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Abstract：
UNASSIGNED: Patellar instability is frequently encountered in patients with Ehlers-Danlos syndrome (EDS). The clinical outcomes of isolated medial patellofemoral ligament reconstruction (MPFLR) for patellar instability in patients with EDS are unknown.
UNASSIGNED: To evaluate midterm clinical outcomes of isolated MPFLR for patellar instability in patients with EDS and factors affecting these outcomes.
UNASSIGNED: Case series; Level of evidence, 4.
UNASSIGNED: In a retrospective study, 31 patients (n = 47 knees) with EDS and patellar instability who underwent isolated MPFLR for recurrent patellar instability between 2008 and 2017 and had a minimum 2-year follow-up were identified. Preoperative radiographic images were measured for anatomic risk factors. Clinical outcomes-including postoperative complications-were evaluated. Factors associated with MPFLR failure were identified. Postoperative patient-reported outcomes (PROs)-including the pediatric version of the International Knee Documentation Committee, the Kujala score, the Hospital for Special Surgery Pediatric Functional Activity Brief Scale, the Banff Patellofemoral Instability Instrument 2.0, and the Knee injury and Osteoarthritis Outcome Score-were collected, and factors affecting PRO scores were analyzed.
UNASSIGNED: The mean age of the cohort was 14.9 ± 2 years. At a mean follow-up of 7.2 years, 18 of 47 (38.3%) knees required reoperations, of which 9 of 47 (19.1%) knees required revision stabilization for recurrent patellar instability. Also, 7 of 31 knees (22.6%) with autografts failed compared with 2 of 16 (12.5%) with allografts (P = .69). For autografts, 6 of 17 (35.3%) failures occurred with gracilis, but 0 of 13 (0%) occurred with semitendinosus (P = .02). Compared with patients without failures, patients with failed primary MPFLR were significantly younger (P = .0005) and were able to touch the palm to the floor with their knees extended (P = .03). For radiographic parameters, the patellar height and tilt were significantly higher in the failure group. The postoperative PROs were suboptimal at a mean follow-up of 5.2 years. All but 1 patient were satisfied with the final outcome.
UNASSIGNED: At the midterm follow-up, 38.3% of patients with EDS required further surgery after isolated MPFLR for patellar instability; half of these revisions (19.1%) were to address recurrent instability. Recurrent instability after isolated MPFLR was more likely in younger patients and those who could touch the palm to the floor with their knees extended. Postoperative PROs were inferior; nonetheless, patient satisfaction was high.
UNASSIGNED: To evaluate midterm clinical outcomes of isolated MPFLR for patellar instability in patients with EDS and factors affecting these outcomes.
UNASSIGNED: Case series; Level of evidence, 4.
UNASSIGNED: In a retrospective study, 31 patients (n = 47 knees) with EDS and patellar instability who underwent isolated MPFLR for recurrent patellar instability between 2008 and 2017 and had a minimum 2-year follow-up were identified. Preoperative radiographic images were measured for anatomic risk factors. Clinical outcomes-including postoperative complications-were evaluated. Factors associated with MPFLR failure were identified. Postoperative patient-reported outcomes (PROs)-including the pediatric version of the International Knee Documentation Committee, the Kujala score, the Hospital for Special Surgery Pediatric Functional Activity Brief Scale, the Banff Patellofemoral Instability Instrument 2.0, and the Knee injury and Osteoarthritis Outcome Score-were collected, and factors affecting PRO scores were analyzed.
UNASSIGNED: The mean age of the cohort was 14.9 ± 2 years. At a mean follow-up of 7.2 years, 18 of 47 (38.3%) knees required reoperations, of which 9 of 47 (19.1%) knees required revision stabilization for recurrent patellar instability. Also, 7 of 31 knees (22.6%) with autografts failed compared with 2 of 16 (12.5%) with allografts (P = .69). For autografts, 6 of 17 (35.3%) failures occurred with gracilis, but 0 of 13 (0%) occurred with semitendinosus (P = .02). Compared with patients without failures, patients with failed primary MPFLR were significantly younger (P = .0005) and were able to touch the palm to the floor with their knees extended (P = .03). For radiographic parameters, the patellar height and tilt were significantly higher in the failure group. The postoperative PROs were suboptimal at a mean follow-up of 5.2 years. All but 1 patient were satisfied with the final outcome.
UNASSIGNED: At the midterm follow-up, 38.3% of patients with EDS required further surgery after isolated MPFLR for patellar instability; half of these revisions (19.1%) were to address recurrent instability. Recurrent instability after isolated MPFLR was more likely in younger patients and those who could touch the palm to the floor with their knees extended. Postoperative PROs were inferior; nonetheless, patient satisfaction was high.
摘要：
■在Ehlers-Danlos综合征（EDS）患者中经常遇到髌骨不稳定。孤立的内侧髌股韧带重建（MPFLR）治疗EDS患者髌骨不稳定的临床结果未知。
■评估孤立性MPFLR治疗EDS患者髌骨不稳定的中期临床结果及影响这些结果的因素。
■案例系列；证据级别，4.
■在一项回顾性研究中，确定了31例（n=47膝）EDS和髌骨不稳定的患者，他们在2008年至2017年期间因复发性髌骨不稳定而接受了单独的MPFLR，并进行了至少2年的随访。术前X线图像测量解剖危险因素。评估了临床结果，包括术后并发症。确定了与MPFLR失败相关的因素。术后患者报告结果（PRO）-包括国际膝关节文献委员会的儿科版本，Kujala比分,特殊外科医院儿科功能活动简明量表,收集Banff髌股不稳定仪器2.0和膝关节损伤和骨关节炎结果评分，并对影响PRO评分的因素进行分析。
■该队列的平均年龄为14.9±2岁。平均随访7.2年，47个膝盖中的18个（38.3％）需要再次手术，其中47个膝关节中的9个(19.1%)因复发性髌骨不稳定而需要翻修稳定.此外，自体移植的31个膝盖中有7个（22.6％）失败，而同种异体移植的16个膝盖中有2个（12.5％）失败（P=.69）。对于自体移植物，17个故障中有6个(35.3%)发生在格拉西利，但13人中有0人(0%)发生在半腱肌(P=.02)。与没有失败的患者相比，原发性MPFLR失败的患者明显年轻(P=.0005),并且能够在膝盖伸展的情况下将手掌触地(P=.03).对于射线照相参数，失败组的髌骨高度和倾斜度明显较高.在平均5.2年的随访中，术后PRO次优。除1例患者外，所有患者对最终结果感到满意。
■在中期随访中，38.3％的EDS患者在孤立的MPFLR治疗髌骨不稳定后需要进一步手术；这些修改中有一半（19.1％）是为了解决复发性不稳定。孤立的MPFLR后复发性不稳定在年轻患者和膝盖伸展时可以将手掌触摸到地板的患者中更有可能发生。术后PRO较差；尽管如此，患者满意度高。
■评估孤立性MPFLR治疗EDS患者髌骨不稳定的中期临床结果及影响这些结果的因素。
■案例系列；证据级别，4.
■在一项回顾性研究中，确定了31例（n=47膝）EDS和髌骨不稳定的患者，他们在2008年至2017年期间因复发性髌骨不稳定而接受了单独的MPFLR，并进行了至少2年的随访。术前X线图像测量解剖危险因素。评估了临床结果，包括术后并发症。确定了与MPFLR失败相关的因素。术后患者报告结果（PRO）-包括国际膝关节文献委员会的儿科版本，Kujala比分,特殊外科医院儿科功能活动简明量表,收集Banff髌股不稳定仪器2.0和膝关节损伤和骨关节炎结果评分，并对影响PRO评分的因素进行分析。
■该队列的平均年龄为14.9±2岁。平均随访7.2年，47个膝盖中的18个（38.3％）需要再次手术，其中47个膝关节中的9个(19.1%)因复发性髌骨不稳定而需要翻修稳定.此外，自体移植的31个膝盖中有7个（22.6％）失败，而同种异体移植的16个膝盖中有2个（12.5％）失败（P=.69）。对于自体移植物，17个故障中有6个(35.3%)发生在格拉西利，但13人中有0人(0%)发生在半腱肌(P=.02)。与没有失败的患者相比，原发性MPFLR失败的患者明显年轻(P=.0005),并且能够在膝盖伸展的情况下将手掌触地(P=.03).对于射线照相参数，失败组的髌骨高度和倾斜度明显较高.在平均5.2年的随访中，术后PRO次优。除1例患者外，所有患者对最终结果感到满意。
■在中期随访中，38.3％的EDS患者在孤立的MPFLR治疗髌骨不稳定后需要进一步手术；这些修改中有一半（19.1％）是为了解决复发性不稳定。孤立的MPFLR后复发性不稳定在年轻患者和膝盖伸展时可以将手掌触摸到地板的患者中更有可能发生。术后PRO较差；尽管如此，患者满意度高。
