Tufts Medical Center, Boston, Massachusetts.
Orthopaedic Services, Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A.
Arthroscopy. 2019 Oct;35(10):2909-2915. doi: 10.1016/j.arthro.2019.05.007.
To comparatively evaluate the clinical outcomes and rates of recurrent instability in young patients with primary medial patellofemoral ligament (MPFL) repair or reconstruction, as well as to assess for radiologic risk factors for worse outcomes.
A retrospective review identified all patients with lateral patellar instability who underwent either MPFL repair and/or imbrication or MPFL reconstruction without any additional osseous procedures between 2008 and 2015 at a single center. Demographic variables and preoperative magnetic resonance imaging were analyzed, and Kujala scores were obtained at a minimum 2-year follow-up. Risk factors for worse outcomes were assessed, including the Caton-Deschamps Index (CDI) Insall-Salvati Index, tibial tubercle-trochlear groove distance, and tibial tubercle-posterior cruciate ligament distance.
We identified 51 knees with isolated MPFL surgery (reconstruction in 32 and imbrication and/or repair in 19) at a mean of 59.7 months' follow-up (range, 24-121 months). The overall rate of recurrent dislocations was significantly greater in the repair group (36.9%) versus the reconstruction group (6.3%, P = .01), despite the average CDI being significantly higher in the reconstruction group (1.34 vs 1.23 in repair group, P = .04). No significant difference in the rate of return to baseline activity was found between the groups (77.8% in reconstruction group vs 70% in repair group, P = .62). The average Kujala score showed no significant difference between the repair and reconstruction groups (84.15 ± 14.2 vs 84.83 ± 14.38, P = .72). No imaging measurements were found to be predictive of a worse postoperative Kujala score; however, the average CDI among the MPFL repair failures (1.30 ± 0.05) was significantly higher than among the MPFL repair nonfailures (1.18 ± 0.12, P = .03).
MPFL reconstruction may provide improved midterm clinical outcomes and a decreased recurrence rate compared with MPFL repair. Increased patellar height as measured by the CDI may be a risk factor for recurrent patellar instability in patients who undergo isolated MPFL repair.
Level III, retrospective comparative study.
比较原发性内侧髌股韧带（MPFL）修复或重建的年轻患者的临床结果和复发性不稳定的发生率，并评估影像学结果不良的相关风险因素。
对 2008 年至 2015 年在单中心接受外侧髌股不稳治疗的患者进行回顾性分析，治疗方式为 MPFL 修复和/或重叠术或 MPFL 重建，不进行任何其他骨手术。分析患者的人口统计学变量和术前磁共振成像（MRI），并在至少 2 年的随访时获取 Kujala 评分。评估与较差结果相关的风险因素，包括 Caton-Deschamps 指数（CDI）、Insall-Salvati 指数、胫骨结节-滑车沟距离和胫骨结节-后十字韧带距离。
共纳入 51 例孤立性 MPFL 手术患者（重建 32 例，重叠和/或修复 19 例），平均随访 59.7 个月（范围 24-121 个月）。修复组的复发性脱位率明显高于重建组（36.9%比 6.3%，P=0.01），尽管重建组的平均 CDI 明显更高（1.34 比修复组的 1.23，P=0.04）。两组患者的活动能力恢复至基线水平的比例无显著差异（重建组为 77.8%，修复组为 70%，P=0.62）。修复组和重建组的 Kujala 评分平均值无显著差异（84.15±14.2 比 84.83±14.38，P=0.72）。影像学测量值均未发现与术后 Kujala 评分较差相关；然而，MPFL 修复失败患者的平均 CDI（1.30±0.05）明显高于 MPFL 修复非失败患者（1.18±0.12，P=0.03）。
与 MPFL 修复相比，MPFL 重建可能提供更好的中期临床结果和降低复发率。CDI 测量的髌骨高度增加可能是接受孤立性 MPFL 修复的患者复发性髌骨不稳定的风险因素。
III 级，回顾性比较研究。
