Wang Zachary, Kaplan Daniel, Dandu Navya, Haneberg Erik, Credille Kevin, Elias Tristan, Verma Nikhil, Cole Brian J, Yanke Adam B
Rush University Medical Center, Chicago, Illinois, U.S.A.
Arthrosc Sports Med Rehabil. 2024 Dec 12;7(2):101066. doi: 10.1016/j.asmr.2024.101066. eCollection 2025 Apr.
To investigate the prognostic utility of an examination under anesthesia (EUA) by evaluating the patient-reported outcome scores (PROs) and failure rates of patients undergoing primary, isolated medial patellofemoral ligament reconstruction (MPFLR) relative to their EUA findings.
A retrospective review was performed on patients who underwent primary, isolated MPFLR between August 2015 and August 2021. During the EUA the instability resolution angle (IRA) was identified by applying a lateral force on the patella through increasing knee flexion and defined by the degree of flexion the patella ceased lateral translation. PROs, including International Knee Documentation Committee (IKDC), Knee Injury and Osteoarthritis Outcome Score Jr, and Kujala, were collected at 1-year and 2-year minimum after surgery. In addition, MPFLR failure was recorded and defined by patellar redislocation.
In total, 94 patients met inclusion criteria, with 42 patients having an IRA <60° and 52 patients with an IRA ≥60° of knee flexion. At 2-year minimum follow-up, IKDC and Kujala PROs were significantly lower in patients with IRA ≥60° compared with patients with IRA <60° for both final and delta PROs. Mean tibial tubercle-trochlear groove distance examined on preoperative magnetic resonance imaging was 17.21 ± 5.00 mm for the IRA ≥60° cohort and 14.36 ± 4.89 mm for the IRA <60° cohort ( .01). Four patients redislocated their patella, and all 4 had an IRA ≥60° ( .07).
Patients who underwent isolated MPFLR with an IRA ≥60° had significantly lower IKDC and Kujala scores than similar patients with IRA <60° of knee flexion at 2-year minimum follow-up. Four (7.7%) patients with IRA ≥60° redislocated their patella, whereas zero patients with IRA <60° experienced redislocation.
Level III, retrospective cohort study.
通过评估接受初次单纯内侧髌股韧带重建术（MPFLR）患者的患者报告结局评分（PROs）以及失败率与麻醉下检查（EUA）结果的相关性，探讨EUA的预后效用。
对2015年8月至2021年8月期间接受初次单纯MPFLR的患者进行回顾性研究。在EUA期间，通过逐渐增加膝关节屈曲角度并向髌骨施加侧向力来确定不稳定解决角度（IRA），其定义为髌骨停止侧向移位时的屈曲程度。术后至少1年和2年收集PROs，包括国际膝关节文献委员会（IKDC）、膝关节损伤和骨关节炎结局评分Jr以及库贾拉评分。此外，记录MPFLR失败情况，并将其定义为髌骨再脱位。
共有94例患者符合纳入标准，其中42例患者IRA＜60°，52例患者IRA≥60°。在至少2年的随访中，对于最终和差值PROs，IRA≥60°的患者的IKDC和库贾拉PROs显著低于IRA＜60°的患者。IRA≥60°组术前磁共振成像检查的平均胫骨结节-滑车沟距离为17.21±5.00mm，IRA＜60°组为14.36±4.89mm（P＜0.01）。4例患者髌骨再脱位，且这4例患者均IRA≥60°（P=0.07）。
在至少2年的随访中，IRA≥60°的接受单纯MPFLR的患者的IKDC和库贾拉评分显著低于膝关节屈曲IRA＜60°的类似患者。IRA≥60°的患者中有4例（7.7%）髌骨再脱位，而IRA＜60°的患者无再脱位情况。
III级，回顾性队列研究。
