Matuszewski Łukasz, Tramś Marek, Ciszewski Andrzej, Wilczyński Michał, Tramś Ewa, Jakubowski Paweł, Matuszewska Anna, John Kishore
Pediatric Orthopedics and Rehabilitation Clinic, Medical University of Lublin.
The Center of Sports Medicin Warsaw, Warsaw.
Medicine (Baltimore). 2018 Dec;97(50):e13605. doi: 10.1097/MD.0000000000013605.
Many surgical procedures have been described to treat recurrent patellar dislocation, but none of these techniques has been successful in all patients. The goal of the study was to evaluate the results of medial patellofemoral ligament reconstruction in children. Two operative procedures were evaluated; a fascia lata allograft and an autologous gracilis graft.
Forty-four children (27 girls and 17 boys) between 13 and 17 years of age with unilateral recurrent patellar dislocation underwent medial patellofemoral ligament (MPFL) reconstruction. Patients were operated in two orthopedic centers. The 1st group contained 22 patients and surgery was performed using a fascia lata allograft. In the 2nd group of patients which also contained 22 children and autologous gracilis graft was used. The mean age of the patients was 14.9 years and the mean follow-up was 24 months. Preoperatively, all patients were evaluated clinically (Kujala score questionnaire) and radiologically. The same evaluation was used 18 to 30 months postoperatively to estimate the results of our treatment.
In 1st group of children operated with cadaver allografts, the Kujala score significantly improved from 73.91 points preoperatively to 94.50 points postoperatively (P < .001). The average duration of operating procedure was 1 hour and 35 minutes. As shown by subjective symptoms, the results in 95% of patients were rated as good or very good. All children returned to full activity. Similar results were obtained in patients in 2nd group, where MPFL was reconstructed with ipsilateral gracilis tendon. Kujala score increased from 70.77 points preoperatively to 94.32 postoperatively (P < .001). Our results were estimated as good or very good in 93% of patients. All patients that were operated returned to full activity. However, median duration of operation was longer and lasted 1 hour and 55 minutes.
Both techniques were effective in the short-term (18-30 months) in treatment of recurrent patellar dislocation. The use of cadaver allograft spares the hamstring muscles and reduces the time of surgery. Therefore, such study appears to be useful because it provides valuable information that would help to guide treatment of this condition in children. Level of evidence II-2.
已有多种手术方法用于治疗复发性髌骨脱位，但这些技术均未在所有患者中取得成功。本研究的目的是评估儿童内侧髌股韧带重建的效果。评估了两种手术方法；阔筋膜同种异体移植和自体股薄肌移植。
44名年龄在13至17岁之间的单侧复发性髌骨脱位儿童（27名女孩和17名男孩）接受了内侧髌股韧带（MPFL）重建。患者在两个骨科中心接受手术。第一组有22名患者，手术采用阔筋膜同种异体移植。第二组患者也有22名儿童，采用自体股薄肌移植。患者的平均年龄为14.9岁，平均随访时间为24个月。术前，所有患者均接受临床（库贾拉评分问卷）和影像学评估。术后18至30个月采用相同的评估方法来评估我们的治疗效果。
在第一组接受尸体同种异体移植手术的儿童中，库贾拉评分从术前的73.91分显著提高到术后的94.50分（P<0.001）。手术平均时长为1小时35分钟。主观症状显示，95%的患者结果被评为良好或非常好。所有儿童均恢复了完全活动。在第二组采用同侧股薄肌腱重建MPFL的患者中也获得了类似结果。库贾拉评分从术前的70.77分提高到术后的94.32分（P<0.001）。93%的患者结果被评为良好或非常好。所有接受手术的患者均恢复了完全活动。然而，手术中位时长更长，持续了1小时55分钟。
两种技术在短期（18 - 30个月）内治疗复发性髌骨脱位均有效。使用尸体同种异体移植可保留腘绳肌并缩短手术时间。因此，这项研究似乎很有用，因为它提供了有价值的信息，有助于指导儿童这种疾病的治疗。证据等级II - 2。
