复发性髌骨脱位患者髌股内侧韧带重建后滑车形态对临床结果的影响：一项回顾性队列研究

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee Pub Date : 2025-07-21 DOI:10.1016/j.knee.2025.07.004

Vivek Pandey , Mohana Suryan , Bishak S. Reddy , Kiran K.V. Acharya , Anika Sait , Ronak Mohanty , Praveen Shastry

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引用次数: 0

摘要

背景：髌股内侧韧带重建（MPFLR）是治疗复发性外侧髌骨脱位的标准手术。低级别滑车发育不良（TD）可以保守治疗，高级别滑车发育不良建议行滑车成形术。然而，其适应症和疗效仍有争议。本研究评估了不做滑车成形术的MPFLR治疗TD患者的临床结果。方法选取57例MPFLR患者，随访至少2年。TD分为低级（Dejour A型）和高级（B、C、D型）。患者报告的结果测量(PROMs) -Kujala， Lysholm和国际膝关节文献委员会评分在术前和术后进行评估，并与TD分级相关。术前和术后PROMs还与年龄、性别、髌骨上缘、髌骨软骨缺损、术前PROMs和手术类型相关。结果平均手术年龄26.9岁，女性占64.9%。平均随访72个月，无患者脱位复发。术后prom明显改善(p <；0.001)。低级别TD患者的PROMs明显优于高级别TD患者(p <；0.05)。虽然年龄增长、软骨病变和滑车发育不良与PROMs有显著相关性，但回归分析显示，术前Kujala评分和滑车发育不良是PROMs的主要决定因素。此外，性别、上髌骨或手术类型对PROMs没有影响。结论：即使在高级别TD患者中，分离的MPFLR也能显著改善PROMs并预防复发。在所有变量中，滑车发育不良是影响PROMs的最重要的决定因素。证据等级：III级，回顾性队列研究。

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Effect of trochlear morphology over clinical outcomes after medial patellofemoral ligament reconstruction in patients with recurrent patellar dislocation: A retrospective cohort study

Background

Medial patellofemoral ligament reconstruction (MPFLR) is the standard procedure for recurrent lateral patellar dislocation. While low-grade trochlear dysplasia (TD) can be managed conservatively, trochleoplasty is recommended for high-grade TD. However, its indications and efficacy remain debatable. This study evaluates the clinical outcomes of MPFLR without trochleoplasty in patients with TD.

Methods

57 patients who underwent MPFLR with a minimum follow-up of two years were included. TD was classified as low-grade (Dejour Type A) or high-grade (Types B, C, D). Patient-reported outcome measures (PROMs)—Kujala, Lysholm, and International Knee Documentation Committee scores were assessed pre and postoperatively and correlated with TD grades. Pre- and postoperative PROMs were also correlated with age, gender, patella alta, patellar cartilage defect, preoperative PROMs, and type of surgery.

Results

The mean age at surgery was 26.9 years, and 64.9 % were female. At a mean follow-up of 72 months, no patient experienced a recurrence of dislocation. Postoperative PROMs showed a significant improvement (p < 0.001). Patients with low-grade TD had significantly better PROMs compared to those with high-grade TD (p < 0.05). While increasing age, cartilage lesions, and trochlear dysplasia had a significant correlation with PROMs, regression analysis revealed that preoperative Kujala score and trochlear dysplasia were major determinants of PROMs. Furthermore, there was no effect of gender, patella alta, or type of surgery on PROMs.

Conclusion

Isolated MPFLR significantly improves PROMs and prevents recurrence, even in patients with high-grade TD. Among all variables, Trochlear dysplasia is the most influential determinant of PROMs.

Level of evidence: III, retrospective cohort study.

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来源期刊

Knee 医学-外科

CiteScore

3.80

自引率

5.30%

发文量

171

审稿时长

6 months

期刊介绍： The Knee is an international journal publishing studies on the clinical treatment and fundamental biomechanical characteristics of this joint. The aim of the journal is to provide a vehicle relevant to surgeons, biomedical engineers, imaging specialists, materials scientists, rehabilitation personnel and all those with an interest in the knee. The topics covered include, but are not limited to: • Anatomy, physiology, morphology and biochemistry; • Biomechanical studies; • Advances in the development of prosthetic, orthotic and augmentation devices; • Imaging and diagnostic techniques; • Pathology; • Trauma; • Surgery; • Rehabilitation.