed to review a series of adolescents with RPD who underwent robot-assisted physeal-sparing medial patellofemoral ligament (MPFL) reconstruction, compare the clinical results with those of a non-robot-assisted group, and measure the vertical distance between Schöttle point and the physis intraoperatively.

Methods

This retrospective clinical analysis included 55 adolescents with RPD who had no significant bone deformities and underwent MPFL reconstruction using either a robot-assisted technique or a non-robot-assisted method between February 2019 to November 2023. Using a 2D intraopertive navigation system, the vertical distance between Schöttle point and the medial distal femoral physis was measured in the robot-assisted group. The operation duration, the number of fluoroscopies and guide needle punctures were recorded in both groups. The anterior and distal tilt angles of the bone tunnel, as well as the distance between Schöttle point and the femoral insertion of the bone tunnel (DST), were measured using postoperative CT imaging in both groups. In addition to CT, MRI, and radiographic evaluations, the International Knee Documentation Committee (IKDC), Lysholm and Kujala scores were used to assess the clinical outcomes.

Results

The mean patient age was 13.1 years (range, 11–16 years). At a mean of 35.5 ± 8.5 months postoperativel, all patients returned for evaluation. In the robot-assisted group, the mean distance from the Schöttle point to medial femoral physis was 6.97 ± 1.92 mm, with all Schöttle points positioned distal to the physis in every case. The IKDC, Lysholm and Kujala scores in the robot-assisted group were significantly higher than those in the non-robot-assisted group three months post-operatively (87.1 ± 6.1 vs. 82.9 ± 5.7, p = 0.011; 85.3 ± 5.7 vs. 81.1 ± 5.2, p = 0.007; 82.7 ± 6.0 vs. 77.5 ± 5.1, p = 0.001); however, at the last follow-up, there was no significant difference (p > 0.05). No patients experienced recurrent patellar instability or physeal invasion following surgery, and significantly improved functional scores and patellar tilt angles were noted at the final follow-up (p < 0.05). In the robot-assisted group, the number of fluoroscopy and guide needle punctures was significantly lower (3.7 ± 0.5 vs. 10.3 ± 1.8; 1.1 ± 0.3 vs. 5.7 ± 1.1, p < 0.001), with smaller anterior tilt angles (14.5 ± 1.7 vs. 16.6 ± 4.7, p = 0.044), larger distal tilt angles (13.8 ± 1.7 vs. 11.4 ± 1.5, p < 0.001) and shorter DST (2.00 ± 0.84 vs. 5.45 ± 1.74, p < 0.001) compared to the non-robot-assisted group.

Conclusion

An anterodistal oblique bone tunnel can be safely used for anatomical MPFL reconstruction in skeletally immature patients, yielding good short-term clinical outcomes. The robot-assisted method is more accurate than the freehand method, requiring fewer intraoperative fluoroscopies and enabling faster early recovery.