PDF(Pubmed)
Abstract：
UNASSIGNED: Surgery is the main treatment for recurrent patellar dislocation (PD). However, due to the complexity of anatomical factors, there is still a lack of consensus on the choice of combined surgical methods. This study aimed to compare the clinical and radiological outcomes of medial patellofemoral ligament reconstruction combined with derotational distal femur osteotomies (MPFLR + DDFO) and combined with tibial tubercle osteotomies (MPFLR + TTO) for recurrent PD with increased femoral anteversion angles (FAA) and excessive tibial tubercle-trochlear groove (TT-TG) distance.
UNASSIGNED: In this retrospective analysis, MPFLR + DDFO and MPFLR + TTO patients from 2015 to 2020 were included. Group A (MPFLR + DDFO, n = 42) and B (MPFLR + TTO, n = 46) were formed. Clinical outcomes included physical examinations, functional outcomes (Kujala, Lysholm, International Knee Documentation Committee (IKDC), visual analog scale (VAS) and intermittent and persistent osteoarthritis pain scale (ICOAP), Tegner scores), and complications. The Caton-Deschamps index (CD-I), patellar title angle, patellar congruence angle, patella-trochlear groove distance, TT-TG distance, and FAA were used to assess radiological outcomes.
UNASSIGNED: All clinical outcomes improved significantly in both groups, but Group A had significantly better postoperative scores than Group B (Kujala: 89.8 ± 6.4 vs. 82.9 ± 7.4, P < 0.01; Lysholm: 90.9 ± 5.1 vs. 81.3 ± 6.3, P = 0.02; IKDC: 87.3 ± 9.0 vs. 82.7 ± 8.0, P < 0.01; Tegner: 6.0 (5.0, 9.0) vs. 5.0 (4.0, 8.0), P = 0.01). However, there was no significant difference in the VAS and ICOAP scores between the two groups. No dislocation recurrences occurred. Radiological outcomes improved significantly in both groups, but Group A had better outcomes. After surgery, the patellar height of 88.5% (23/26) patients in Group A and 82.8% (24/29) patients in Group B was restored to normal (the Caton-Deschamps index <1.2).
UNASSIGNED: Both MPFLR + TTO and MPFLR + DDFO obtained satisfactory clinical and radiological outcomes in the treatment of recurrent PD with increased FAA and excessive TT-TG. However, the outcomes of MPFLR + DDFO were better and should be considered a priority. MPFLR + TTO may be not necessary for such patients.
UNASSIGNED: In this retrospective analysis, MPFLR + DDFO and MPFLR + TTO patients from 2015 to 2020 were included. Group A (MPFLR + DDFO, n = 42) and B (MPFLR + TTO, n = 46) were formed. Clinical outcomes included physical examinations, functional outcomes (Kujala, Lysholm, International Knee Documentation Committee (IKDC), visual analog scale (VAS) and intermittent and persistent osteoarthritis pain scale (ICOAP), Tegner scores), and complications. The Caton-Deschamps index (CD-I), patellar title angle, patellar congruence angle, patella-trochlear groove distance, TT-TG distance, and FAA were used to assess radiological outcomes.
UNASSIGNED: All clinical outcomes improved significantly in both groups, but Group A had significantly better postoperative scores than Group B (Kujala: 89.8 ± 6.4 vs. 82.9 ± 7.4, P < 0.01; Lysholm: 90.9 ± 5.1 vs. 81.3 ± 6.3, P = 0.02; IKDC: 87.3 ± 9.0 vs. 82.7 ± 8.0, P < 0.01; Tegner: 6.0 (5.0, 9.0) vs. 5.0 (4.0, 8.0), P = 0.01). However, there was no significant difference in the VAS and ICOAP scores between the two groups. No dislocation recurrences occurred. Radiological outcomes improved significantly in both groups, but Group A had better outcomes. After surgery, the patellar height of 88.5% (23/26) patients in Group A and 82.8% (24/29) patients in Group B was restored to normal (the Caton-Deschamps index <1.2).
UNASSIGNED: Both MPFLR + TTO and MPFLR + DDFO obtained satisfactory clinical and radiological outcomes in the treatment of recurrent PD with increased FAA and excessive TT-TG. However, the outcomes of MPFLR + DDFO were better and should be considered a priority. MPFLR + TTO may be not necessary for such patients.
摘要：
■手术是复发性髌骨脱位（PD）的主要治疗方法。然而,由于解剖因素的复杂性，对于联合手术方法的选择仍缺乏共识。本研究旨在比较内侧髌股韧带重建联合股骨远端脱位截骨术（MPFLRDDFO）和联合胫骨结节截骨术（MPFLRTTO）治疗复发性PD的临床和放射学结果。股骨前倾角（FAA）和过大的胫骨结节-滑车沟（TT-TG）距离。
■在此回顾性分析中，纳入2015-2020年MPFLR+DDFO和MPFLR+TTO患者。A组(MPFLR+DDFO,n=42)和B(MPFLR+TTO,n=46)形成。临床结果包括体检，功能结果(Kujala，Lysholm,国际膝关节文献委员会(IKDC)视觉模拟量表（VAS）和间歇性和持续性骨关节炎疼痛量表（ICOAP），Tegner得分)，和并发症。卡顿-德尚指数（CD-I），髌骨标题角,髌骨全等角,髌骨-滑车沟距离,TT-TG距离,和FAA用于评估放射学结果.
■两组的所有临床结果均有明显改善，但A组的术后评分明显优于B组（Kujala：89.8±6.4vs.82.9±7.4，P<0.01；Lysholm：90.9±5.1vs.81.3±6.3，P=0.02；IKDC：87.3±9.0vs.82.7±8.0，P<0.01；Tegner：6.0（5.0，9.0）vs.5.0(4.0,8.0),P=0.01）。然而,两组间VAS和ICOAP评分差异无统计学意义。无脱位复发。两组的放射学结果均有显著改善，但A组有更好的结果。手术后,A组88.5%(23/26)和B组82.8%(24/29)的患者髌骨高度恢复正常(Caton-Deschamps指数<1.2).
■MPFLR+TTO和MPFLR+DDFO在FAA升高和TT-TG过高的复发性PD的治疗中都获得了令人满意的临床和放射学结果。然而,MPFLR+DDFO的结果较好,应优先考虑.MPFLR+TTO对于此类患者可能不是必需的。
■在此回顾性分析中，纳入2015-2020年MPFLR+DDFO和MPFLR+TTO患者。A组(MPFLR+DDFO,n=42)和B(MPFLR+TTO,n=46)形成。临床结果包括体检，功能结果(Kujala，Lysholm,国际膝关节文献委员会(IKDC)视觉模拟量表（VAS）和间歇性和持续性骨关节炎疼痛量表（ICOAP），Tegner得分)，和并发症。卡顿-德尚指数（CD-I），髌骨标题角,髌骨全等角,髌骨-滑车沟距离,TT-TG距离,和FAA用于评估放射学结果.
■两组的所有临床结果均有明显改善，但A组的术后评分明显优于B组（Kujala：89.8±6.4vs.82.9±7.4，P<0.01；Lysholm：90.9±5.1vs.81.3±6.3，P=0.02；IKDC：87.3±9.0vs.82.7±8.0，P<0.01；Tegner：6.0（5.0，9.0）vs.5.0(4.0,8.0),P=0.01）。然而,两组间VAS和ICOAP评分差异无统计学意义。无脱位复发。两组的放射学结果均有显著改善，但A组有更好的结果。手术后,A组88.5%(23/26)和B组82.8%(24/29)的患者髌骨高度恢复正常(Caton-Deschamps指数<1.2).
■MPFLR+TTO和MPFLR+DDFO在FAA升高和TT-TG过高的复发性PD的治疗中都获得了令人满意的临床和放射学结果。然而,MPFLR+DDFO的结果较好,应优先考虑.MPFLR+TTO对于此类患者可能不是必需的。
