Ntagiopoulos Panagiotis, Pozzi Pierrenzo, Kalinterakis Georgios, Fligkos Dimitris, Dimou Triantafyllia, Compagnoni Riccardo, Ferrua Paolo, Randelli Pietro Simone
Hip and Knee Unit Mediterraneo Hospital Athens Greece.
U.O.C. 1° Clinica Ortopedica, ASST G. Pini-CTO Milan Italy.
J Exp Orthop. 2024 Oct 22;11(4):e70063. doi: 10.1002/jeo2.70063. eCollection 2024 Oct.
Recurrent patellar dislocation is a prevalent orthopaedic issue among active paediatric and adolescent populations. Bony surgical procedures are not recommended in growing patients; therefore, the focus of surgery is on restoring the medial patellar ligaments, with different reconstructive techniques available. This retrospective case series focuses on the 2-year outcomes of medial patellofemoral ligament (MPFL) reconstruction in skeletally immature patients with open physis.
Twenty-four consecutive patients with patellofemoral instability and open growth plates underwent anatomic MPFL reconstruction with a physeal-sparing technique. All subjects have had more than three episodes of true patellar dislocations. Preoperative radiographic examination included anteroposterior and lateral views to assess patella alta and limb alignment. Magnetic resonance imaging was performed to evaluate trochlear dysplasia and tibial tubercle-trochlear groove (TT-TG) distance. The patients were questioned regarding complications and clinical outcomes using the visual analogue scale (VAS), Kujala and Paediatric International Knee Documentation Committee (Pedi-IKDC) score. Variables were evaluated using paired test with significance at < 0.05.
The mean age at the time of operation was 13.04 years (9-16 years). The cohort was followed for a mean duration of 38.66 months (24-86 months). The mean time from injury to surgery was 50.45 days (16-80 days). No growth arrest, limb-length discrepancies or angular deformities were observed post-operatively during the whole follow-up period. No patellar re-dislocations were recorded throughout the study period. The VAS score improved significantly from 5.67 (4-8) to 1.88 (0-4) ( < 0.01). The Kujala score improved significantly from 64.67 (44-81) preoperatively to 87.58 (77-100) post-operatively ( < 0.01). The Pedi-IKDC also increased significantly from 58.81 (34.80-77.70) preoperatively to 90.64 (70.70-100) post-operatively ( < 0.01). The vast majority of patients (87.5%) returned to their pre-injury activity level. Boys scored better than girls in VAS, Pedi-IKDC and Kujala score post-operatively, but these differences were not statistically significant.
Physeal-sparing MPFL reconstruction in children and adolescents yields excellent midterm results and allows patients to return to sports without redislocation of the patella. Boys scored better than girls in VAS, Pedi-IKDC and Kujala score post-operatively, but these differences were not statistically significant.
IV: case series with no comparative group.
复发性髌骨脱位是活跃的儿童和青少年人群中普遍存在的骨科问题。对于仍在生长发育的患者，不建议进行骨性手术；因此，手术重点在于恢复髌内侧韧带，目前有多种重建技术可供选择。本回顾性病例系列研究聚焦于骨骼未成熟且骨骺开放的患者行髌股内侧韧带（MPFL）重建术后2年的疗效。
连续24例患有髌股关节不稳定且骨骺开放的患者接受了保留骨骺技术的解剖学MPFL重建术。所有受试者均有超过3次真正的髌骨脱位发作。术前影像学检查包括前后位和侧位片，以评估髌骨高位和肢体对线情况。进行磁共振成像以评估滑车发育不良和胫骨结节 - 滑车沟（TT - TG）距离。使用视觉模拟量表（VAS）、库贾拉评分和小儿国际膝关节文献委员会（Pedi - IKDC）评分对患者进行并发症及临床疗效方面的询问。使用配对t检验评估变量，P < 0.05具有统计学意义。
手术时的平均年龄为13.04岁（9 - 16岁）。该队列平均随访38.66个月（24 - 86个月）。受伤至手术的平均时间为50.45天（16 - 80天）。在整个随访期间，术后未观察到生长停滞、肢体长度差异或角形畸形。在整个研究期间未记录到髌骨再次脱位。VAS评分从术前的5.67（4 - 8）显著改善至1.88（0 - 4）（P < 0.01）。库贾拉评分从术前的64.67（44 - 81）显著提高至术后的87.58（77 - 100）（P < 0.01）。Pedi - IKDC评分也从术前的58.81（34.80 - 77.70）显著提高至术后的90.64（70.70 - 100）（P < 0.01）。绝大多数患者（87.5%）恢复到受伤前的活动水平。术后男孩在VAS、Pedi - IKDC和库贾拉评分方面优于女孩，但这些差异无统计学意义。
儿童和青少年保留骨骺的MPFL重建术可产生优异的中期疗效，并使患者能够恢复运动且髌骨不再脱位。术后男孩在VAS、Pedi - IKDC和库贾拉评分方面优于女孩，但这些差异无统计学意义。
IV：无比较组的病例系列。
