Department of Orthopaedic Surgery, University of Utah.
University of Utah.
J Pediatr Orthop B. 2024 Mar 1;33(2):119-129. doi: 10.1097/BPB.0000000000001102. Epub 2023 Aug 15.
Genu valgum contributes to patellar instability, though outcomes following temporary hemiepiphysiodesis via eight plating are less understood. The purpose of this study was to evaluate the outcomes and need for additional procedures following temporary hemiepiphysiodesis for the treatment of pediatric genu valgum and patellar instability, as well as evaluating the utility of a concurrent medial patellofemoral ligament (MPFL) repair. Patients who underwent medial distal femoral epiphysiodesis for the treatment of genu valgum and recurrent patellar instability were identified. Inclusion criteria were minimum 1-year follow-up and lack of concurrent ligamentous reconstruction. Patients were contacted to complete a questionnaire which included the International Knee Documentation Committee (IKDC) form and questions pertaining to knee function and patient satisfaction. Thirty-one patients aged 12.0 ± 1.9 years underwent 47 guided growth procedures and were included in final analysis. Seventeen knees (36%) required subsequent surgery for patellar instability. All patients requiring subsequent surgery were female, compared with 70% of patients not requiring subsequent surgery ( P = 0.017). The MPFL repair group underwent fewer subsequent procedures to address instability, though this difference was NS (17 vs. 46%, P = 0.318). Mean IKDC score at 5.3 years follow-up among 18 survey respondents was 78.6. Medial distal femoral hemiepiphysiodesis may partially address recurrent patellar instability in skeletally immature patients with genu valgum. Concurrent MPFL repair may minimize the need for subsequent procedures to address recurrent instability. While correcting alignment may be helpful, patients should be aware of the potential need for further patellar instability surgery. Level of evidence: IV, case series.
膝内翻导致髌骨不稳定，尽管通过 8 块钢板进行临时骺板切开固定术的结果了解较少。本研究的目的是评估临时骺板切开固定术治疗儿童膝内翻和髌骨不稳定的结果和需要进一步手术的情况，以及评估同期内侧髌股韧带（MPFL）修复的效果。确定了因膝内翻和复发性髌骨不稳定而行内侧股骨远端骺板切开固定术的患者。纳入标准为至少 1 年的随访且无同期韧带重建。联系患者完成一份问卷，其中包括国际膝关节文献委员会（IKDC）表格和与膝关节功能及患者满意度相关的问题。31 名年龄 12.0±1.9 岁的患者接受了 47 次引导生长手术，最终纳入分析。17 个膝关节（36%）因髌骨不稳定需要进一步手术。所有需要进一步手术的患者均为女性，而不需要进一步手术的患者中 70%为女性（P=0.017）。需要进一步手术以解决不稳定的 MPFL 修复组，尽管这一差异无统计学意义（17 对 46%，P=0.318）。18 名调查对象中有 17 名在 5.3 年随访时的 IKDC 平均评分为 78.6。骺板切开固定术可能部分解决骨骼未成熟的膝内翻患者的复发性髌骨不稳定。同期 MPFL 修复可能会减少解决复发性不稳定所需的进一步手术。虽然矫正排列可能有帮助，但患者应意识到进一步髌骨不稳定手术的潜在需求。证据水平：IV，病例系列。
