Iseki Tomoya, Nakayama Hiroshi, Daimon Takashi, Kambara Shunichiro, Kanto Ryo, Yamaguchi Motoi, Onishi Shintaro, Tachibana Toshiya, Yoshiya Shinichi
Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan.
Department of Biostatistics, Hyogo College of Medicine, Nishinomiya, Japan.
Arthrosc Sports Med Rehabil. 2020 Oct 16;2(6):e697-e704. doi: 10.1016/j.asmr.2020.04.014. eCollection 2020 Dec.
To compare the clinical utility of tibial tubercle-midepicondyle (TT-ME) and tibial tubercle-trochlear groove (TT-TG) distances in predicting the risk for recurrent instability after isolated MPFL reconstruction.
A consecutive series of patients with recurrent patellar dislocation who underwent isolated MPFL reconstruction made up the study population. The patients were followed for a minimum of 2 years. In assessment of surgical outcome, the patient was deemed to exhibit "postoperative recurrent patellar instability" when ≥1 of the following 3 conditions was identified: redislocation, positive apprehension sign, and positive J-sign (manifestation of abnormal patellar tracking). As for radiological parameters for position of the tibial tubercle, TT-ME distance (transverse distance between the tibial tubercle and midpoint of the transepicondylar line) and TT-TG distance were measured on axial computed tomography images. The clinical utility as a factor to predict the outcome of MPFL reconstruction was compared between the 2 distances using receiver operating characteristic (ROC) analysis. In addition, various radiological indices potentially influencing the surgical outcome were subjected to multivariable logistic regression analysis.
We examined 38 knees in 38 patients with a mean age at surgery of 17.6 years. Postoperative recurrent patellar instability was encountered in 8 of the 38 knees. The ROC curve analysis showed the TT-ME distance to be a significantly better indicator in predicting surgical outcome than the TT-TG distance ( = .001). The univariate analysis for radiological factors demonstrated that the TT-ME distance was significantly associated with postoperative recurrent patellar instability (odds ratio 1.42, = .012) whereas all other factors including the TT-TG distance did not correlate with recurrent instability. The multivariable logistic regression analysis revealed that only the TT-ME distance was significantly associated with recurrent instability ( = .035).
Analysis of our patient population undergoing isolated MPFL reconstruction showed that the TT-ME distance was a significantly better indicator than the TT-TG distance to predict the risk for recurrent instability after isolated MPFL reconstruction performed for patellar instability.
Level IV, therapeutic case series.
比较胫骨结节-内上髁（TT-ME）距离和胫骨结节-滑车沟（TT-TG）距离在预测单纯内侧髌股韧带（MPFL）重建术后复发性不稳定风险方面的临床效用。
连续纳入一系列接受单纯MPFL重建的复发性髌骨脱位患者组成研究人群。对患者进行至少2年的随访。在评估手术结果时，当出现以下3种情况中的至少1种时，判定患者表现为“术后复发性髌骨不稳定”：再脱位、阳性恐惧征和阳性J征（髌骨轨迹异常表现）。对于胫骨结节位置的放射学参数，在轴向计算机断层扫描图像上测量TT-ME距离（胫骨结节与髁间线中点之间的横向距离）和TT-TG距离。使用受试者操作特征（ROC）分析比较这两个距离作为预测MPFL重建结果的因素的临床效用。此外，对可能影响手术结果的各种放射学指标进行多变量逻辑回归分析。
我们检查了38例患者的38个膝关节，手术时的平均年龄为17.6岁。38个膝关节中有8个出现术后复发性髌骨不稳定。ROC曲线分析显示，TT-ME距离在预测手术结果方面明显优于TT-TG距离（P = 0.001）。放射学因素的单变量分析表明，TT-ME距离与术后复发性髌骨不稳定显著相关（优势比1.42，P = 0.012），而包括TT-TG距离在内的所有其他因素与复发性不稳定均无相关性。多变量逻辑回归分析显示，只有TT-ME距离与复发性不稳定显著相关（P = 0.035）。
对我们接受单纯MPFL重建的患者群体的分析表明，在预测因髌骨不稳定而进行的单纯MPFL重建术后复发性不稳定风险方面，TT-ME距离明显优于TT-TG距离。
IV级，治疗性病例系列。
