Pappa Nicholas, Flanigan David C, Long Joseph, Dorweiler Matthew, Fowler Brian, Duerr Robert, Dibartola Alex C, Kaeding Christopher K, Magnussen Robert A
Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio, USA.
Orthop J Sports Med. 2022 Jun 29;10(6):23259671221104414. doi: 10.1177/23259671221104414. eCollection 2022 Jun.
Patella alta and elevated tibial tubercle-trochlear groove (TT-TG) distance can predispose patients to lateral patellar dislocations and recurrent instability. Their influence on patient-reported outcomes (PROs) after medial patellofemoral ligament (MPFL) reconstruction is less clear.
We hypothesized that neither moderately increased TT-TG distance nor patella alta would negatively affect PROs after isolated MPFL reconstruction in patients with relatively normal patellar tracking (no large J-sign).
Cohort study; Level of evidence, 3.
We identified patients who underwent isolated MPFL reconstruction at a single institution between 2008 and 2016. The decision to perform an isolated MPFL reconstruction was at the discretion of the operating surgeon but was not performed in the setting of a large J-sign. Patient characteristics and surgical details were collected, and patients completed the Norwich Patellar Instability Score, Knee injury and Osteoarthritis Outcome Score, and Marx activity score. Patellar height (Caton-Deschamps Index [CDI]) was assessed on preoperative lateral radiographs, and TT-TG distance was measured on preoperative axial magnetic resonance imaging (MRI) scans. Patients were grouped based on CDI and TT-TG distance, and outcomes were compared. Linear regression modeling was performed to determine whether patella alta or elevated TT-TG distance was associated with poorer PRO scores.
Of 165 knees in 152 patients who underwent isolated MPFL reconstruction, 115 patients (125 knees; 76%) with minimum 1-year follow-up were contacted at a mean of 5.2 years after surgery. Recurrent dislocation occurred in 5 of 125 knees (4%). Preoperative radiographs were available in 111 knees (89%), and preoperative MRI scans were available in 89 knees (71%). Mean CDI was 1.13, and 35% had a CDI ≥1.20. Mean TT-TG distance was 17.5 mm, and 26% had a TT-TG distance >20 mm. After adjusting for patient age, sex, body mass index, and graft choice, we observed that neither patella alta nor elevated TT-TG distance were associated with poorer PROs.
Isolated MPFL reconstruction in the setting of moderately elevated TT-TG distance or patella alta was not associated with worse PROs in this cohort with relatively normal patellar tracking (no large J-sign).
高位髌骨和胫骨结节-滑车沟（TT-TG）距离增加会使患者易发生髌骨外侧脱位和复发性不稳定。它们对内侧髌股韧带（MPFL）重建术后患者报告结局（PROs）的影响尚不清楚。
我们假设，对于髌股轨迹相对正常（无大J征）的患者，单纯MPFL重建术后，TT-TG距离适度增加和高位髌骨均不会对PROs产生负面影响。
队列研究；证据等级，3级。
我们纳入了2008年至2016年间在单一机构接受单纯MPFL重建的患者。是否进行单纯MPFL重建由手术医生决定，但大J征患者不进行该手术。收集患者特征和手术细节，患者完成诺维奇髌骨不稳定评分、膝关节损伤和骨关节炎结局评分以及马克思活动评分。术前通过侧位X线片评估髌骨高度（Caton-Deschamps指数[CDI]），术前通过轴向磁共振成像（MRI）扫描测量TT-TG距离。根据CDI和TT-TG距离对患者进行分组，并比较结局。进行线性回归建模以确定高位髌骨或TT-TG距离增加是否与较差的PRO评分相关。
152例接受单纯MPFL重建的患者共165膝，其中115例患者（125膝；76%）在术后平均5.2年时接受随访，随访时间至少1年。125膝中有5膝（4%）发生复发性脱位。111膝（89%）有术前X线片，89膝（71%）有术前MRI扫描。平均CDI为1.13，35%的患者CDI≥1.20。平均TT-TG距离为17.5 mm，26%的患者TT-TG距离>20 mm。在对患者年龄、性别、体重指数和移植物选择进行校正后，我们观察到高位髌骨和TT-TG距离增加均与较差的PROs无关。
在本队列中，对于髌股轨迹相对正常（无大J征）的患者，在TT-TG距离适度增加或高位髌骨情况下进行单纯MPFL重建与较差的PROs无关。
