Fisher Michael, Singh Satbir, Samora Walter P, Beran Matthew C, Klingele Kevin E
Department of Orthopedic Surgery, Nationwide Children's Hospital, Columbus, OH.
J Pediatr Orthop. 2021 Aug 1;41(7):e494-e498. doi: 10.1097/BPO.0000000000001836.
Recurrent instability following a lateral patellar dislocation is a common indication for surgical intervention. Several surgical procedures are described in the literature to address recurrent patellar instability. Medial patellofemoral ligament (MPFL) reconstruction utilizing the quadriceps turndown technique attempts to restore medial stability. Results of the quadriceps turndown technique have previously only been reported in adult populations. The purpose of this study was to assess the safety, efficacy, and patient-reported outcomes following a quadriceps turndown MPFL reconstruction in the pediatric and adolescent population.
Records of all patients who underwent MPFL reconstruction using a quadriceps turndown technique between 2011 and 2018 were reviewed for demographics, risk factors, complications, mechanism of injury, and concomitant procedures. Return to activities of daily living (ADLs), return to presurgery level of sport, length of bracing, and recurrent instability were assessed with the administration of the Kujala Anterior Knee Pain Score. All analyses were completed using IBM SPSS Statistics 26.
Thirty-six knees [14 female (39%), 22 male (61%)] from 34 patients met inclusion/exclusion criteria. The average follow-up length was 35.9±15.2 months. The average age was 16.3±1.8 years at the time of surgery. The average time for resumption of ADLs was 8.1±6.0 weeks after surgery. Ninety-four percent of patients returned to preinjury level of sport at an average of 23.6±12.0 weeks after surgery. Mean Kujala Anterior Knee Pain Score was 90.7±10.3. Female patients (P<0.001) reported significantly lower Kujala scores. Three patients (8%) experienced recurrent instability during ADLs and an additional 4 (11%) reported subjective feelings of instability only during sport or elevated activity. One knee required a return to the operating room for irrigation and debridement due to infection.
This study demonstrates that the quadriceps turndown technique for MPFL reconstruction is a safe and effective procedure for the management of recurrent patellar instability in pediatric and adolescent patients.
Level III-therapeutic.
髌骨外侧脱位后复发性不稳定是手术干预的常见指征。文献中描述了几种治疗复发性髌骨不稳定的手术方法。采用股四头肌翻转技术重建髌股内侧韧带（MPFL）试图恢复内侧稳定性。股四头肌翻转技术的结果此前仅在成人人群中报道过。本研究的目的是评估在儿童和青少年人群中采用股四头肌翻转MPFL重建术后的安全性、有效性以及患者报告的结局。
回顾了2011年至2018年间所有采用股四头肌翻转技术进行MPFL重建的患者的记录，包括人口统计学资料、危险因素、并发症、损伤机制和伴随手术。通过使用库贾拉前膝痛评分来评估恢复日常生活活动（ADL）的情况、恢复术前运动水平的情况、支具佩戴时间以及复发性不稳定情况。所有分析均使用IBM SPSS Statistics 26完成。
34例患者的36个膝关节[14例女性（39%），22例男性（61%）]符合纳入/排除标准。平均随访时间为35.9±15.2个月。手术时的平均年龄为16.3±1.8岁。术后恢复ADL的平均时间为8.1±6.0周。94%的患者在术后平均23.6±12.周恢复到受伤前的运动水平。库贾拉前膝痛评分的平均值为90.7±10.3。女性患者（P<0.001）报告的库贾拉评分明显较低。3例患者（8%）在ADL期间出现复发性不稳定，另外4例（11%）仅在运动或高强度活动期间报告有主观不稳定感。1例膝关节因感染需要返回手术室进行冲洗和清创。
本研究表明，采用股四头肌翻转技术进行MPFL重建是治疗儿童和青少年复发性髌骨不稳定的一种安全有效的方法。
三级治疗性。
