Roberts Tobias, Casey Laura, Abelleyra Lastoria Diego Agustín, Walters Samuel, Smith Toby, Hing Caroline
St. George's University Hospitals NHS Foundation Trust, London, SW17 0QT, UK.
University of Warwick, Coventry, CV4 7AJ, UK.
J Clin Orthop Trauma. 2024 Nov 27;60:102835. doi: 10.1016/j.jcot.2024.102835. eCollection 2025 Jan.
medial patellofemoral ligament reconstruction (MPFLr) is a common surgical procedure for treating patellar instability. Grafts can be fixed to the femur using a bone-tunnel technique with an interference screw. However, this may lead to femoral tunnel enlargement (FTE) post-operatively. The aim of this study was to assess the correlation between time after MPFLr and FTE, to evaluate factors that might influence FTE and to determine if FTE can be reliably evaluated with plain radiographs.
we conducted a single-surgeon series, retrospective review of 70 MPFLr (52 female; 18 male) between 2014 and 2022. We assessed change in femoral tunnel area compared with original tunnel area (TP0), on lateral radiographs at two time points. Time point one (TP1): mean 34 days (standard deviation (SD): 25); and Time Point 2 (TP2): mean 490 days (SD: 333). We analysed the relationship between surgical characteristics to FTE, and assessed inter- and intra-rater reliability of FTE.
tunnel area significantly increased from TP0 to TP1 and TP2 (p < 0.001). Mean percentage increase in cross-sectional tunnel area (CTA) between TP0 and TP1 was 113 % (SD: 49 %). Mean percentage increase in CTA between TP0 and TP2 was 139 % (SD: 64 %). There were 25 cases (36 %) of tunnel malposition. There was no significant correlation between distance from the isometric point and FTE at TP1 (r = 0.05; 95 % confidence intervals (CI): -0.19 to 0.29) or TP2 (r = 0.17: 95 % CI: -0.068 to 0.39). There were no other significant correlations with FTE. Inter-rater reliability for FTE at TP1 was moderate (Inter-Class Coefficient (ICC): 0.67; 95 % CI: 0.47 to 0.80; p < 0.001), with intra-rater reliability being excellent (ICC: 0.94; 95 % CI: 0.90 to 0.96; p < 0.001).
FTE after MPFLr is common. Plain radiographs can be used reliably to monitor tunnel enlargement in clinical practice.
内侧髌股韧带重建术（MPFLr）是治疗髌骨不稳的常见外科手术。可使用带挤压螺钉的骨隧道技术将移植物固定于股骨。然而，这可能导致术后股骨隧道扩大（FTE）。本研究的目的是评估MPFLr术后时间与FTE之间的相关性，评估可能影响FTE的因素，并确定平片能否可靠地评估FTE。
我们对2014年至2022年间由单一外科医生进行的70例MPFLr手术（52例女性；18例男性）进行了回顾性研究。我们在两个时间点的侧位X线片上评估股骨隧道面积相对于原始隧道面积（TP0）的变化。时间点1（TP1）：平均34天（标准差（SD）：25）；时间点2（TP2）：平均490天（SD：333）。我们分析了手术特征与FTE之间的关系，并评估了FTE的评分者间和评分者内信度。
从TP0到TP1和TP2，隧道面积显著增加（p < 0.001）。TP0与TP1之间横断面隧道面积（CTA）的平均百分比增加为113%（SD：49%）。TP0与TP2之间CTA的平均百分比增加为139%（SD：64%）。有25例（36%）隧道位置不当。在TP1（r = 0.05；95%置信区间（CI）：-0.19至0.29）或TP2（r = 0.17：95%CI：-0.068至0.39）时，距等距点的距离与FTE之间无显著相关性。与FTE无其他显著相关性。TP1时FTE的评分者间信度为中等（组内相关系数（ICC）：0.67；95%CI：0.47至0.80；p < 0.001），评分者内信度极佳（ICC：0.94；95%CI：0.90至0.96；p < 0.001）。
MPFLr术后FTE很常见。在临床实践中，平片可可靠地用于监测隧道扩大情况。
