Heyworth Benton E, Hidalgo Perea Sofia, Green Daniel W, Veerkamp Matthew W, Wall Eric J, Wilson Philip L, Ellis Henry B, Chipman Danielle E, Shubin Stein Beth E, Parikh Shital N, Brady Jacqueline, Fabricant Peter, Farr Jack, Koh Jason, Kramer Dennis, Magnussen Robert, Milewski Matthew, Redler Lauren, Strickland Sabrina, Tompkins Marc, Yanke Adam, Yen Yi-Meng
Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Hospital for Special Surgery, New York, New York, USA.
Orthop J Sports Med. 2025 Feb 6;13(2):23259671241300516. doi: 10.1177/23259671241300516. eCollection 2025 Feb.
Management approaches and surgical techniques for patellofemoral instability (PFI) continue to lack clear clinical guidelines and indications. Medial patellofemoral ligament reconstruction (MPFLR) is the most frequently used surgical procedure; however, variation in technique remains significant, particularly in skeletally immature patients.
PURPOSE/HYPOTHESIS: The purpose of this study was to examine variations in MPFLR technique in skeletally immature patients as represented by 20 orthopaedic surgeons with different experience levels and specialty training backgrounds who perform a high volume of PFI surgery in this age group. The hypothesis was that variation would be high.
Cross-sectional study; Level of evidence, 3.
Operative records of skeletally immature patients who underwent a primary, single-stage MPFLR between 2016 and 2021 within the JUPITER (JUstifying Patellar Instability Treatment by Results) cohort, a multicenter prospective study involving 13 tertiary care academic centers, were analyzed, including demographic information, injury data, and surgical technique details.
Of the 305 surgical PFI cases in skeletally immature patients, 245 knees (46% female, 54% male; mean age, 13.6 ± 1.8 years; range, 5.1-19.0 years) met inclusion criteria. High variation was identified in MPFLR tendon graft type (59% allograft, 41% autograft), patellar fixation (62% suture anchor, 32% patellar bone bridge/tunnel), and femoral fixation (76% interference/tenodesis screw, 23% suture anchor). All cases (100%) used fluoroscopic guidance and physeal-sparing principles, with femoral implant placement distal to the distal femoral physis. High variation was seen in adjunctive procedures, including lateral retinacular release or lengthening (22%), osteochondral fracture treatment (13% overall; 53% of which underwent loose body removal, 44% fixation, and 3% osteochondral allograft implantation), concomitant hemi-epiphysiodesis for genu valgum (9%), and patellar tendon medialization (Grammont procedure, 2%).
Despite the presence of open physes, which generally limits PFI surgical technique options, variation in multiple aspects of MPFLR was high among this cohort of 20 high-volume surgeons.
髌股关节不稳（PFI）的管理方法和手术技术仍然缺乏明确的临床指南和适应证。内侧髌股韧带重建术（MPFLR）是最常用的手术方法；然而，技术差异仍然很大，尤其是在骨骼未成熟的患者中。
目的/假设：本研究的目的是研究骨骼未成熟患者中MPFLR技术的差异，这些差异由20名具有不同经验水平和专业培训背景、在该年龄组中进行大量PFI手术的骨科医生表现出来。假设差异会很大。
横断面研究；证据等级，3级。
分析了JUPITER（通过结果证明髌股关节不稳治疗的合理性）队列中2016年至2021年间接受初次单阶段MPFLR的骨骼未成熟患者的手术记录，该队列是一项涉及13个三级医疗学术中心的多中心前瞻性研究，包括人口统计学信息、损伤数据和手术技术细节。
在305例骨骼未成熟患者的手术PFI病例中，245例膝关节（46%为女性，54%为男性；平均年龄13.6±1.8岁；范围5.1 - 19.0岁）符合纳入标准。在MPFLR肌腱移植类型（59%为同种异体移植物，41%为自体移植物）、髌骨固定（62%为缝合锚钉，32%为髌骨骨桥/隧道）和股骨固定（76%为干涉/张力带螺钉，23%为缝合锚钉）方面发现了高度差异。所有病例（100%）均采用透视引导和保留骨骺原则，股骨植入物放置在股骨远端骨骺的远侧。在辅助手术中也发现了高度差异，包括外侧支持带松解或延长（22%）、骨软骨骨折治疗（总体为13%；其中53%进行了游离体取出，44%进行了固定，3%进行了骨软骨异体移植植入）、膝外翻的同期半骨骺阻滞（9%）和髌骨肌腱内移（Grammont手术，2%）。
尽管存在开放骨骺，这通常限制了PFI手术技术的选择，但在这20名高手术量外科医生的队列中，MPFLR多个方面的差异很大。
