Markes Alexander R, Ghanta Ramesh B, Zhang Alan L, Ma C Benjamin, Feeley Brian T, Lansdown Drew A
Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, California, U.S.A.
Arthrosc Sports Med Rehabil. 2024 Sep 6;6(6):100994. doi: 10.1016/j.asmr.2024.100994. eCollection 2024 Dec.
To use a large nationwide administrative database to directly compare usage, complications, and need for revision stabilization surgery after medial patellofemoral ligament reconstruction (MPLFR), tibial tubercle osteotomy (TTO), and combined MPFLR and TTO (MPFLRTTO).
The PearlDiver Mariner database was queried for all reported cases of MPLFR, TTO, and combined MPFLRTTO performed between 2010 and 2020 using Current Procedural Terminology codes. Subsets from those cohorts with laterality-specific , , codes for patellar instability were used to evaluate 2-year incidence of infection, stiffness, fracture, and revision stabilization with MPFLR and/or TTO. Multiple linear regression and χ analysis were used to analyze incidence trends and to compare complication rates.
A total of 70,070 patients were identified. MPFLR was found to be the most common procedure (73.1%), followed by TTO (19.2%) and then MPFLRTTO (7.6%). MPLFR was observed to have the lowest overall complication rate (5.4%), whereas both TTO (7.5%) and MPFLRTTO (7.1%) had greater complication rates ( < .001). MPFLR had the greatest rate of revision stabilization surgery at 3.7% compared with TTO at 2.7% and MPFLRTTO, which carried the lowest risk for revision at 2.4% ( < .001).
Isolated MPFLR is the most common modality used for patellar instability, with increasing prevalence and the lowest 2-year complication rate. Isolated TTO was unchanged in its use and had the greatest overall complication rate. Combined MPFLRTTO increased the overall complication rate but had a lower 2-year rate of recurrent instability requiring revision than MPFLR alone.
Level III, retrospective cohort study.
利用一个大型全国性管理数据库，直接比较髌股内侧韧带重建术（MPLFR）、胫骨结节截骨术（TTO）以及MPLFR与TTO联合手术（MPFLRTTO）后的使用情况、并发症以及翻修稳定手术的必要性。
使用当前手术操作术语编码，在PearlDiver Mariner数据库中查询2010年至2020年间所有报告的MPLFR、TTO以及联合MPFLRTTO病例。从那些具有髌骨不稳定特定侧别编码的队列子集中，评估MPLFR和/或TTO术后2年感染、僵硬、骨折以及翻修稳定的发生率。采用多元线性回归和χ分析来分析发生率趋势并比较并发症发生率。
共识别出70,070例患者。发现MPLFR是最常见的手术方式（73.1%），其次是TTO（19.2%），然后是MPFLRTTO（7.6%）。观察到MPLFR的总体并发症发生率最低（5.4%），而TTO（7.5%）和MPFLRTTO（7.1%）的并发症发生率更高（P <.001）。MPLFR的翻修稳定手术率最高，为3.7%，而TTO为2.7%，MPFLRTTO的翻修风险最低，为2.4%（P <.001）。
单纯MPLFR是治疗髌骨不稳定最常用的方式，其患病率不断增加且2年并发症发生率最低。单纯TTO的使用情况未变，总体并发症发生率最高。联合MPFLRTTO增加了总体并发症发生率，但与单独的MPLFR相比，2年复发性不稳定需要翻修的发生率较低。
III级，回顾性队列研究。
