Department of Orthopaedic Surgery, Atrium Health, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC, 28207, USA.
OrthoCarolina Sports Medicine Center, 1915 Randolph Road, Charlotte, NC, 28207, USA.
Knee Surg Sports Traumatol Arthrosc. 2022 Jul;30(7):2227-2234. doi: 10.1007/s00167-021-06784-5. Epub 2021 Nov 7.
To determine the reoperation rate, risk factors for reoperation, and patient-reported outcomes after isolated or combined tibial tubercle transfer and medial patellofemoral ligament reconstruction, for patellofemoral instability surgery.
Patient's records who underwent medial patellofemoral ligament reconstruction and/or tibial tubercle transfer for patellar instability by 35 surgeons from 2002 to 2018 at a single academic institution were retrospectively reviewed using CPT codes. Four-hundred-and-eighty-six patients were identified. Radiographic measurements, demographic parameters, and subsequent revision procedures and their indications were identified. A modified anterior knee pain survey was conducted by mail and with follow-up phone survey.
The overall rate of reoperation was 120/486 (24.7%). The most common cause for reoperation was removal of hardware 42/486 (8.6%). The rate of reoperation for isolated medial patellofemoral ligament reconstruction 43/226 (19%) was lower than that of isolated tibial tubercle transfer 45/133 (33.8%) or a combined procedure 32/127 (25.2%) (P = 0.007). Woman had a higher rate of reoperation (29.4%) compared to men (15.9%) (P = 0.002). Patients at risk for a revision stabilization procedure included those with severe trochlear morphology (C or D) (6.1%) and those with Caton-Deschamps index > 1.3 (7.3%). Patients who underwent reoperation of any kind had poorer patient-reported outcomes.
The overall reoperation rate after patellofemoral instability surgery remains high, and any reoperation portends worse patient-reported outcomes. Re-operations for instability are more likely in patients with trochlear dysplasia and patella alta and may benefit from more aggressive initial treatment, such as medial patellofemoral ligament reconstruction and tibial tubercle transfer in combination. Using the results of this study, surgeons will be able to engage in meaningful discussion with patients to counsel patients on expectations postoperatively.
IV.
确定孤立或联合胫骨结节转移和内侧髌股韧带重建后髌股不稳定手术的再次手术率、再次手术的危险因素和患者报告的结果。
通过 CPT 代码回顾了 2002 年至 2018 年间，35 位外科医生在单一学术机构对髌股不稳定患者进行内侧髌股韧带重建和/或胫骨结节转移的患者记录。共确定了 486 名患者。确定了影像学测量、人口统计学参数以及随后的修订程序及其适应证。通过邮件和后续电话调查进行改良的前膝痛调查。
总体再手术率为 120/486（24.7%）。再手术最常见的原因是 42/486 例（8.6%）取出内固定物。单纯内侧髌股韧带重建的再手术率 43/226（19%）低于单纯胫骨结节转移 45/133（33.8%）或联合手术 32/127（25.2%）（P=0.007）。女性的再手术率（29.4%）高于男性（15.9%）（P=0.002）。有风险进行修订稳定手术的患者包括滑车形态严重（C 或 D）（6.1%）和 Caton-Deschamps 指数>1.3（7.3%）的患者。任何类型的再手术患者的患者报告结果都较差。
髌股不稳定手术后的总体再手术率仍然很高，任何再手术都预示着患者报告的结果更差。不稳定的再手术更可能发生在滑车发育不良和髌骨高位的患者中，可能受益于更积极的初始治疗，如内侧髌股韧带重建和胫骨结节转移的联合治疗。使用本研究的结果，外科医生将能够与患者进行有意义的讨论，以向患者提供术后预期的咨询。
IV。
