Cincinnati Children's Hospital, Department of Orthopaedic Surgery, Cincinnati, OH.
J Pediatr Orthop. 2023 Apr 1;43(4):237-245. doi: 10.1097/BPO.0000000000002351. Epub 2023 Jan 23.
Habitual and fixed patellar dislocations represent extreme forms of patellar instability and can lead to significant functional loss. The underlying complex pathoanatomy of a laterally positioned and shortened extensor mechanism poses challenges in its management. The purpose of our study was to evaluate the anatomic risk factors and outcomes of a 4-in-1 quadricepsplasty (wide lateral releases, Insall proximal tube realignment, Roux-Goldthwait patellar tendon hemi-transfer, and step-wise quadriceps lengthening) for stabilization of habitual and fixed patellar dislocation.
In a retrospective study, all patients with habitual and fixed patellar dislocation who underwent 4-in-1 quadricepsplasty and had a minimum 2-year follow-up were identified. Preoperative magnetic resonance imagings were evaluated for the presence of anatomic risk factors. As a prospective part of the study, patient-reported outcomes were collected using validated instruments including Pedi-IKDC, HSS-Pedi FABS activity score, BPII 2.0 score, Kujala score, and KOOS score.
Seventeen knees (12 patients) formed the study cohort. Twelve knees had habitual dislocation (9 in extension and 4 in flexion) and 5 had fixed dislocation. Mean age was 9 years. 6/17 (35.3%) knees were associated with syndromes. On magnetic resonance imaging, trochlear dysplasia was the most common anatomic risk factor present in 15/17 (88.2%) knees. 13/17 (76%) knees had presence of 2 or more risk factors. At the mean follow-up of 43.3 months, the mean Pedi-IKDC score was 88.1, the HSS-Pedi FABS activity score was 15.6, the BPII 2.0 score was 78.2, the Kujala score was 90, KOOS score was 93.9, and overall patient satisfaction score was 83.3. For complications, 3/17 knees (17.6%) had recurrent patellar instability, 1 knee had postoperative stiffness that required manipulation under anesthesia and 1 knee had a superficial wound infection.
Most patients with habitual and fixed patellar dislocation present during the first decade of life. There are several underlying anatomic risk factors, the most common being trochlear dysplasia and patellar tilt. The 4-in-1 quadricepsplasty technique provides reliable patellar stabilization, satisfactory clinical results, and acceptable patient-reported outcomes at a minimum 2-year follow-up, with a 17.6% redislocation rate.
Level IV.
习惯性和固定性髌骨脱位代表了髌骨不稳定的极端形式，可导致显著的功能丧失。外侧定位和缩短的伸肌机制的复杂潜在病理解剖结构给其治疗带来了挑战。我们研究的目的是评估 4-in-1 股四头肌成形术（广泛的外侧松解、Insall 近端管重新排列、Roux-Goldthwait 髌腱半转移和逐步股四头肌延长）对于习惯性和固定性髌骨脱位稳定化的解剖风险因素和结果。
在一项回顾性研究中，我们确定了所有接受 4-in-1 股四头肌成形术且随访时间至少 2 年的习惯性和固定性髌骨脱位患者。对术前磁共振成像进行评估，以确定是否存在解剖学风险因素。作为研究的前瞻性部分，使用经过验证的工具（包括 Pedi-IKDC、HSS-Pedi FABS 活动评分、BPII 2.0 评分、Kujala 评分和 KOOS 评分）收集患者报告的结果。
17 个膝关节（12 名患者）形成了研究队列。12 个膝关节有习惯性脱位（9 个在伸展位和 4 个在屈曲位），5 个有固定性脱位。平均年龄为 9 岁。6/17（35.3%）个膝关节与综合征有关。在磁共振成像上，滑车发育不良是最常见的解剖学风险因素，存在于 17/17（88.2%）个膝关节中。13/17（76%）个膝关节存在 2 个或更多的风险因素。在平均 43.3 个月的随访中，平均 Pedi-IKDC 评分为 88.1，HSS-Pedi FABS 活动评分为 15.6，BPII 2.0 评分为 78.2，Kujala 评分为 90，KOOS 评分为 93.9，总体患者满意度评分为 83.3。并发症方面，3/17（17.6%）个膝关节出现复发性髌骨不稳定，1 个膝关节出现术后僵硬，需要在全身麻醉下进行手法复位，1 个膝关节出现浅表伤口感染。
大多数习惯性和固定性髌骨脱位患者在生命的第一个十年出现。存在多种潜在的解剖学风险因素，最常见的是滑车发育不良和髌骨倾斜。4-in-1 股四头肌成形术技术可提供可靠的髌骨稳定化、满意的临床结果和可接受的患者报告结果，在至少 2 年的随访中，复发性脱位率为 17.6%。
IV 级。
