Ryskamp David, Meeks Brett D, Gonzalez Roberto, Cavendish Parker A, Milliron Eric, DiBartola Alex C, Duerr Robert A, Flanigan David C, Magnussen Robert A
Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
Orthop J Sports Med. 2024 Dec 13;12(12):23259671241274769. doi: 10.1177/23259671241274769. eCollection 2024 Dec.
Patellar dislocation is a common knee injury and up to 35% of those who dislocate the patella can develop recurrent patellar instability. In the setting of recurrent instability, medial patellofemoral ligament (MPFL) reconstruction is often performed to restore knee stability. There has been recent interest in patient and surgical factors that influence outcomes of MPFL reconstruction. Much of the previous work has focused on influences of anatomic measures; however, patients and injury characteristics may also impact surgical outcomes.
Patients who experience >2 patellar dislocations before MPFL reconstruction would demonstrate poorer patient-reported outcomes (PROs) compared with those with ≤2 previous dislocations.
Cohort study; Level of evidence, 3.
Records were reviewed to identify patients who underwent MPFL reconstruction at a single institution between 2008 and 2016. Patients who underwent concomitant tibial tubercle osteotomy or fixation of an osteochondral fracture were excluded. Patient demographics (age, sex, body mass index [BMI]), number of previous patellar dislocations, and patient anatomic measures (Caton-Deschamps index (CDI), tibial tubercle-trochlear groove (TT-TG) distance, and trochlear sulcus angle) were collected. PROs were assessed with Norwich Patellar Instability score, Knee injury and Osteoarthritis Outcome Score (KOOS), and Marx activity score. Outcomes of patients with >2 patellar dislocations were compared with those with ≤2 dislocations using multiple linear regression analysis.
Medical record review revealed 160 patients who underwent isolated MPFL reconstruction (71 with ≥2 dislocations and 89 with >2 dislocations); 95 patients (59%) completed PROs at a median follow-up of 4.6 years postoperation (range, 1.0-12.6 years). Patients with ≥2 dislocations were younger (≥2 dislocations: 20.7 ± 7.3 years, >2 dislocations: 28.5 ± 10.0 years; < .001), although there were no other differences in demographics or radiographic anatomic measures between groups. Adjusting for age, sex, BMI, CDI, TT-TG distance, and trochlear sulcus angle, patients with >2 dislocations had 13.7 points lower KOOS-Pain ( = .003), 8.3 points lower KOOS-Activities of Daily Living ( = .025), 18.2 points lower KOOS-Sports and Recreation ( = .009), and 19.8 points lower KOOS-Knee-Related Quality of Life ( = .008) subscale scores than patients with ≤2 dislocations. No significant differences in KOOS symptoms subscale, Norwich Patellar Instability, or Marx score were noted between groups.
Patients with >2 patellar dislocations before MPFL reconstruction exhibited poorer PROs at a median of 4.8 years postoperation compared with those who had ≤2 dislocations before surgery, when adjusting for age, sex, BMI, CDI, TT-TG distance, and trochlear sulcus angle.
髌骨脱位是一种常见的膝关节损伤，高达35%的髌骨脱位患者会出现复发性髌骨不稳定。在复发性不稳定的情况下，常进行内侧髌股韧带（MPFL）重建以恢复膝关节稳定性。最近，人们对影响MPFL重建结果的患者和手术因素产生了兴趣。以前的许多工作都集中在解剖学测量的影响上；然而，患者和损伤特征也可能影响手术结果。
与之前髌骨脱位≤2次的患者相比，在MPFL重建前经历>2次髌骨脱位的患者在患者报告结局（PROs）方面表现更差。
队列研究；证据等级，3级。
回顾记录，以确定2008年至2016年期间在单一机构接受MPFL重建的患者。排除同时接受胫骨结节截骨术或骨软骨骨折固定术的患者。收集患者人口统计学资料（年龄、性别、体重指数[BMI]）、既往髌骨脱位次数以及患者解剖学测量数据（Caton-Deschamps指数[CDI]、胫骨结节-滑车沟[TT-TG]距离和滑车沟角）。使用诺维奇髌骨不稳定评分、膝关节损伤和骨关节炎结局评分（KOOS）以及马克思活动评分评估PROs。采用多元线性回归分析比较髌骨脱位>2次的患者与脱位≤2次的患者的结局。
病历回顾显示160例患者接受了单纯MPFL重建（71例脱位≥2次，89例脱位>2次）；95例患者（59%）在术后中位随访4.6年（范围1.0 - 12.6年）时完成了PROs评估。脱位≥2次的患者更年轻（≥2次脱位：20.7±7.3岁，>2次脱位：28.5±10.0岁；P <.001），尽管两组在人口统计学或影像学解剖学测量方面没有其他差异。在调整年龄、性别、BMI、CDI、TT-TG距离和滑车沟角后，脱位>2次的患者的KOOS-疼痛亚量表评分比脱位≤2次的患者低13.7分（P = .003），KOOS-日常生活活动亚量表评分低8.3分（P = .025），KOOS-运动和娱乐亚量表评分低18.2分（P = .009），KOOS-膝关节相关生活质量亚量表评分低19.8分（P = .008）。两组在KOOS症状亚量表、诺维奇髌骨不稳定评分或马克思评分方面未发现显著差异。
在调整年龄、性别、BMI、CDI、TT-TG距离和滑车沟角后，与术前脱位≤2次的患者相比，MPFL重建前髌骨脱位>2次的患者在术后中位4.8年时PROs表现更差。
