Quinlan Noah J, Tomasevich Kelly M, Mortensen Alexander J, Hobson Taylor E, Adeyemi Temitope, Metz Allan K, Aoki Stephen K
Department of Orthopaedic Surgery, University of Utah, Salt Lake City, U.S.A.
Arthrosc Sports Med Rehabil. 2022 Aug 8;4(5):e1589-e1599. doi: 10.1016/j.asmr.2022.05.007. eCollection 2022 Oct.
To evaluate short- to mid-term-outcomes, including instability rates, following medial patellofemoral ligament (MPFL) reconstruction in skeletally immature versus mature pediatric patients.
Patients younger than age 18 with recurrent patellar instability who underwent primary allograft MPFL reconstruction by a single surgeon from 2013 to 2019 were identified. Skeletally immature patients underwent all-epiphyseal drilling and mature patients underwent metaphyseal drilling at the Schöttle's point. Patients 1 year from surgery were contacted to complete questionnaires, which included the International Knee Documentation Committee score. Further data included chart and imaging review. Significance was determined by < .05.
Of 118 eligible patients, 88 completed questionnaires. There were 67 skeletally mature and 21 skeletally immature patients. The mature group was older (15 vs 13 years, < .001), predominantly female (67 vs 43%, = .046), and heavier (24.7 vs 18.9, < .001). Trochlear dysplasia ( = .594), concomitant procedures ( = .336), graft choice ( = .274), and follow-up length ( = .107) did not differ, although mature patients more often underwent suture tape augmentation (68 vs 13%, < .001). Immature patients had greater rates of ipsilateral injury (35 vs 16%, = .043); redislocation rate did not differ (9 vs 3%, = .225). Mature patients were more likely to respond "definitely yes or probably yes" when asked if they would undergo the same care if needed (96 vs 76%, = .007). At minimum 2-year follow-up, subsequent ipsilateral injury rates did not differ, although willingness to undergo the same care remained significant (95 vs 69%, = .010). In a multivariable elimination logistic regression model, skeletal maturity was the only variable associated with subsequent ipsilateral injury ( = .049).
Pediatric patients undergoing MPFL reconstruction have good and comparable outcomes regardless of skeletal maturity. However, younger age and lack of tape augmentation in skeletally immature patients may predispose them to subsequent injury.
III, case-control study.
评估骨骼未成熟与成熟的儿科患者在接受内侧髌股韧带（MPFL）重建术后的短期至中期结果，包括不稳定率。
确定2013年至2019年由同一外科医生进行初次同种异体MPFL重建的18岁以下复发性髌骨不稳定患者。骨骼未成熟的患者进行全骨骺钻孔，成熟患者在朔特勒点进行干骺端钻孔。对术后1年的患者进行随访以完成问卷调查，其中包括国际膝关节文献委员会评分。进一步的数据包括病历和影像学检查。显著性以P<0.05确定。
118例符合条件的患者中，88例完成了问卷调查。其中骨骼成熟患者67例，骨骼未成熟患者21例。成熟组患者年龄更大（15岁对13岁，P<0.001），女性占比更高（67%对43%，P=0.046），体重更重（24.7对18.9，P<0.001）。滑车发育不良（P=0.594）﹑伴随手术（P=0.336）﹑移植物选择（P=0.274）和随访时间（P=0.107）无差异，尽管成熟患者更常接受缝线带增强术（68%对13%，P<0.001）。未成熟患者同侧损伤发生率更高（35%对16%，P=0.043）；再脱位率无差异（9%对3%；P=0.225）。当被问及如果需要是否会接受相同治疗时，成熟患者更有可能回答“肯定会或可能会”（96%对76%，P=0.007）。在至少2年的随访中，后续同侧损伤发生率无差异，尽管接受相同治疗的意愿仍然有显著差异（95%对69%，P=0.010）。在多变量消除逻辑回归模型中，骨骼成熟度是与后续同侧损伤相关的唯一变量（P=0.049）。
接受MPFL重建的儿科患者无论骨骼成熟度如何，都有良好且可比的结果。然而，年龄较小且骨骼未成熟患者未进行缝线带增强术可能使他们更容易发生后续损伤。
III级，病例对照研究。
