关节镜下外侧支持带松解治疗以髌股内侧韧带为中心的青少年膝关节疼痛
Arthroscopic Lateral Retinacular Release in Adolescents With Medial Patellofemoral Ligament-centered Knee Pain.
作者信息
Blackman Andrew J, Smith June C, Luhmann Scott J
机构信息
*Department of Orthopaedic Surgery, Washington University School of Medicine †St Louis Children's Hospital ‡St Louis Shriners Hospital, St Louis, MO.
出版信息
J Pediatr Orthop. 2016 Apr-May;36(3):268-73. doi: 10.1097/BPO.0000000000000445.
BACKGROUND
The medial patellofemoral ligament (MPFL) has been implicated as a common pain generator in adolescents with anterior knee pain. The purpose of this study is to report the clinical outcomes of arthroscopic lateral retinacular release (ALRR) for refractory MPFL-centered pain and to identify risk factors for poor outcomes and surgical failures.
METHODS
A single-surgeon database was queried to identify all patients undergoing ALRR. Inclusion criteria included minimum 12-month follow-up and ALRR performed for MPFL pain rather than for generalized anterior knee pain or patellar instability. All patients had persistent MPFL-centered pain despite participating in a nonsurgical protocol before surgery. Primary outcomes included International Knee Documentation Committee (IKDC) subjective score and need for further surgery, typically tibial tubercle osteotomy (TTO).
RESULTS
Eighty-eight knees in 71 patients [66 female, 5 male; average age, 15.7 y (range, 8.4 to 20.2 y)] were included. Average follow-up was 59 months (range, 12 to 138 mo). Average preoperative IKDC score was 41.9 (range, 18.4 to 67.8), whereas average postoperative IKDC score was 77.8 (range, 11.5 to 98.9; P<0.01). Postoperative IKDC scores were worse in patients with a preoperative sulcus angle of <134 degrees than those with sulcus angle of ≥134 degrees (69.9±22.1 vs. 82.0±12.5, P=0.04). Lower preoperative IKDC score correlated negatively with improvement of IKDC score postoperatively (r=-0.40, P<0.05). Seventeen knees (19.3%) subsequently underwent TTO for persistent symptoms. Patients who ultimately required TTO were younger than patients who did not (14.8±1.5 vs. 15.9±2.1; P=0.04) and had lower mean preoperative Blackburne-Peel ratio (0.95±0.25 vs. 1.11±0.24; P=0.02).
CONCLUSIONS
This study demonstrates that patients with refractory MPFL-centered knee pain had significant improvements in clinical outcomes after undergoing ALRR at mean 5 years' follow-up. Poor outcomes and surgical failures were associated with lower preoperative IKDC score, younger age, lower preoperative Blackburne-Peel ratio, and sulcus angle of <134 degrees. Outcomes were not recorded prospectively, but mean IKDC scores <60 months postoperatively were similar to those collected ≥60 months after surgery (80.4 vs. 78.3, P=0.15).
LEVEL OF EVIDENCE
Level IV.
背景
内侧髌股韧带（MPFL）被认为是青少年前膝痛的常见疼痛根源。本研究的目的是报告关节镜下外侧支持带松解术（ALRR）治疗以MPFL为中心的顽固性疼痛的临床结果，并确定预后不良和手术失败的危险因素。
方法
查询单一外科医生的数据库，以确定所有接受ALRR的患者。纳入标准包括至少12个月的随访，以及因MPFL疼痛而非广泛性前膝痛或髌股不稳定而进行的ALRR。所有患者在手术前尽管参与了非手术方案，但仍存在以MPFL为中心的持续性疼痛。主要结果包括国际膝关节文献委员会（IKDC）主观评分以及是否需要进一步手术，通常是胫骨结节截骨术（TTO）。
结果
纳入了71例患者的88个膝关节[66例女性，5例男性；平均年龄15.7岁（范围8.4至20.2岁）]。平均随访时间为59个月（范围12至138个月）。术前IKDC平均评分为41.9（范围18.4至67.8），而术后IKDC平均评分为77.8（范围11.5至98.9；P<0.01）。术前沟角<134度的患者术后IKDC评分比沟角≥134度的患者更差（69.9±22.1对82.0±12.5，P=0.04）。术前IKDC评分较低与术后IKDC评分的改善呈负相关（r=-0.40，P<0.05）。17个膝关节（19.3%）随后因持续症状接受了TTO。最终需要TTO的患者比不需要的患者更年轻（14.8±1.5对15.9±2.1；P=0.04），术前平均Blackburne-Peel比率更低（0.95±0.25对1.11±0.24；P=0.02）。
结论
本研究表明，以MPFL为中心的顽固性膝关节疼痛患者在平均5年的随访后接受ALRR后临床结果有显著改善。预后不良和手术失败与术前IKDC评分较低、年龄较小、术前Blackburne-Peel比率较低以及沟角<134度有关。结果未进行前瞻性记录，但术后<60个月的平均IKDC评分与术后≥60个月收集的评分相似（80.4对78.3，P=0.15）。
证据级别
IV级。
Zotero 插件