CHU de Grenoble, Grenoble, France.
CHU de Grenoble, Grenoble, France.
Orthop Traumatol Surg Res. 2023 Dec;109(8):103530. doi: 10.1016/j.otsr.2022.103530. Epub 2022 Dec 21.
Medial patello-femoral ligament (MPFL) reconstruction is one of the therapeutic options to treat patellofemoral instability. Classically, a à la carte treatment of skeletal and ligament abnormalities is described. This option is difficult to achieve in children because bony procedures can damage the femoral and/or tibial growth plate. The objective was to evaluate a strategy for isolated reconstruction of the MPFL in the treatment of objective patellar instabilities in children, in a large cohort. The return to sport, knee function and pain or discomfort were studied as secondary endpoints.
This French multicenter retrospective study included 54 pediatric patients with objective patellofemoral instability. Patients were included if they had presented at least 2 episodes of objective patella dislocation. A Deie-like technique with gracilis tendon graft, soft tissue femoral fixation and patellar bone tunnels for patellar fixation was used. Recurrence of dislocation was studied as the primary endpoint, and the recurrence rate was compared with the literature. A comparison of functional scores (Kujala, Lille femoro-patellar instability score or LFPI Score and Tegner activity score) and NRS between pre- and postoperative was studied as a secondary objective.
A recurrence of femoro-patellar instability was observed for five patients within 2 years follow up (9%). A significant improvement of the Kujala, LFPI score, Tegner and NRS scores was observed (p<0.001).
Isolated reconstruction of the MPFL presents a risk of recurrence of 9% at 2years follow-up. This technique significantly improves the functional scores of the knee. This modified Deie technique provides good clinical and functional results, allowing return to sports with an acceptable risk of recurrence of patellar dislocation, similar to those observed in the literature. Isolated MPFL reconstruction as a first-line treatment appears to be a reliable and effective technique in terms of recurrence of dislocation and functional scores. It allows early recovery and rehabilitation and has lower morbidity than procedures requiring bone gestures.
III, retrospective comparative study.
内侧髌股韧带（MPFL）重建是治疗髌股不稳定的治疗选择之一。经典的治疗方法是针对骨骼和韧带异常进行逐一治疗。然而，这种方法在儿童中难以实现，因为骨骼手术可能会损伤股骨和/或胫骨生长板。本研究的目的是评估一种在儿童中针对客观髌股不稳定进行孤立性 MPFL 重建的策略，并对大量患者进行研究。将重返运动、膝关节功能和疼痛或不适作为次要终点进行研究。
这是一项法国多中心回顾性研究，共纳入 54 例有客观髌股不稳定的儿童患者。纳入标准为至少有 2 次客观髌骨脱位发作。采用 Deie 样技术，使用股薄肌腱移植物、软组织股骨固定和髌骨骨隧道进行髌骨固定。将脱位复发作为主要终点进行研究，并与文献中的复发率进行比较。作为次要目标，比较术前和术后的功能评分（Kujala、Lille 髌股不稳定评分或 LFPI 评分和 Tegner 活动评分）和 NRS。
在 2 年的随访中，有 5 例（9%）患者出现髌股不稳定复发。Kujala、LFPI 评分、Tegner 和 NRS 评分均显著改善（p<0.001）。
孤立性 MPFL 重建在 2 年随访时有 9%的复发风险。该技术可显著改善膝关节功能评分。这种改良的 Deie 技术可提供良好的临床和功能结果，使患者能够重返运动，且髌骨脱位复发率可接受，与文献报道相似。孤立性 MPFL 重建作为一线治疗方法，在脱位复发和功能评分方面似乎是一种可靠且有效的技术。它可以实现早期康复，并且与需要骨骼手术的方法相比，其发病率更低。
III，回顾性比较研究。
