股四头肌肌腱股骨韧带重建和内侧髌股韧带重建治疗外侧髌股不稳的临床结果无显著差异：一项匹配队列研究。
Medial quadriceps tendon femoral ligament reconstruction and medial patellofemoral ligament reconstruction have no significant differences in clinical outcomes for treatment of lateral patellar instability: a matched-cohort study.
机构信息
Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, 333 East 38th St, 4th Floor, New York, NY, 10016, USA.
Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, 333 East 38th St, 4th Floor, New York, NY, 10016, USA.
出版信息
J ISAKOS. 2024 Aug;9(4):502-509. doi: 10.1016/j.jisako.2024.03.008. Epub 2024 Mar 14.
OBJECTIVES
The purpose of this study was to compare clinical outcomes of medial quadriceps tendon-femoral ligament reconstruction (MQTFLR) and medial patellofemoral ligament reconstruction (MPFLR) among patients with recurrent lateral patellar instability.
METHODS
A retrospective matched-cohort study was conducted involving patients who underwent MQTFLR or MPFLR with or without tibial tubercle osteotomy (TTO) from 2019 to 2021. Subjects were matched 1:1 on age, concomitant osteochondral allograft (OCA), concomitant TTO, and follow-up time. Measured outcomes included 90-day complications, Visual Analog Scale (VAS) knee pain, return to sport/work, Kujala score, Tegner score, and MPFL-Return to Sport after Injury (MPFL-RSI) score. Outcomes were compared between groups using Mann-Whitney U-test for continuous variables and Fisher's exact test for categorical variables. P-values <0.05 were considered significant.
RESULTS
Ten MQTFLR patients (mean age 28.7 years, 80% female, mean follow-up 19.7 months) and ten MPFLR patients (mean age 29.1 years, 90% female, mean follow-up 28.3 months) were included in the study. One MQTFLR patient (10%) and three MPFLR patients (30%) underwent reoperation for postoperative arthrofibrosis. Postoperative VAS resting pain was not significantly different between the groups (MQTFLR mean 1.1, MPFLR mean 0.6, p = 0.31). There were no significant differences in rates of recurrent subluxations (MQTFLR 20%, MPFLR 0%, p = 0.47), return to sport (MQTFLR 50%, MPFLR 75%, p = 0.61), return to work (MQTFLR 100%, MPFLR 88%, p = 1.00), or MPFL-RSI pass rate (MQTFLR 75% vs. MPFLR 38%, p = 0.31).
CONCLUSION
There were no significant differences in knee pain and function, return to work, and rates of recurrent patellar instability between patients who underwent MQTFLR versus MPFLR, though these results should be interpreted with caution given the small sample size and potential selection bias.
LEVEL OF EVIDENCE
III.
目的
本研究旨在比较复发性外侧髌股不稳患者行内侧股四头肌腱-股韧带重建术（MQTFLR）与内侧髌股韧带重建术（MPFLR）的临床疗效。
方法
本回顾性配对队列研究纳入了 2019 年至 2021 年期间行 MQTFLR 或 MPFLR 加或不加胫骨结节骨块切除术（TTO）的患者。按照年龄、同种异体骨软骨移植（OCA）、TTO 及随访时间进行 1:1 配对。测量的结果包括 90 天内的并发症、视觉模拟评分（VAS）膝关节疼痛、重返运动/工作、Kujala 评分、Tegner 评分和髌股韧带损伤后重返运动评分（MPFL-RSI）。采用 Mann-Whitney U 检验比较两组间连续变量的差异，采用 Fisher 确切概率法比较两组间分类变量的差异。P 值<0.05 为差异有统计学意义。
结果
本研究纳入了 10 例 MQTFLR 患者（平均年龄 28.7 岁，80%为女性，平均随访 19.7 个月）和 10 例 MPFLR 患者（平均年龄 29.1 岁，90%为女性，平均随访 28.3 个月）。1 例 MQTFLR 患者（10%）和 3 例 MPFLR 患者（30%）因术后关节纤维化而行再次手术。两组术后 VAS 静息疼痛无显著差异（MQTFLR 组平均 1.1，MPFLR 组平均 0.6，p=0.31）。复发性髌骨半脱位率（MQTFLR 组 20%，MPFLR 组 0%，p=0.47）、重返运动率（MQTFLR 组 50%，MPFLR 组 75%，p=0.61）、重返工作率（MQTFLR 组 100%，MPFLR 组 88%，p=1.00）或髌股韧带损伤后重返运动评分（MQTFLR 组 75%与 MPFLR 组 38%，p=0.31）无显著差异。
结论
尽管由于样本量小且存在选择偏倚，这些结果应谨慎解释，但与行 MPFLR 相比，行 MQTFLR 的患者膝关节疼痛和功能、重返工作以及复发性髌股不稳的发生率无显著差异。
证据等级
III 级。
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