Vo Nam Q, Nguyen Trung H, Phan Thai H
Pediatric Orthopaedic Department, Hospital for Traumatology and Orthopaedics, Ho Chi Minh, VNM.
Cureus. 2024 Apr 17;16(4):e58437. doi: 10.7759/cureus.58437. eCollection 2024 Apr.
Purpose Understanding the relevant risk factors for patellar instability and the clinical and radiographic tests necessary to determine optimal treatment. This case series intends to evaluate arthroscopic indications in the treatment of patellar instability in children. Methods From 2013 to 2021, 33 patients (seven to 16 years of age) with 35 knees sustaining first-time dislocation with loose bodies, recurrent dislocation or subluxation, and habitual dislocation were arthroscopically operated on according to the flow chart. Periods of follow-up were two to 10 years (avg. 5.5 years). Follow-up assessment included the recurrence, complications (joint stiffness and excessive reduction), and the final function outcomes by using the Kujala score. Results Among 35 knees, there were two (5.7%) first dislocations, 30 (85.7%) recurrent dislocations, and three (8.6%) habitual dislocations, lateral release 27/35 (77.1%), medial reefing 23/35 (65.7%), reconstruction of the medial patellofemoral ligament (MPFL) 12/35 (34.3%). The major complication was a knee of extensive stiffness after medial reefing and lateral release. Recurrence was in 4/35 (11.4%) of knees, not correlated to lateral release (p=0.21), medial reefing, or reconstruction of MPFL (p=0.07); in about 23 knees of medial reefing, recurrence was significantly correlated to number of knots (p=0.045). The final functional results according to Kujala were 88-100 (avg. 95.5). Conclusions This study showed the role of arthroscopy in both medial reefing and reconstruction of MPFL in children by low recurrence rate and high Kujala score at final follow-up. There was no significant correlation between recurrence and the procedures as arthroscopic indications counted on the flow chart.
目的 了解髌骨不稳定的相关危险因素以及确定最佳治疗方案所需的临床和影像学检查。本病例系列旨在评估关节镜检查在儿童髌骨不稳定治疗中的适应证。方法 2013年至2021年，33例年龄在7至16岁之间、35个膝关节首次出现脱位伴游离体、复发性脱位或半脱位以及习惯性脱位的患者，按照流程图接受了关节镜手术。随访时间为2至10年（平均5.5年）。随访评估包括复发情况、并发症（关节僵硬和过度复位）以及使用库贾拉评分评估最终功能结果。结果 在35个膝关节中，有2个（5.7%）为首次脱位，30个（85.7%）为复发性脱位，3个（8.6%）为习惯性脱位，27/35（77.1%）进行了外侧松解，23/35（65.7%）进行了内侧紧缩，12/35（34.3%）进行了髌股内侧韧带（MPFL）重建。主要并发症是内侧紧缩和外侧松解后膝关节广泛僵硬。4/35（11.4%）的膝关节出现复发，与外侧松解（p = 0.21）、内侧紧缩或MPFL重建（p = 0.07）无关；在约23个进行内侧紧缩的膝关节中，复发与打结数量显著相关（p = 0.045）。根据库贾拉评分，最终功能结果为88 - 100（平均95.5）。结论 本研究表明，关节镜检查在儿童内侧紧缩和MPFL重建中发挥了作用，最终随访时复发率低且库贾拉评分高。复发与流程图上作为关节镜检查适应证的手术操作之间无显著相关性。
