Felus Jaroslaw, Kowalczyk Bart, Starmach Michal, Wyrobek Lukasz
Pediatric Orthopedics and Trauma Surgery Department, University Children's Hospital, Krakow, Poland.
Orthop J Sports Med. 2022 Jul 14;10(7):23259671221107608. doi: 10.1177/23259671221107608. eCollection 2022 Jul.
Osteochondral fractures (OCFs) are common injuries during acute patellar dislocation (APD), carrying a high risk of early joint deterioration if left untreated. The recommended approach is reduction and stable fixation; however, data on the results of such treatment are limited.
To evaluate midterm results of fixation of APD-related OCFs in adolescents and to identify predictive factors for poor outcomes.
Case series; Level of evidence, 4.
This was a retrospective analysis of adolescent patients who underwent internal fixation of APD-related OCFs between 2004 and 2015 at a single tertiary pediatric trauma center. The primary outcome variables included Knee injury and Osteoarthritis Outcome Score (KOOS), patient satisfaction (0-10 scale), and sports participation compared with preoperative level. Secondary outcome variables included relationship between final results and OCF location (patellofemoral vs tibiofemoral), surgical delay (>6 weeks), and patellar instability after OCF fixation. OCF healing was evaluated using magnetic resonance imaging (MRI).
Included were 40 patients (19 female, 21 male) with 42 OCFs (29 patellar OCFs, 13 lateral femoral condyle OCFs). The median patient age at surgery was 14.5 years (interquartile range [IQR], 13-15.5 years), and median follow-up was 76 months (IQR, 52.5-95 months). Recurrence of patellar instability occurred in 27.5% of patients. Median overall KOOS was 93.8 (IQR, 90.8-97.6); KOOS-Symptoms, 92.9 (IQR, 85.7-96.4); KOOS-Pain, 97.2 (IQR, 91.7-100); KOOS-Activities of Daily Living, 100 (IQR, 97.1-100); KOOS-Sports, 90 (IQR, 80-100); and KOOS-Quality of Life, 78.1 (IQR, 56.2-87.5). Median satisfaction score was 8 (IQR, 8-9), and 16 patients (40%) returned to sports participation at their preinjury level. MRI scans revealed a 100% rate of bone healing. Abnormalities exceeding the fracture area were evident on MRI scans in 86.5% of patients. Recurrence of patellar instability (even after surgical fixation) and unstable patella at final follow-up were independent predictors of worse results after OCF fixation.
In the current study, reduction and internal fixation for APD-related OCF in adolescents yielded favorable midterm outcomes. Recurrence of dislocation and persistent patellar instability jeopardized clinical results.
骨软骨骨折（OCFs）是急性髌骨脱位（APD）期间的常见损伤，如果不治疗，早期关节退变风险很高。推荐的方法是复位和稳定固定；然而，关于这种治疗结果的数据有限。
评估青少年APD相关OCFs固定的中期结果，并确定预后不良的预测因素。
病例系列；证据等级，4级。
这是一项对2004年至2015年在一家三级儿科创伤中心接受APD相关OCFs内固定治疗的青少年患者的回顾性分析。主要结局变量包括膝关节损伤和骨关节炎结局评分（KOOS）、患者满意度（0-10分）以及与术前水平相比的运动参与情况。次要结局变量包括最终结果与OCF位置（髌股关节与胫股关节）、手术延迟（>6周）以及OCF固定后髌骨不稳定之间的关系。使用磁共振成像（MRI）评估OCF愈合情况。
纳入40例患者（19例女性，21例男性），共42处OCFs（29处髌骨OCFs，13处股骨外侧髁OCFs）。手术时患者的中位年龄为14.5岁（四分位间距[IQR]，13 - 15.5岁），中位随访时间为76个月（IQR，52.5 - 95个月）。27.5%的患者出现髌骨不稳定复发。总体KOOS的中位数为93.8（IQR，90.8 - 97.6）；KOOS - 症状，92.9（IQR，85.7 - 96.4）；KOOS - 疼痛，97.2（IQR，91.7 - 100）；KOOS - 日常生活活动，100（IQR，97.1 - 100）；KOOS - 运动，90（IQR，80 - 100）；KOOS - 生活质量，78.1（IQR，56.2 - 87.5）。满意度评分的中位数为8（IQR，8 - 9），16例患者（40%）恢复到受伤前的运动参与水平。MRI扫描显示骨愈合率为100%。86.5%的患者MRI扫描显示骨折区域以外存在异常。髌骨不稳定复发（即使在手术固定后）以及最终随访时髌骨不稳定是OCF固定后结果较差的独立预测因素。
在本研究中，青少年APD相关OCF的复位和内固定产生了良好的中期结果。脱位复发和持续的髌骨不稳定危及临床结果。
