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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Outcomes of Arthroscopic Loose Body Management in Patella Instability: Medial Patellofemoral Ligament Neglect or Repair Versus Reconstruction
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Outcomes of Arthroscopic Loose Body Management in Patella Instability: Medial Patellofemoral Ligament Neglect or Repair Versus Reconstruction

机译：髌骨稳定性关节镜宽松体系的结果：内侧Patelloforal韧带疏忽或修复与重建

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Objectives: Patellar instability is common in adolescents during their growth. Management of the actual patellar instability at the time of arthroscopic treatment for concomitant intra-articular loose body has been debated since many surgeons will manage first-time dislocations without surgery. To demonstrate that medial patellofemoral joint reconstruction, rather than neglect or repair of the ligament, should be performed at the time of arthroscopic loose body removal for first-time patellar instability events in children. Methods: Retrospective study design was performed on all patients who sustained a patellar instability event that resulted in an intra-articular loose body between 2011 and 2017 at our institution. Data was collected using ICD-9/10 and/or CPT codes. Patients included in the analysis were required to have a minimum of 24 month follow-up documented. We then performed chart review and radiographic review (XR and MRI). Variables collected included: demographics, weight, BMI, pain score, SANE score, Kujala score, subsequent recurrent instability, need for second surgery, growth plate status, trochlear dysplasia, TT-TG, Insall-Salvati ratio, and Blackburne-Peel ratio. Data analysis pooled the “neglect” and “repair” groups together and compared it to the “reconstruction” group. Continuous variables were examined for normal distribution and homogeneity and analyzed with ANOVA or Mann Whitney. Chi square was utilized for categorical variables. Results: 64 patients (34 males, 30 females) with a mean age at surgery of 14 years (range 9 to 18) met criteria. These participants had a reported mean weight (kg) and BMI of 67.6 kg and 23.9, respectively. In our two-cohort analysis, the reconstruction cohort demonstrated significantly less subsequent instability, with the rate of recurrence being 58.7% in the neglect/repair compared to 16.7% in the reconstruction group (p=0.002). In addition, the reconstruction group demonstrated significantly less patients that required second surgery (p=0.024). The only continuous variable that showed any statistically significant difference was the Insall-Salvati ratio (p=0.048) with the reconstruction group being a mean 1.3 versus a mean 1.4 in the neglect/ repair group. There was no difference was found for age, weight, BMI, Blackburn ratio, TDI, TT-TG, Pain, SANE, Kujala score, satisfaction, or length of follow-up. Conclusion: Medial patellofemoral ligament reconstruction in the setting of adolescent patellar instability with an intra-articular loose body results in significantly less recurrent instability and reduced need for subsequent surgery compared to those who do not undergo a concomitant ligament reconstruction.
机译：目标：髌骨不稳定性在其成长期间在青少年中常见。由于许多外科医生将在没有手术的情况下管理首次脱位，因此在关节镜治疗时，在关节镜治疗时的实际髌骨不稳定性已经讨论。为了证明内侧髌户关节重建，而不是忽视或修复韧带，应在关节镜下松散的身体去除儿童时的首次髌骨不稳定事件时进行。方法：对所有持续髌骨不稳定事件的患者进行了回顾性研究设计，导致2011年和2017年间的关节内松散的身体。使用ICD-9/10和/或CPT代码收集数据。在分析中包含的患者需要至少有24个月的随访。然后，我们进行了图表审查和射线照相审查（XR和MRI）。收集的变量包括：人口统计，重量，BMI，疼痛评分，理智评分，Kujala评分，随后的反复发育不稳定，需要进行第二次手术，生长板状态，Trochlear发育不良，TT-Tg，Insand-Salvati比和黑毛行李比率。数据分析汇总了“忽视”和“修复”组，并将其与“重建”组进行比较。检查正常分布和均匀性的连续变量，并用Anova或Mann Whitney分析。 Chi广场用于分类变量。结果：64名患者（34名男性，30名女性），手术中的平均年龄为14岁（范围9至18岁）符合标准。这些参与者分别具有报告的平均重量（千克）和37.6千克和23.9的BMI。在我们的双队队列分析中，重建队列显着较低的不稳定，复发率在忽视/修复中的58.7％，重建组中的16.7％（P = 0.002）。此外，重建组显着较低的患者需要第二次手术（P = 0.024）。显示任何统计学上显着差异的唯一连续变量是InsAll-Salvati比率（P = 0.048），重建组是忽略/修复组中的平均1.3与平均1.4。发现年龄，体重，BMI，黑卷比率，TDI，TT-TG，疼痛，理智，Kujala得分，满意度或随访时间没有差异。结论：与关节内松散体内的青少年髌骨不稳定性的内侧髌韧带重建导致与不经历伴随韧带重建的人相比，对随后的手术进行明显较低的稳定性和随后的手术。

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