Ladd Patricia E, Laor Tal, Emery Kathleen H, Salisbury Shelia R, Parikh Shital N
Department of Radiology, Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
J Pediatr Orthop. 2010 Apr-May;30(3):224-30. doi: 10.1097/BPO.0b013e3181d47305.
The medial patellofemoral ligament (MPFL), a chief medial restraint preventing lateral patellar dislocation, often is reconstructed in children with recurrent dislocation. The femoral MPFL attachment can be difficult to delineate at surgery. Therefore, the origin of the medial collateral ligament (MCL) frequently is used to approximate the reattachment site. The purpose of our study was to compile normative data from MR imaging examinations over different patient ages, to determine the effect of growth on the relationship of the MCL origin site to the distal femoral physis and medial femoral condyle (MFC).
This HIPAA-compliant study was IRB approved. Informed consent requirement was waived. Three hundred knee MR imaging examinations (143 boys, 157 girls, 0-20 y) were evaluated. MCL origin to femoral physis distance, MFC height, and MCL origin-physis distance: MFC height ratio (MCL:MFC ratio) were calculated. Relationships between these values and age, gender, and physeal patency were assessed using linear regression models.
With physeal patency, MCL origin-physis distance was significantly associated with increasing age in boys (P=0.0394), and trended toward significance in girls (P=0.0557). Distance increased 0.01 cm/y in both genders. MFC height increased 0.15 cm/y in boys and 0.13 cm/y in girls (P<0.0001). MCL:MFC ratio decreased 0.01/y (P<0.0001). With physeal closure, no significant change was measured for any variable.
During growth, there are statistically significant, albeit minimal, changes of the MCL origin-physis distance and MFC height. As these changes are essentially negligible, no adjustment for age is needed during restorative MPFL surgery in growing children.
As there is neglible change in location of the origin of the MCL relative to the distal femoral physis during skeletal growth in both boys and girls, no adjustment for patient age is necessary when using the origin of the MCL as a landmark to locate the site of femoral reattachment of a disrupted MPFL.
髌股内侧韧带（MPFL）是防止髌骨外侧脱位的主要内侧稳定结构，在复发性脱位的儿童中常需重建。手术时，MPFL在股骨上的附着点可能难以清晰界定。因此，内侧副韧带（MCL）的起点常被用来近似替代重新附着的位置。本研究的目的是汇总不同年龄段患者的磁共振成像（MR）检查的规范数据，以确定生长对MCL起点与股骨远端骨骺及股骨内侧髁（MFC）关系的影响。
本研究符合健康保险流通与责任法案（HIPAA）要求，并经机构审查委员会（IRB）批准。豁免了知情同意要求。评估了300例膝关节MR检查（143例男孩，157例女孩，年龄0 - 20岁）。计算了MCL起点至股骨骨骺的距离、MFC高度以及MCL起点 - 骨骺距离与MFC高度的比值（MCL:MFC比值）。使用线性回归模型评估这些值与年龄、性别和骨骺通畅情况之间的关系。
在骨骺通畅的情况下，MCL起点 - 骨骺距离在男孩中与年龄增长显著相关（P = 0.0394），在女孩中呈显著趋势（P = 0.0557）。两性的距离均以每年0.01 cm的速度增加。男孩的MFC高度每年增加0.15 cm，女孩每年增加0.13 cm（P < 0.0001）。MCL:MFC比值每年下降0.01（P < 0.0001）。在骨骺闭合后，未观察到任何变量有显著变化。
在生长过程中，MCL起点 - 骨骺距离和MFC高度虽有统计学上的显著变化，但变化极小。由于这些变化基本可忽略不计，因此在对生长中的儿童进行MPFL修复手术时无需考虑年龄因素。
由于在男孩和女孩的骨骼生长过程中，MCL起点相对于股骨远端骨骺的位置变化可忽略不计，因此在将MCL起点作为定位受损MPFL股骨重新附着部位的标志时，无需根据患者年龄进行调整。
