Banff Sport Medicine, Banff, Alberta, Canada.
Department of Surgery, University of Calgary, Calgary, Alberta, Canada.
Am J Sports Med. 2019 Jun;47(7):1638-1644. doi: 10.1177/0363546519841371. Epub 2019 May 7.
Medial patellofemoral ligament (MPFL) reconstruction has become a well-accepted procedure for recurrent patellofemoral instability. Despite a growing volume of research assessing surgical results, the relationship of age and sex to outcomes after MPFL reconstruction surgery is unclear.
To investigate whether age at the time of surgery or sex influenced patient-reported quality of life and clinical outcome after MPFL reconstruction for recurrent lateral patellofemoral instability.
Cohort study; Level of evidence, 3.
Between January 2010 and May 2016, 328 patients underwent primary patellofemoral stabilization. Demographic and clinical data were collected preoperatively. Patients completed the Banff Patellofemoral Instability Instrument (BPII) at the pre- and postoperative visits and were assessed clinically at 12 and 24 months. To assess the effects of age at surgery and sex on BPII, multiple linear regression models were fit predicting BPII at 12 and 24 months. An unadjusted regression was applied with the predictors being age at the time of surgery and sex. A second regression model was applied adjusting for age at first dislocation, grade of trochlear dysplasia, knee hyperextension, and the WARPS/STAID score-a measure of the risky patellofemoral instability characteristics of the patient.
Of 328 patients, 298 (91%) had complete data and minimum 12-month BPII scores available for analysis. There were 11 redislocations in the cohort (3.4%), all in female patients. When stratified by sex, baseline characteristics were not statistically different except for higher age at first dislocation ( P = .022) as well as higher WARPS/STAID scores ( P = .006) for males. Age at the time of surgery was statistically significant for each postoperative follow-up, with lower BPII scores apparent for each 10-year increase in age at the time of surgery. In the adjusted model, the WARPS/STAID score was significantly associated with the preoperative BPII score. For the 24-month postoperative BPII scores, age at time of surgery and preoperative WARPS/STAID score were both significant. Lower BPII scores were apparent for each 10-year increase in age at the time of surgery, as well as for lower scores on the WARPS/STAID classification.
This study demonstrated that when adjusted for risky pathoanatomy, neither age at first dislocation nor sex influences patient-reported quality of life outcomes after MPFL reconstruction. Age at the time of surgery was correlated with outcome, with lower BPII scores apparent for each 10-year increase in age at the time of MPFL reconstruction.
内侧髌股韧带（MPFL）重建已成为复发性髌股不稳定的一种公认的手术方法。尽管有越来越多的研究评估手术结果，但年龄和性别与 MPFL 重建手术后的结果之间的关系尚不清楚。
研究手术时的年龄或性别是否影响复发性外侧髌股不稳定行 MPFL 重建后的患者报告的生活质量和临床结果。
队列研究；证据等级，3 级。
2010 年 1 月至 2016 年 5 月，328 例患者行初次髌股稳定手术。术前收集人口统计学和临床数据。患者在术前和术后访视时完成 Banff 髌股不稳定量表（BPII），并在 12 个月和 24 个月时进行临床评估。为评估手术时的年龄和性别对 BPII 的影响，采用多元线性回归模型预测 12 个月和 24 个月时的 BPII。应用未调整的回归分析，预测因子为手术时的年龄和性别。然后应用第二个回归模型，调整初次髌骨脱位的年龄、滑车发育不良的程度、膝关节过伸和 WARPS/STAID 评分（患者髌股不稳定的高危特征的衡量指标）。
在 328 例患者中，298 例（91%）具有完整的数据和至少 12 个月的 BPII 评分可用于分析。队列中有 11 例（3.4%）再次脱位，均为女性患者。按性别分层，除男性初次髌骨脱位的年龄较高（ P =.022）和 WARPS/STAID 评分较高（ P =.006）外，基线特征无统计学差异。手术时的年龄在每个术后随访中均具有统计学意义，随着手术时年龄每增加 10 岁，BPII 评分明显降低。在调整后的模型中，WARPS/STAID 评分与术前 BPII 评分显著相关。对于术后 24 个月的 BPII 评分，手术时的年龄和术前的 WARPS/STAID 评分均有统计学意义。手术时的年龄每增加 10 岁，BPII 评分明显降低，而 WARPS/STAID 分级的评分也较低。
本研究表明，当调整高危解剖结构后，初次髌骨脱位的年龄或性别均不影响 MPFL 重建后患者报告的生活质量结果。手术时的年龄与结果相关，随着 MPFL 重建时年龄每增加 10 岁，BPII 评分明显降低。
