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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Tibial Tubercle Osteotomy and Medial Patellofemoral Ligament Imbrication for Patellar Instability Due to Trochlear Dysplasia
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Tibial Tubercle Osteotomy and Medial Patellofemoral Ligament Imbrication for Patellar Instability Due to Trochlear Dysplasia

机译：胫骨结节截骨术和Pat股内侧韧带韧带化治疗滑车不典型增生引起的Pat骨不稳定性

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Background: The treatment of patellar instability in the setting of trochlear dysplasia is challenging. Purpose/Hypothesis: The purpose of this study was to evaluate outcomes for the treatment of recurrent patellar dislocations due to trochlear dysplasia using anteromedialization tibial tubercle osteotomy combined with medial patellofemoral ligament (MPFL) imbrication. We hypothesized that the treatment of patellar instability with tibial tubercle osteotomy and MPFL imbrication would result in improved patient satisfaction and decrease patellar instability events in patients with prior instability and trochlear dysplasia. Study Design: Case series; Level of evidence, 4. Methods: We performed a retrospective analysis of patients who underwent MPFL imbrication and concomitant anteromedialization tibial tubercle osteotomy for recurrent patellofemoral instability at a single institution. The minimum follow-up was 1 year. Patient demographic information including age at the time of surgery, sex, body mass index (BMI), tibial tubercle–trochlear groove (TT-TG) distance, and grade of trochlear dysplasia was collected along with relevant operative data. Postoperatively, recurrent dislocation events as well as Knee injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster Universities Osteoarthritis Index, and Kujala scores were collected, and satisfaction was ascertained by asking patients whether they would undergo the procedure again. Results: A total of 37 knees from 31 patients (23 female) with a mean follow-up of 3.8 years (range, 1-8.9 years) were included. The mean patient age was 28.8 years (range, 14-45 years), the mean BMI was 24 kg/m ~(2) (range, 20-38 kg/m ~(2)), and the mean preoperative TT-TG distance was 18.9 mm (range, 8.4-32.4 mm). Two knees were classified as low-grade trochlear dysplasia (Dejour A) and 35 as high-grade trochlear dysplasia (Dejour B-D). At final follow-up, patients reported mean KOOS subscale scores of 86.5 (Pain), 79.8 (Symptoms), 93.9 (Activities of Daily Living), 74.3 (Sports/Recreation), and 61.9 (Quality of Life), as well as a mean Kujala score of 81.3. Mean patient satisfaction was 8.3 of 10. The majority of knees (86.5%; 32/37) remained stable without recurrent instability after this procedure, while 13.5% (5 knees) suffered a recurrent dislocation, with 2 requiring revision surgery. Eight knees (21.6%) underwent subsequent hardware removal. Conclusion: Anteromedialization tibial tubercle osteotomy with MPFL imbrication can improve recurrent patellofemoral instability and provide significant clinical benefit to patients with trochlear dysplasia.
机译：背景：在滑车发育不良的情况下The骨不稳的治疗具有挑战性。目的/假设：本研究的目的是评估前路胫腓结节截骨术联合media股内侧韧带（MPFL）内固定治疗滑车不典型增生引起的pa骨脱位的疗效。我们假设用胫骨结节截骨术和MPFL固定术治疗tell骨不稳将改善患者的满意度，并减少先前不稳定和滑车不典型增生患者的pa骨不稳事件。研究设计：案例系列;证据等级：4。方法：我们对在单个机构中因复发性pa股不稳定性行MPFL锁骨并同时行胫骨结节正骨前路置换术的患者进行了回顾性分析。最低随访时间为1年。收集患者的人口统计学信息，包括手术时的年龄，性别，体重指数（BMI），胫骨结节-滑车槽（TT-TG）距离和滑车发育不良的等级以及相关的手术数据。术后收集复发性脱臼事件以及膝关节损伤和骨关节炎结果评分（KOOS），西安大略省和麦克马斯特大学骨关节炎指数以及Kujala评分，并通过询问患者是否再次接受该手术来确定其满意度。结果：共纳入31例患者（共23例女性）的37个膝关节，平均随访3.8年（范围1-8.9年）。平均患者年龄为28.8岁（范围为14-45岁），平均BMI为24 kg / m〜（2）（范围为20-38 kg / m〜（2）），平均术前TT-TG距离为18.9毫米（范围8.4-32.4毫米）。将两个膝盖归为轻度滑车不典型增生（Dejour A），将35个归为轻度滑车不典型增生（Dejour B-D）。在最后的随访中，患者报告的KOOS平均分项评分分别为86.5（疼痛），79.8（症状），93.9（日常生活活动），74.3（体育/娱乐）和61.9（生活质量），以及库贾拉平均得分为81.3。平均患者满意度为8.3 /10。大多数膝关节（86.5％; 32/37）保持稳定，没有反复不稳定，而13.5％（5膝）经常性脱位，其中2例需要翻修。八个膝盖（21.6％）进行了后续的硬件拆除。结论：伴有MPFL的胫骨结核截骨术可以改善复发的pa股不稳定，并为滑车不典型增生提供重要的临床益处。

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