Reikersdorfer Kristen, Wright Connor, Jayne Chris, Federico Sofia, Grottkau Brian, Paschos Nikolaos
Department of Orthopedics, Massachusetts General Hospital, Boston, Massachusetts, U.S.A.; Harvard Medical School, Boston, Massachusetts, U.S.A.
Department of Orthopedics, Massachusetts General Hospital, Boston, Massachusetts, U.S.A.; University of Michigan Medical School, Ann Arbor, Michigan, U.S.A.
Arthroscopy. 2025 Jan 30. doi: 10.1016/j.arthro.2025.01.021.
To evaluate the clinical outcomes of nonoperative versus operative treatment, consisting of combined medial patellofemoral ligament and medial quadriceps tendon femoral ligament (MPFL/MQTFL) reconstruction, for first-time patellar dislocation in the skeletally immature population through a standardized, rigorous approach.
This consecutive retrospective cohort was composed of all skeletally immature patients who sustained a first-time patellofemoral dislocation. Patients were grouped into nonoperative management (bracing and physical therapy) and operative management (MPFL/MQTFL reconstruction) cohorts. The primary outcome, failure, was defined as subsequent dislocation or subluxation. Additional outcomes included demographics, risk factors for patellofemoral instability, functional outcomes (Kujala and Pediatric International Knee Documentation Committee scores), return to sports, and complications. Minimum follow-up was 2 years. A correlation analysis attempted to identify potential associations between failure and risk factors.
In total, 142 consecutive patients were included with 90 patients in the nonoperative group and 52 patients in the operative group. Failure rates differed by intervention; those receiving operative management had significantly lower failure rates than conservative management (15.4% vs 58.8%, P < .0001). Kujala and Pediatric International Knee Documentation Committee scores were significantly greater in the operative group compared with the nonoperative group (91.5 ± 7.8 vs 82.5 ± 12.1, P < .0001 and 89.0 ± 9.3 vs 78.4 ± 12.9, P < .0001, respectively). Tegner activity level was also greater in the operative group (6.0 ± 1.4 vs 4.0 ± 1.4, P < .0001). Return to sport was significantly greater for those in the operative group (88.5% vs 66.2%, P < .001). Return to same level of activity was achieved in greater percentage of patients treated surgically (91.3% vs 69.6%, P = .0075). Complication rates were more frequent in the operative group compared with the nonoperative group (11.5% vs 1.1%, P < .001).
MPFL/MQTFL reconstruction in skeletally immature patients with first-time patellofemoral dislocation demonstrated lower failure rates and improved functional outcomes at a minimum 2-year follow-up compared with nonoperative management.
Level III, retrospective cohort study.
通过标准化、严格的方法，评估非手术治疗与手术治疗（包括联合髌股内侧韧带和股四头肌内侧头韧带重建，即MPFL/MQTFL重建）对骨骼未成熟人群首次髌骨脱位的临床疗效。
本连续回顾性队列研究纳入了所有骨骼未成熟的首次髌骨脱位患者。患者被分为非手术治疗组（支具固定和物理治疗）和手术治疗组（MPFL/MQTFL重建）。主要结局指标“失败”定义为随后的脱位或半脱位。其他结局指标包括人口统计学特征、髌股关节不稳定的危险因素、功能结局（Kujala评分和儿童国际膝关节文献委员会评分）、恢复运动情况及并发症。最小随访时间为2年。进行相关性分析以确定失败与危险因素之间的潜在关联。
总共纳入142例连续患者，其中非手术组90例，手术组52例。失败率因治疗方式而异；接受手术治疗的患者失败率显著低于保守治疗（15.4%对58.8%，P <.0001）。与非手术组相比，手术组的Kujala评分和儿童国际膝关节文献委员会评分显著更高（分别为91.5±7.8对82.5±12.1，P <.0001；89.0±9.3对78.4±12.9，P <.0001）。手术组的Tegner活动水平也更高（6.0±1.4对4.0±1.4，P <.0001）。手术组患者恢复运动的比例显著更高（88.5%对66.2%，P <.001）。接受手术治疗的患者恢复到相同活动水平的比例更高（91.3%对69.6%，P =.0075）。与非手术组相比，手术组的并发症发生率更高（11.5%对1.1%，P <.001）。
在至少2年的随访中，对于骨骼未成熟的首次髌骨脱位患者，MPFL/MQTFL重建与非手术治疗相比，失败率更低，功能结局更好。
III级，回顾性队列研究。
