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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >MPFL Reconstruction in the Pediatric Population: Does Skeletal Maturity Matter?
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MPFL Reconstruction in the Pediatric Population: Does Skeletal Maturity Matter?

机译：在儿科人口中的MPFL重建：骨骼成熟吗？

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Objectives: Patellar instability requiring medial patellofemoral ligament reconstruction (MPFL) in the pediatric population poses a challenge in that the isometric point of femoral fixation (Schottle’s point) is in close proximity to the distal physis. As a result, various alternative fixation techniques have been described to avoid physeal damage, however the consequences of this are unclear. Continued growth and altered graft mechanics in the growing child are areas of concern. The objective of the current study was to evaluate short to midterm outcomes, including redislocation rates, following MPFL reconstruction in skeletally immature versus mature pediatric patients. Methods: Patients under age 18 with recurrent patellar instability that underwent primary MPFL reconstruction by a single surgeon from 2013 to 2019 were identified using current procedural terminology (CPT) codes. Patients who were a minimum of 1 year from surgery were contacted to complete questionnaires. Questions pertained to knee pain and function, including International Knee Documentation Committee (IKDC) score, as well as further injury or surgery. Further data included chart and imaging review. Based on radiographic appearance of the distal physis, patients were placed into either the skeletally mature or immature cohort for comparison. Statistical analysis included chi-square, fisher’s exact, and Mann-Whitney U tests. Significance was determined by p-value &0.05. Results: There were 103 primary MPFL reconstructions in 94 patients: 70 skeletally mature and 24 immature. As expected, the skeletally mature group was older (15.5 vs. 13.1 years). Skeletally immature patients had a higher incidence of trochlear dysplasia (88 vs. 63%, p=0.04). No other baseline differences were identified. Average follow-up was similar at 4.1 years for the mature group and 3.5 years in the immature. Skeletally immature patients were more likely to sustain a subsequent dislocation or any ipsilateral knee injury (15 vs. 3%, p=0.03; 35 vs. 16%, p=0.04 respectively). Skeletally immature patients underwent more revision instability procedures, which trended towards but did not reach significance (23 vs. 9%, p=0.06). No significant difference was observed in IKDC score (80 each), perceived percent of normal for that knee (85% each), frequency of instability events, current sport participation (42 vs. 31%), sport avoidance (46 vs. 35%), or subjective stiffness (38 vs. 41%). Visual analog scale pain scores for skeletally immature compared to mature patients were not different at rest, with activities of daily living, or with sport (0.9 vs. 0.8, 1.5 vs. 1.7, 2.5 vs. 3 respectively). Significantly fewer patients in the skeletally immature group were satisfied (79 vs. 97%, p&0.05) and would undergo the surgery again (68 vs. 100%, p&0.05). Conclusions: In pediatric patients undergoing MPFL reconstruction, both skeletally immature and mature patients have good and comparable outcomes. However, those that are skeletally immature are more likely to have a subsequent ipsilateral injury or dislocation. These patients are also less likely to be satisfied with their results. Of note, there was a higher incidence of trochlear dysplasia in skeletally immature patients which may predispose them to subsequent injury.
机译：目的：在儿科人口中需要内侧髌骨的韧带重建（MPFL）的髌骨不稳定性在股骨固定（Schottle点）的等距点靠近远端物质的挑战。结果，已经描述了各种替代固定技术以避免性能损坏，但是这的后果尚不清楚。持续的增长和变化的嫁接力学在不断增长的孩子中是关注的领域。目前研究的目的是评估中期结果，包括重新分配率，在骨架不成熟与成熟小儿患者中的MPFL重建之后。方法：使用当前程序术语（CPT）代码确定由一名外科医生接受初级MPFL重建的经常性髌骨不稳定的患者。从手术中至少1年的患者联系到完整的问卷。膝关节疼痛和功能的问题，包括国际膝关节文件委员会（IKDC）得分，以及进一步伤害或手术。更多数据包括图表和成像审查。基于远端物理体的射线照相外观，将患者置于骨骼成熟或不成熟的队列中以进行比较。统计分析包括Chi-Square，Fisher的确切和Mann-Whitney U测试。通过p值和amp测定意义; <0.05。结果：94例患者中有103名初级MPFL重建：70例骨骼成熟，24个未成熟。正如预期的那样，骨骼成熟的群体较旧（15.5针对13.1岁）。骨骼未成熟的患者的Trochlear Dysplasia的发病率较高（88 vs.63％，P = 0.04）。没有确定其他基线差异。成熟集团的4.1年平均随访相似，未成熟的3.5岁。骨骼未成熟的患者更有可能维持随后的脱位或任何同侧膝关节损伤（15 vs.3％，P = 0.03; 35 vs.16％，P = 0.04）。骨骼未成熟的患者接受了更多的修改不稳定程序，趋于趋于但未达到意义（23 vs.9％，P = 0.06）。在IKDC得分（每人80分）中没有观察到显着差异，对该膝关节（每次85％），不稳定事件频率，当前运动参与（42 vs.3％），运动避免（46 vs.35％） ）或主观刚度（38 vs.41％）。与成熟患者相比，胸骨不成熟的视觉模拟规模疼痛评分在休息时没有差异，日常生活活动或运动（0.9与0.8，1.5，2.5，2.5与2.5和3.3，2.5和3）。满足骨骼未成熟组中的患者显着较少（79 vs.97％，P＆amp; 0.05），并将再次接受手术（68 vs.100％，P＆amp; 0.05）。结论：在接受MPFL重建的儿科患者中，骨骼未成熟和成熟患者既具有良好且可比的结果。然而，那些骨骼不成熟的人更可能具有随后的同侧损伤或脱位。这些患者也不太可能对其结果感到满意。值得注意的是，骨骼未成熟患者中的Trochlear Dysplasia的发病率较高，这可能使它们易于损伤。

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