Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Orthop J Sports Med. 2016 Aug 31;4(8):2325967116662873. doi: 10.1177/2325967116662873. eCollection 2016 Aug.
Treatment of patellofemoral instability has evolved as our understanding of the relevant pathoanatomy has improved. In light of these developments, current practice patterns and management trends have likely changed to reflect these advancements; however, this has not been evaluated in a formal study.
To determine nationwide patient demographics, surgical trends, and postoperative complications associated with the operative management of patellar instability surgery.
Descriptive epidemiological study.
A large private-payer database (PearlDiver) comprising patients covered by Humana and United Healthcare insurance policies was retrospectively reviewed using Current Procedural Terminology (CPT) codes to identify patients who underwent surgery for patellar instability. The study cohort was established by querying for patients billed under CPT codes 27420, 27422, or 27427 while satisfying the diagnostic requirement of patellar instability (International Classification of Diseases-9th Revision codes 718.36, 718.86, or 836.3). Patient demographics, surgical trends, concomitant procedures, and postoperative complications were determined.
A total of 6190 patients underwent surgical management for patellar instability. Adolescents (age range, 10-19 years) represented 51.5% of cases, and 59.6% were female. The number of patellar instability procedures increased annually over the study period in both the Humana (P = .004, R (2) = 0.76) and United Healthcare (P = .097, R (2) = 0.54) cohorts. The most common concomitant procedures were lateral retinacular release (43.7%), chondroplasty (31.1%), tibial tubercle osteotomy (13.1%), removal of loose bodies (10.5%), osteochondral grafting (9.5%), and microfracture surgery (9.5%). Manipulation under anesthesia was required in 4.6% of patients within 1 year. Patellar fracture within 1 year and infection within 30 days occurred in 2.1% and 1.2% of patients, respectively.
Patellar instability surgery has increased over the past decade. This finding may be attributed to growing clinical evidence to support these procedures as well as increased surgeon familiarity and comfort with these specific techniques. We observed an unexpectedly high rate of concomitant lateral retinacular release. Overall, the rates of commonly recognized complications (stiffness, patellar fracture, and postoperative infection) were similar to those observed in smaller case series.
随着我们对相关病理解剖学的理解的提高，髌股不稳定的治疗方法也在不断发展。有鉴于此，当前的实践模式和管理趋势可能已经发生了变化，以反映这些进展；然而，这并没有在正式研究中得到评估。
确定全国范围内与髌股不稳定手术相关的患者人口统计学资料、手术趋势和术后并发症。
描述性流行病学研究。
使用当前程序术语 (CPT) 代码对 Humana 和 United Healthcare 保险政策涵盖的患者进行大型私人支付者数据库 (PearlDiver) 的回顾性审查，以确定接受髌股不稳定手术的患者。通过查询 CPT 代码 27420、27422 或 27427 并满足髌股不稳定的诊断要求 (国际疾病分类第 9 版代码 718.36、718.86 或 836.3) 来建立研究队列。确定了患者人口统计学资料、手术趋势、伴随手术和术后并发症。
共有 6190 例患者接受了髌股不稳定的手术治疗。青少年 (10-19 岁) 占 51.5%，女性占 59.6%。在研究期间，Humana (P =.004，R (2) = 0.76) 和 United Healthcare (P =.097，R (2) = 0.54) 队列中，髌股不稳定手术的数量每年都在增加。最常见的伴随手术是外侧支持带松解术 (43.7%)、软骨成形术 (31.1%)、胫骨结节截骨术 (13.1%)、游离体取出术 (10.5%)、骨软骨移植物 (9.5%) 和微骨折手术 (9.5%)。在 1 年内，4.6%的患者需要在麻醉下进行手法复位。髌股骨折和 30 天内感染的发生率分别为 2.1%和 1.2%。
过去十年中，髌股不稳定手术有所增加。这一发现可能归因于越来越多的临床证据支持这些手术，以及外科医生对这些特定技术的熟悉程度和舒适度的提高。我们观察到伴随外侧支持带松解术的比例出乎意料地高。总的来说，常见并发症 (僵硬、髌股骨折和术后感染) 的发生率与较小的病例系列相似。
