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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >CLINICAL OUTCOMES AFTER MEDIAL PATELLOFEMORAL LIGAMENT RECONSTRUCTION UTILIZING ALLOGRAFT TISSUE IN PEDIATRIC AND ADOLESCENT PATIENTS: MINIMUM 2-YEAR FOLLOW-UP
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CLINICAL OUTCOMES AFTER MEDIAL PATELLOFEMORAL LIGAMENT RECONSTRUCTION UTILIZING ALLOGRAFT TISSUE IN PEDIATRIC AND ADOLESCENT PATIENTS: MINIMUM 2-YEAR FOLLOW-UP

机译：中介髌果韧带重建在儿科和青少年患者同种异体包膜后的临床结果：最短2年随访

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Background: Medial patellofemoral ligament (MPFL) reconstruction has gained popularity as a tool to manage recurrent patellar instability. The use of allograft for reconstruction includes benefits of quicker surgical time and obviating donor-site morbidity. In anterior cruciate ligament (ACL) reconstruction hesitancy exists to use allograft in younger patients based on data demonstrating higher graft failure rates. However, a similar trend of allograft failure has not been demonstrated for reconstruction of the MPFL, which has a lower tensile strength than that of the ACL. Hypothesis/Purpose: The purpose of this study is to evaluate outcomes including recurrent instability after MPFL reconstruction utilizing allograft tissue in pediatric and adolescent patients. Methods: A retrospective review was performed to identify patients of a single surgeon with MPFL reconstructions with allograft for recurrent patellar instability with minimum two-year follow-up. Surgical management was recommended after minimum six weeks of nonoperative management including bracing, physical therapy, and activity modification. Pre-operative x-rays were evaluated to assess physeal closure, lower extremity alignment and trochlear morphology, and Insall-Salvati and Caton-Deschamps ratios. MRIs were reviewed to evaluate the MPFL, trochlear morphology, and tibial tubercle trochlear groove distance (TT-TG). The allograft was fixed with a bioabsorbable screw. Descriptive statistics were used to characterize data. The primary outcome was recurrent instability. Results: 20 patients (23 knees) 14 females (17 knees) with average age 15.8 years (range: 11.5-19.6 years) underwent MPFL reconstruction with allograft with average follow-up of 3.6 years (range: 2.2-5.9 years). Physes were open in 8 knees. Average Insall-Salvati ratio was 1.08 ± 0.16 and Caton-Deschamps index was 1.18 ± 0.15. Eighteen patients were noted to have trochlear dysplasia pre-operatively and TT-TG was 15.4 ± 3.9 mm. The three knees (13.0%) with complications had open physes – two (8.7%) had recurrent instability requiring subsequent operation and one sustained a patella fracture requiring open reduction internal fixation. The average Insall-Salvati of these three patients was 1.26 ± 0.21, Caton-Deschamps was 1.18 ± 0.21, and TT-TG was 18.3 ± 3.5mm. There were no growth disturbances noted post-operatively. Conclusion: MPFL reconstruction using allograft tissue may be performed safely in the pediatric and adolescent population with good outcomes at mid-term follow-up with few complications and low rate of recurrent instability. Anatomic factors for may contribute to recurrent instability and complications post-operatively, though larger numbers are needed for statistical analyses. Further prospective and randomized evaluation comparing autograft to allograft reconstruction is warranted to understand graft failure rates.
机译：背景：内侧Patellofemoral韧带（MPFL）重建已经获得了管理经常性髌骨不稳定的工具。同种异体移植物用于重建包括更快的手术时间和避免供体现场的益处。在前十字韧带（ACL）的重建中，重建犹豫不决在基于数据的较高患者中使用同种异体移植物，证明更高的接枝失效率。然而，尚未对同种异体移植失败的类似趋势进行证明，用于重建MPFL，其具有比ACL的拉伸强度较低。假设/目的：本研究的目的是评估在MPFL重建后使用同种异体移植组织在儿科和青少年患者中的常规不稳定的结果。方法：进行回顾性审查，以鉴定与同种异体移植的MPFL重建的单个外科医生的患者，用于复发髌骨不稳定性，最短的两年随访。在最少六周的非手术管理包括支撑，物理治疗和活性修改之后推荐手术管理。评估前术前X射线以评估性能闭合，下肢对齐和Trochlear形态，以及InsAll-Salvati和Caton-Deschamps比率。审查了MRIS以评估MPFL，Trochlear形态和胫骨结节Trochlear槽距离（TT-Tg）。同种异体移植物用生物可吸收螺钉固定。描述性统计数据用于表征数据。主要结果是反复发作不稳定。结果：20名患者（23个膝盖）14名女性（17膝）平均为15.8岁（范围：11.5-19.6岁）接受了同种异体移植的MPFL重建，平均随访3〜6年（范围：2.2-5.9岁）。物理在8个膝盖上开放。平均INSALL-SALVATI比率为1.08±0.16，CATON-DESCHAMPS指数为1.18±0.15。 18名患者被注意到预先操作性，TT-TG为15.4±3.9mm。三个膝盖（13.0％）的并发症具有开放性物理 - 两种（8.7％）具有经常性的不稳定性，需要随后的操作，并且一个持续的髌骨骨折需要开放的缩短内固定。这三名患者的平均INSALL-SALVATI为1.26±0.21，CATON-DESCHAMPS为1.18±0.21，TT-TG为18.3±3.5mm。可操作地没有产生增长障碍。结论：使用同种异体移植组织的MPFL重建可以在儿科和青少年群体中安全地进行，在中期随访中具有良好的结果，并具有很少的并发症和反复性不稳定的低。统计分析需要更大的数量，可以促进可操作地造成反复稳定性和并发症的解剖因素。需要将自体移植到同种异体移植重建的进一步前瞻性和随机评估得到了解，以了解移植失败率。

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