Orellana Kevin J, Batley Morgan G, Lawrence J Todd R, Nguyen Jie C, Williams Brendan A
University of Texas Rio Grande Valley School of Medicine, Edinburg, TX, USA.
Department of Orthopaedics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Curr Rev Musculoskelet Med. 2022 Oct;15(5):411-426. doi: 10.1007/s12178-022-09780-5. Epub 2022 Aug 6.
The purpose of this review is to highlight the radiographic assessments of utility in the evaluation of a pediatric patient with patellofemoral instability to facilitate a thorough work-up. Understanding of these measures is useful in understanding evolving research in this field, providing accurate patient risk assessment, and appropriately directing surgical decision-making.
Recent literature has broadened the radiographic characterization of the pediatric patellar instability and its anatomic risk factors. Knee MRI can inform the assessment of skeletal maturity and novel axial alignment measurements may enhance our identification of patients at increased risk of recurrent instability. Additional improvements have been made in the objective measurement and classification of trochlear dysplasia. Knee MRI-based skeletal age assessments may obviate the need for hand bone age assessments in growing children with patellofemoral instability. Novel objective measures exist in the evaluation of pediatric patellar instability both in the assessment of axial alignment and trochlear dysplasia. Future work should focus on how these measures can aid in guiding surgical decision-making.
本综述的目的是强调在评估患有髌股关节不稳定的儿科患者时，影像学评估在全面检查中的作用。了解这些测量方法有助于理解该领域不断发展的研究，提供准确的患者风险评估，并适当地指导手术决策。
近期文献拓宽了小儿髌骨不稳定及其解剖学危险因素的影像学特征。膝关节MRI可用于评估骨骼成熟度，新的轴向对线测量方法可能会增强我们对复发性不稳定风险增加患者的识别能力。在滑车发育不良的客观测量和分类方面也有了进一步改进。基于膝关节MRI的骨骼年龄评估可能使患有髌股关节不稳定的生长中儿童无需进行手部骨龄评估。在小儿髌骨不稳定的评估中，无论是轴向对线还是滑车发育不良的评估，都存在新的客观测量方法。未来的工作应集中在这些测量方法如何有助于指导手术决策。
