Rothman Institute, New York, New York, USA.
Division of Sports and Shoulder, Hospital for Special Surgery, New York, New York, USA.
Am J Sports Med. 2019 May;47(6):1331-1337. doi: 10.1177/0363546519835800. Epub 2019 Apr 15.
It is unclear which patients with recurrent patellar instability require a bony procedure in addition to medial patellofemoral ligament (MPFL) reconstruction.
To report 1- and 2-year outcomes of patients after isolated MPFL reconstruction performed for patellar instability regardless of patellar height, tibial tubercle-trochlear groove (TT-TG) distance, or trochlear dysplasia.
Case series; Level of evidence, 4.
All patients with recurrent patellar instability and without significant unloadable chondral defects (Outerbridge grade IV), cartilage defects (especially inferior/lateral patella), previous failed surgery, or pain >50% as their chief complaint were prospectively enrolled beginning March 2014. All patients underwent primary, unilateral, isolated MPFL reconstruction regardless of concomitant bony pathology for treatment of recurrent patellar instability. Information on recurrent subjective instability, dislocations, ability to return to sport (RTS), and outcome scores was recorded at 1 and 2 years. TT-TG distance, patellar height (with the Caton-Deschamps index), and trochlear depth were measured.
Ninety patients (77% female; mean ± SD age, 19.4 ± 5.6 years) underwent MPFL reconstruction between March 2014 and August 2017: 72 (80%) reached 1-year follow-up, and 47 (52.2%) reached 2-year follow-up (mean follow-up, 2.2 years). Mean TT-TG distance was 14.7 ± 5.4 mm (range, -2.2 to 26.8 mm); mean patellar height, 1.2 ± 0.11 mm (range, 0.89-1.45 mm); and mean trochlear depth, 1.8 ± 1.4 mm (range, 0.05-6.85 mm). Ninety-six percent of patients at 1 year and 100% at 2 years had no self-reported patellofemoral instability; 1 patient experienced a redislocation at 3.5 years. RTS rates at 1 and 2 years were 90% and 88%, respectively. Mean time to RTS was 8.8 months. All patients had clinically and statistically significant improvement in mean Knee injury and Osteoarthritis Outcome Score-Quality of Life (32.7 to 72.0, P < .001), mean International Knee Documentation Committee subjective form (51.4 to 82.6, P < .001), and mean Kujala score (62.2 to 89.5, P < .001). No difference existed between 1- and 2-year outcome scores (all P > .05).
At early follow-up of 1 and 2 years, isolated MPFL reconstruction is an effective treatment for patellar instability and provides significant improvements in outcome scores with a low redislocation/instability rate regardless of bony pathologies, including TT-TG distance, Caton-Deschamps index, and trochlear dysplasia. Future data from this cohort will be used to assess long-term outcomes.
对于复发性髌骨不稳定患者，哪些患者需要在进行内侧髌股韧带（MPFL）重建术之外进行骨手术，目前尚不清楚。
报告无论髌骨高度、胫骨结节-滑车沟（TT-TG）距离或滑车发育不良如何，均因髌骨不稳定而接受单纯 MPFL 重建的患者的 1 年和 2 年结果。
病例系列；证据水平，4 级。
所有因复发性髌骨不稳定且无明显不可负重软骨缺损（Outerbridge 分级 IV）、软骨缺损（尤其是髌骨下/外侧）、既往手术失败或疼痛>50%为主诉的患者，自 2014 年 3 月开始前瞻性入组。所有患者均接受了初次、单侧、单纯的 MPFL 重建，无论是否伴有伴发的骨病理学，以治疗复发性髌骨不稳定。在 1 年和 2 年时记录复发性主观不稳定、脱位、重返运动（RTS）能力和结果评分的信息。测量 TT-TG 距离、髌骨高度（用 Caton-Deschamps 指数）和滑车深度。
90 例患者（77%为女性；平均年龄±标准差，19.4±5.6 岁）接受了 MPFL 重建，时间在 2014 年 3 月至 2017 年 8 月之间：72 例（80%）达到 1 年随访，47 例（52.2%）达到 2 年随访（平均随访时间，2.2 年）。平均 TT-TG 距离为 14.7±5.4mm（范围，-2.2 至 26.8mm）；平均髌骨高度为 1.2±0.11mm（范围，0.89-1.45mm）；平均滑车深度为 1.8±1.4mm（范围，0.05-6.85mm）。1 年时有 96%的患者和 2 年时有 100%的患者自述髌股不稳定；1 例患者在 3.5 年后出现再脱位。1 年和 2 年的 RTS 率分别为 90%和 88%。平均 RTS 时间为 8.8 个月。所有患者的膝关节损伤和骨关节炎结局评分-生活质量（从 32.7 至 72.0，P<.001）、国际膝关节文献委员会主观评分（从 51.4 至 82.6，P<.001）和 Kujala 评分（从 62.2 至 89.5，P<.001）均有显著的临床和统计学改善。1 年和 2 年的结果评分之间无差异（均 P>.05）。
在 1 年和 2 年的早期随访中，单纯 MPFL 重建是治疗髌骨不稳定的有效方法，无论 TT-TG 距离、Caton-Deschamps 指数和滑车发育不良等骨病理学如何，都能显著提高结果评分，并降低再脱位/不稳定率。该队列的未来数据将用于评估长期结果。
