PATELLAR STABILIZATION PROCEDURES IN THE PEDIATRIC POPULATION: INCIDENCE AND DEMOGRAPHICS

Lauren Agatstein; Alton W. Skaggs; Matthew J. Brown; Nicole Friel; Brian Haus

摘要

BACKGROUND: Patellar instability is a relatively common condition in the young athletic population. There are multiple surgical options for management of patellar instability including medial patellofemoral ligament reconstruction (MPFL), tibial tubercle osteotomy (TTO), and lateral release, as well as different combinations of these procedures. Prior investigations of the adult population have demonstrated an increase in the amount of surgeries over time. In this study, we investigated the demographics and surgical treatment of patellar instability in pediatric and adolescent patients to determine if 1) there had been more surgeries performed year over year, 2) if there had been a change in the type of surgery performed over time, and 3) if age affected the type of surgery performed. METHODS: We queried a California statewide ambulatory surgery database (OSHPD) for all patients under 20 years old diagnosed with patellar instability or patella dislocations in the state of California from 2008-2016. Relevant ICD-9 diagnostic codes, ICD-10 diagnostic codes, and CPT procedural codes were used to identify and analyze this data. The incidence, concomitant procedures, demographics, hospital type, and insurance type were obtained to descriptively describe this population. RESULTS: 4590 patients under the age of 20 received outpatient surgery for patellar instability in 2008-2016. 1472 of the 4590 included concomitant cartilage procedures, while 2733 of the 4590 were patellar stabilization procedures. The average age was 15.5. Of the 4,590 surgeries, 59.6% were female and 40.4% were male. A total of 273 were surgeries were performed on under 13 year-olds, 1808 on 13-15 year-olds, and 2509 on 16-19 year-olds. Included in these 4590 surgeries were 2733 patellar stabilization procedures of interest. Trends were identified concerning the type of patellar stabilization procedures performed. In the youngest population, MPFL alone is performed most frequently (53% of under 13 cases), followed by lateral release alone (34%) and the combination of MPFL and lateral release (13%). For 13-15 year-olds, more lateral release alone procedures (42% of 13-15 cases) were performed. MPFL alone procedures were 40% of cases, with far less MPFL and lateral release combination procedures (13%), TTO and lateral release combination (3%), and TTO alone (2%). For 16-19 year-olds, the frequency of MPFL alone and lateral release alone each accounted for 40% of the patellar stabilization procedures in this age group. 10% of 16-19 cases were then a combination of MPFL and lateral release procedures. TTO alone (4%), TTO and lateral release (4%), and MPFL and TTO (1%) comprised the final 9% of patella stabilization procedures in our oldest patient category. Procedures performed increased in frequency by age group, as indicated by 5.78% (158 for under 13), 38.6% (1055 for 13-15), and 55.62% (1520 for 16-19) of the total patellar stabilization procedures. The frequency of patellar stabilization procedure categories increased by age group in all categories except for the combination of MPFL and TTO. The same number of MPFL and lateral release procedures were performed, with roughly an equal distribution by age group. Over the nine-year period, trends within the age groups stayed roughly consistent for MPFL and MPFL with lateral release. For the under 13 group, the number also remained consistent for lateral release alone. However, for 13-15 and 16-29, the number of lateral releases performed each year drastically decreased from 2008-2016. Related to the prevalence of older pediatric patients undergoing this surgery, 81% (3706) received care at an adult hospital while 19% (884) were treated at a children’s hospital. The majority of California patients receiving surgery were White (53.9%), followed by Hispanic (26.8%), Other (9.1%), Black (5.4%), and Asian (4.8%) race/ethnicity categories. 3472 patients had private insurance, 859 had MediCal, and 259 had another insurance type. The use of private insurance gradually decreased from 2008, while the rate of MediCal coverage greatly increased. CONCLUSIONS: For the pediatric and adolescent population, the total amount of patellar stabilization procedures performed over time has been stable. However, there has been a decrease in the frequency of lateral releases preformed, with an increase in MPFL reconstructions alone over time and with additional procedures. Age was a factor in determining treatment, and as the patients became older, there was a greater percentage of concomitant cartilage procedures. Table 1. Procedure Incidence By Age Age (years) Total Patellar Instability Surgeries Patellar Stabilization Procedures Cartilage Concomitant Procedures Total Patellar Stabilization Procedures MPFL alone TTO alone lateral release alone MPFL + TTO MPFL + lateral release MPFL + TTO + lateral release TTO + lateral release micro fracture chondro plasty Osteo chondral grafting-arthroscopy loose cartilage removal Un

机译：背景：Pat骨不稳定是年轻运动人群中相对普遍的状况。有多种pa骨不稳的手术选择，包括media股内侧韧带重建术（MPFL），胫骨结节截骨术（TTO）和外侧释放术，以及这些手术的不同组合。先前对成年人口的调查显示，随着时间的流逝，手术数量有所增加。在这项研究中，我们调查了儿童和青少年患者pa骨不稳的人口统计学和手术治疗方法，以确定是否1）每年进行的外科手术更多，2）随时间进行的手术类型是否发生变化，以及3）年龄是否影响所进行的手术类型。方法：我们查询了加利福尼亚州全州门诊手术数据库（OSHPD），该数据库针对所有2008年至2016年在加利福尼亚州被诊断为pa骨不稳或骨脱位的20岁以下患者。相关的ICD-9诊断代码，ICD-10诊断代码和CPT程序代码用于识别和分析此数据。获得发病率，伴随的程序，人口统计学，医院类型和保险类型来描述性地描述该人群。结果：2008-2016年，有4590名20岁以下的患者因pa骨不稳而接受了门诊手术。 4590中的1472包括伴随的软骨手术，而4590中的2733是were骨稳定手术。平均年龄为15.5岁。在4,590例手术中，女性占59.6％，男性占40.4％。共有273例手术在13岁以下的人群中进行，1808例在13-15岁的人群中进行，2509例在16-19岁的人群中进行。这4590例手术中包括2733例pa骨稳定手术。确定了有关performed骨稳定手术类型的趋势。在最年轻的人群中，单独进行MPFL的频率最高（13岁以下病例中的53％），其次是单独进行侧向释放（34％），以及同时进行MPFL和侧向释放（13％）。对于13-15岁的孩子，进行了更多的单独侧向释放手术（13-15岁病例的42％）。仅MPFL手术占病例的40％，MPFL和侧向释放联合手术（13％），TTO和侧向释放联合手术（3％）和仅TTO（2％）少得多。在16-19岁的年龄组中，单独的MPFL和单独的侧面释放频率分别占stabilization骨稳定操作的40％。然后，在16-19例病例中，有10％合并了MPFL和侧向释放程序。在我们最年长的患者类别中，仅TTO（4％），TTO和侧向释放（4％）以及MPFL和TTO（1％）构成了9骨稳定手术的最后9％。 age骨稳定术的总频率分别为5.78％（13岁以下为158），38.6％（13-15岁为1055）和55.62％（16-19岁为1520）。除MPFL和TTO的组合外，所有年龄组的group骨稳定手术类别的频率均按年龄组增加。进行了相同数量的MPFL和侧向释放程序，各年龄组的分布大致相等。在这九年期间，MPFL和横向释放MPFL的年龄组趋势大致保持一致。对于13岁以下的人群，仅横向释放的人数也保持一致。但是，对于13-15和16-29，每年执行的侧向释放次数从2008-2016年急剧下降。与接受该手术的老年儿科患者的患病率相关，有81％（3706）在成人医院接受了护理，而19％（884）在儿童医院接受了治疗。加利福尼亚接受手术的大多数患者是白人（53.9％），其次是西班牙裔（26.8％），其他（9.1％），黑人（5.4％）和亚洲（4.8％）种族/族裔类别。 3472位患者拥有私人保险，859位患者享有MediCal，259位患者拥有另一种保险类型。从2008年开始，私人保险的使用逐渐减少，而MediCal的覆盖率大大提高。结论：对于儿童和青少年，随着时间的推移performed骨稳定手术的总量一直稳定。然而，随着时间的流逝，单独进行MPFL重建以及采用其他程序，横向释放的频率有所降低。年龄是决定治疗的一个因素，并且随着患者年龄的增长，伴随软骨手术的比例也越来越高。表1.按年龄分类的手术发生率年龄（年）Pat总不稳定手术ella稳定手术软骨伴随手术Pat总稳定手术单独MPFL单独TTO单独侧向释放MPFL + TTO MPFL +侧向释放MPFL + TTO +侧向释放TTO +侧向释放微骨折软骨成形术骨软骨移植-关节镜检查软骨松动术Un

PATELLAR STABILIZATION PROCEDURES IN THE PEDIATRIC POPULATION: INCIDENCE AND DEMOGRAPHICS

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