Morgan Vince K, Warrier Alec A, Credille Kevin, Wang Zachary, Elias Tristan, Haneberg Erik, Hevesi Mario, Yanke Adam B
Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA.
Department of Orthopedics, Houston Methodist Hospital, Houston, Texas, USA.
Orthop J Sports Med. 2025 Apr 3;13(4):23259671251322724. doi: 10.1177/23259671251322724. eCollection 2025 Apr.
Various medial patellofemoral ligament (MPFL) reconstruction techniques have been developed to minimize risks to the physis in skeletally immature patients.
To examine outcomes of MPFL reconstruction (MPFLR) based on fixation technique in skeletally immature patients.
Systematic review; Level of evidence, 4.
PubMed, Scopus, Ovid, Cochrane Library, and CINAHL databases were searched for the literature on outcomes of MPFLR in the pediatric population, utilizing various anatomic and nonanatomic techniques. Primary outcomes were postoperative redislocation rates, return-to-sports (RTS) rates, and patient-reported outcomes (PROs). Moreover, outcomes involving sequela of growth plate disturbance were collected.
The final analysis included 17 studies-2 using sling-based techniques, 3 using surface-based techniques, 5 using soft tissue realignments, and 7 utilizing transosseous femoral fixations. Higher rates of postoperative redislocation were found in the sling-based (14.8%) and distal soft tissue realignment using semitendinosus tenodesis (38%) techniques, while lower rates were noted with surface-based (1.3%) and transosseous (3.4%) techniques. For PROs, there were large amounts of heterogeneity among studies, but all reported postoperative improvements, with more positive PROs generally seen in anatomic reconstructions. The RTS rate was 100% for surface-based techniques, 79.4% for distal soft tissue realignments, 79.5% for soft tissue realignment techniques, and 83.2% for transosseous techniques. No negative outcomes as a sequela of growth plate disturbance were reported.
Nonanatomic techniques-such as sling-based and distal soft tissue realignment techniques-have higher rates of redislocation and lower RTS rates in skeletally immature patients undergoing MPFLR. Surface-based and transosseous tunnel-based techniques were shown to have lower redislocation and higher RTS rates.
This review provides insight into the most appropriate surgical management of patellar instability in patients with open growth plates.
已经开发出多种内侧髌股韧带（MPFL）重建技术，以将骨骼未成熟患者的骨骺风险降至最低。
基于固定技术，研究骨骼未成熟患者MPFL重建（MPFLR）的结果。
系统评价；证据等级，4级。
检索PubMed、Scopus、Ovid、Cochrane图书馆和CINAHL数据库，以获取有关小儿人群中MPFLR结果的文献，这些文献采用了各种解剖学和非解剖学技术。主要结果是术后再脱位率、恢复运动（RTS）率和患者报告的结果（PROs）。此外，还收集了涉及生长板紊乱后遗症的结果。
最终分析包括17项研究，2项使用吊带技术，3项使用表面技术，5项使用软组织重新排列，7项使用经骨股骨固定。使用吊带技术（14.8%）和半腱肌腱固定的远端软组织重新排列技术（38%）的术后再脱位率较高，而表面技术（1.3%）和经骨技术（3.4%）的再脱位率较低。对于PROs，各研究之间存在大量异质性，但所有研究均报告术后有所改善，解剖重建中通常可见更积极的PROs。表面技术的RTS率为100%，远端软组织重新排列为79.4%，软组织重新排列技术为79.5%，经骨技术为83.2%。未报告生长板紊乱后遗症的负面结果。
在接受MPFLR的骨骼未成熟患者中，非解剖技术，如吊带技术和远端软组织重新排列技术，具有较高的再脱位率和较低的RTS率。表面技术和经骨隧道技术显示出较低的再脱位率和较高的RTS率。
本综述为生长板开放患者髌股关节不稳定的最合适手术治疗提供了见解。
