Department of Orthopedics, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China.
Key Laboratory of Biomechanics of Hebei Province, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China.
Int Orthop. 2019 Jun;43(6):1495-1501. doi: 10.1007/s00264-018-4243-x. Epub 2018 Nov 20.
The acute primary (first-time) lateral patellar dislocation is associated with a high rate of functional disability. There is no consensus as to the choice of surgical or non-surgical treatment for these patients. The aim of this study is to compare the clinical results between the surgical (reconstruction of the medial patellofemoral ligament [MPFL]) and non-surgical treatments for acute primary patellar dislocations.
Sixty-nine skeletally mature patients (69 knees) were included in this prospective non-randomized controlled trial. At least one predisposing factor for patellar dislocation (including patella alta, high lateral patellar tilt, trochlear dysplasia, and increased TT-TG distance) was identified in the included patients. Thirty patients were treated surgically with MPFL reconstruction, and the other 39 patients were treated non-surgically. The main outcome variable was patellar redislocation within a two year follow-up period. The Kujala questionnaire was applied for analyzing the pain and the quality of life. The additional surgeries due to patellofemoral problems were also recorded.
Patellar redislocation occurred in eight patients in the non-surgical group, while no redislocation occurred in the surgical group (P < 0.05). Four patients in non-surgical group underwent further surgery due to patellar redislocation and poor function during the follow-up period. The Kujala score and the percentage of "good/excellent" results on the Kujala score of the surgical group were significantly better than that of the non-surgical group (P < 0.05).
The surgical MPFL reconstruction achieved better clinical outcomes compared with non-surgical treatment for the acute primary patellar dislocation in the skeletally mature patients with the presence of abnormal patellofemoral anatomy. Surgery should be considered as the better choice for these specific patients.
急性初次（首次）外侧髌骨脱位与较高的功能障碍发生率相关。对于这些患者，手术或非手术治疗的选择尚无共识。本研究旨在比较急性初次髌骨脱位患者的手术（内侧髌股韧带[MPFL]重建）和非手术治疗的临床结果。
这项前瞻性非随机对照试验纳入了 69 例骨骼成熟患者（69 膝）。纳入患者中至少存在一种髌骨脱位的易患因素（包括高位髌骨、高位外侧髌骨倾斜、滑车发育不良和 TT-TG 距离增加）。30 例患者接受了 MPFL 重建手术治疗，另外 39 例患者接受了非手术治疗。主要结局变量是两年随访期间髌骨再脱位。采用 Kujala 问卷评估疼痛和生活质量。还记录了由于髌股问题而进行的额外手术。
非手术组中有 8 例患者发生髌骨再脱位，而手术组无髌骨再脱位（P<0.05）。非手术组中有 4 例患者因髌骨再脱位和随访期间功能不佳而接受进一步手术。手术组的 Kujala 评分和 Kujala 评分“良好/优秀”的比例均明显优于非手术组（P<0.05）。
对于骨骼成熟且髌股解剖异常的急性初次髌骨脱位患者，与非手术治疗相比，MPFL 重建手术可获得更好的临床结果。对于这些特定患者，手术应被视为更好的选择。
