Department of Orthopedic Surgery, University of California, San Diego, California, USA.
Pediatric Orthopedics & Scoliosis Center, Rady Children's Hospital, San Diego, California, USA.
Am J Sports Med. 2019 Jan;47(1):66-70. doi: 10.1177/0363546518808486. Epub 2018 Nov 28.
First-time patellar dislocation with an associated chondral or osteochondral loose body is typically treated operatively to address the loose fragment. The incidence of recurrent instability in this patient population if the medial patellofemoral ligament (MPFL) is not reconstructed is unknown.
To determine the recurrent instability rate in patients undergoing surgery for patellar instability with chondral or osteochondral loose bodies, as well as to identify and stratify risk factors for recurrent instability.
Case series; Level of evidence, 4.
This was a retrospective analysis of adolescent patients treated operatively for acute patellar dislocation with associated chondral or osteochondral loose bodies between 2010 and 2016 at a single pediatric level I trauma center with minimum 2-year follow-up. Potential demographic, injury-related, radiographic, and surgical risk factors were recorded. The primary outcome variable was recurrent subluxation and/or dislocation. Secondary outcome variables included need for additional procedures, Kujala score, Single Assessment Numerical Evaluation (SANE) score, and patient satisfaction.
Forty-one patients were included. In total, 61% experienced recurrent instability at a mean follow-up of 4.1 years and 39% required subsequent MPFL reconstruction. Tibial tubercle-trochlear groove (TT-TG) distance greater than 15 mm was a risk factor for recurrent instability ( P = .03). Patients with TT-TG distance greater than 15 mm and greater than 20 mm had recurrent instability rates of 75% and 86%, respectively. MPFL repair did not reduce the rate of recurrent instability ( P = .87). Recurrent instability was associated with significantly worse mean Kujala (93.9 vs 83.0; P = .01), SANE (88.9 vs 73.1; P = .01), and patient satisfaction scores (9.4 vs 7.3; P = .002).
If the MPFL is not reconstructed during index loose body treatment, children have a 61% recurrent instability rate. Patients with TT-TG distance greater than 15 mm, and particularly greater than 20 mm, are at highest risk for recurrent instability.
初次发生伴软骨或骨软骨游离体的髌骨脱位通常需要手术治疗以解决游离体问题。如果不重建内侧髌股韧带（MPFL），该患者人群中复发性不稳定的发生率尚不清楚。
确定因髌骨不稳定伴软骨或骨软骨游离体而行手术治疗的患者的复发性不稳定率，并确定和分层复发性不稳定的危险因素。
病例系列；证据等级，4 级。
这是对 2010 年至 2016 年期间在一家单儿科一级创伤中心因急性髌骨脱位伴伴软骨或骨软骨游离体而行手术治疗的青少年患者进行的回顾性分析，所有患者均获得至少 2 年的随访。记录了潜在的人口统计学、损伤相关、影像学和手术危险因素。主要结局变量为复发性半脱位和/或脱位。次要结局变量包括需要额外的手术、Kujala 评分、单项评估数值评分（SANE）和患者满意度。
共纳入 41 例患者。在平均 4.1 年的随访中，共有 61%的患者出现复发性不稳定，39%的患者需要进行后续的 MPFL 重建。胫骨结节-滑车沟（TT-TG）距离大于 15mm 是复发性不稳定的危险因素（P=.03）。TT-TG 距离大于 15mm 和大于 20mm 的患者复发性不稳定率分别为 75%和 86%。MPFL 修复并未降低复发性不稳定的发生率（P=.87）。复发性不稳定与 Kujala 评分（93.9 比 83.0；P=.01）、SANE 评分（88.9 比 73.1；P=.01）和患者满意度评分（9.4 比 7.3；P=.002）显著降低显著相关。
如果在初次游离体治疗时不重建 MPFL，儿童的复发性不稳定率为 61%。TT-TG 距离大于 15mm，特别是大于 20mm 的患者，复发性不稳定的风险最高。
