Lind Martin, Enderlein Ditte, Nielsen Torsten, Christiansen Svend Erik, Faunø Peter
Division of Sports Trauma, Orthopaedic Department, Aarhus University Hospital, Tage Hansens Gade 2, 8000, Århus C, Denmark.
Knee Surg Sports Traumatol Arthrosc. 2016 Mar;24(3):666-71. doi: 10.1007/s00167-014-3439-x. Epub 2014 Nov 22.
Medial patellofemoral ligament (MPFL) reconstruction has recently been broadly accepted as primary surgical treatment in adults. Reconstruction techniques with osseous fixation in femur cannot be used for patients with open growth plates. Operative treatment of patella instability in children therefore is a challenge and requires alternative MPFL reconstruction techniques. Limited knowledge exists concerning outcome after MPFL reconstruction in children and adolescents. This study present clinical outcome in a consecutive single clinic series of children treated with paediatric MPFL reconstruction using a soft tissue femoral fixation technique.
Twenty-four MPFL reconstructions in 20 operated children aged 8-16 were included in the study. Indication for surgery was two or more patella dislocations. MPFL reconstruction was performed by looping the released gracilis tendon around the adductor magnus tendon insertion and through drill holes in the proximal medial patella edge. Clinical outcome was evaluated by Kujala score and NRS pain score preoperatively, at 1-year follow-up and final follow-up at 39 months. Outcome was compared with a cohort of 179 adult patients with recurrent patella instability operated with an adult MPFL reconstruction technique.
Kujala score improved from 61 (13) to 81 (16). NRS pain score improved from 3.0 (3.1) to 1.5 (1.3) in activity. Four patients (20%) experienced redislocation within the first postoperative year compared with 5% in an adult patient population. Five patients (25%) experienced subluxations. One patient with a redislocation was re-operated with adult MPFL reconstruction technique. Cartilage injury was seen in six patients.
There are clinical relevant improvements in knee function and pain after MPFL reconstruction in paediatric patients. Patella stability after MPFL reconstruction using femoral soft tissue graft fixation in paediatric patients was inferior to MPFL reconstruction using bony femoral fixation in adult patients.
Case-Control study, Level III.
内侧髌股韧带（MPFL）重建术近来已被广泛接受为成人的主要手术治疗方法。股骨采用骨固定的重建技术不适用于生长板开放的患者。因此，儿童髌骨不稳定的手术治疗具有挑战性，需要采用替代的MPFL重建技术。关于儿童和青少年MPFL重建后的疗效，目前了解有限。本研究呈现了在单一诊所连续收治的一组采用软组织股骨固定技术进行小儿MPFL重建治疗的儿童的临床疗效。
本研究纳入了20例8至16岁接受手术的儿童的24例MPFL重建病例。手术指征为两次或更多次髌骨脱位。MPFL重建通过将松解的股薄肌腱绕过内收大肌腱止点并穿过髌骨内侧近端边缘的钻孔来进行。术前、术后1年随访以及39个月的最终随访时，采用库贾拉评分和数字等级评定量表（NRS）疼痛评分评估临床疗效。将结果与一组采用成人MPFL重建技术治疗复发性髌骨不稳定的179例成年患者进行比较。
库贾拉评分从61（13）提高到81（16）。活动时NRS疼痛评分从3.0（3.1）改善至1.5（1.3）。4例患者（20%）在术后第一年内出现再脱位，而成人患者群体中的这一比例为5%。5例患者（25%）出现半脱位。1例再脱位患者采用成人MPFL重建技术再次手术。6例患者出现软骨损伤。
小儿患者MPFL重建后膝关节功能和疼痛有临床相关改善。小儿患者采用股骨软组织移植物固定进行MPFL重建后的髌骨稳定性低于成人患者采用股骨骨固定进行MPFL重建后的稳定性。
病例对照研究，III级。
