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How Does Isolated Medial Patellofemoral Ligament Reconstruction Influence Patellar Height?
The American Journal of Sports Medicine ( IF 4.8 ) Pub Date : 2020-02-14 , DOI: 10.1177/0363546520902132
Francesco Luceri 1, 2 , Julien Roger 1 , Pietro Simone Randelli 3, 4 , Sébastien Lustig 1, 5 , Elvire Servien 1, 6
Affiliation  

BACKGROUND Reconstruction of the medial patellofemoral ligament (MPFL) is the gold standard treatment for recurrent patellar dislocation. Patella alta has been reported in about half of patients with recurrent patellofemoral instability. HYPOTHESIS MPFL reconstruction (MPFLr) has a beneficial role in the correction of patellar height in patients with mild patella alta (Caton-Deschamps index [CDI] between 1.20 and 1.40). STUDY DESIGN Case series; Level of evidence, 4. METHODS Skeletally mature patients, with no history of previous or concomitant knee surgical procedures, who underwent isolated MPFLr using hamstring autograft for recurrent patellar instability between 2005 and 2018, were included in this study. The authors calculated CDI, modified Insall-Salvati index (MISI), and Blackburne-Peel index (BPI) ratios. Measurements done by 2 independent observers were calculated and used to compare pre- and postoperative patellar height (patella alta: CDI >1.20). RESULTS A total of 89 patients (95 knees) were included in the study, with a mean age of 25.0 years (range, 15.0-45.0 years). There were 70% women and 30% men. We found patella alta in 35.8% of cases preoperatively. Among them, 79.4% had reduced patellar height indices, within normal limits, postoperatively (mean follow-up, 18.4 ± 12.0 months). All the ratios showed a significant reduction in patellar height after surgery (CDI: 0.19 [range, -0.05, 0.60]; MISI: 0.22 [-0.14, 0.76]; BPI: 0.18 [-0.08, 0.59]; P < .00001). The CDI of 79.4% of the study knees was reduced to within normal limits postoperatively. The CDI was maintained within normal limits postoperatively in 93.4% of the knees with normal patellar height and reduced to normal in 50% of the knees with severe patella alta before surgery . No patient reported patella infera before surgery, whereas this condition was found in 8.2% of study patients postoperatively. A moderate correlation was reported between preoperative radiographic indices and their reduction after surgery (CDI: P < .001, ρ = 0.39; MISI: P < .001, ρ = 0.39; BPI: P < .001, ρ = 0.48). CONCLUSION The higher the preoperative patellar height, the more important is the lowering effect of MPFLr using the hamstring for patellar instability. Bony procedures should not be indicated in patients with patellar instability and a CDI between 1.20 and 1.40.

中文翻译:

孤立的Pat股内侧韧带重建如何影响Pat骨高度?

背景技术重建pa股内侧韧带(MPFL)是复发性pa骨脱位的金标准治疗方法。about骨复发的patients骨患者中约有一半报道过al骨。假说MPFL重建(MPFLr)在轻度骨患者(Caton-Deschamps指数[CDI]在1.20和1.40之间)对the骨高度的校正中具有有益作用。研究设计案例系列;证据级别,第4级。方法本研究包括2005年至2018年间使用auto绳肌自体植骨进行分离的MPFLr治疗复发性pa骨不稳的无手术或无膝关节手术史的骨骼成熟患者。作者计算了CDI,修改的Insall-Salvati指数(MISI)和Blackburne-Peel指数(BPI)比率。计算由2位独立观察员进行的测量,并将其用于比较术前和术后pa骨高度(pat骨al:CDI> 1.20)。结果研究共纳入89例患者(95膝),平均年龄25.0岁(范围15.0-45.0岁)。妇女占70%,男子占30%。术前发现35骨占35.8%。其中,有79.4%的患者pa骨高度指数在术后正常范围内降低(平均随访,18.4±12.0个月)。所有比率均显示术后pa骨高度显着降低(CDI:0.19 [范围,-0.05,0.60]; MISI:0.22 [-0.14,0.76]; BPI:0.18 [-0.08,0.59]; P <.00001) 。术后79.4%的研究膝关节的CDI降低到正常范围内。术后93例CDI维持在正常范围内。before骨高度正常的膝盖中有4%的膝盖,severe骨严重的膝盖中有50%的膝盖在手术前降至正常。术前没有患者报告fer骨下垂,而在术后8.2%的研究患者中发现了这种情况。据报道,术前影像学指标与其术后降低之间有中等相关性(CDI:P <.001,ρ= 0.39; MISI:P <.001,ρ= 0.39; BPI:P <.001,ρ= 0.48)。结论术前pa骨高度越高,使用the绳肌进行for骨不稳定降低MPFLr的作用越重要。pa骨不稳且CDI在1.20和1.40之间的患者不宜采用Bony手术。术前没有患者报告fer骨下垂,而在术后8.2%的研究患者中发现了这种情况。据报道,术前影像学指标与其术后降低之间有中等相关性(CDI:P <.001,ρ= 0.39; MISI:P <.001,ρ= 0.39; BPI:P <.001,ρ= 0.48)。结论术前pa骨高度越高,使用the绳肌进行for骨不稳定降低MPFLr的作用越重要。pa骨不稳且CDI在1.20和1.40之间的患者不宜采用Bony手术。术前没有患者报告fer骨下垂,而在术后8.2%的研究患者中发现了这种情况。据报道,术前影像学指标与其术后降低之间有中等相关性(CDI:P <.001,ρ= 0.39; MISI:P <.001,ρ= 0.39; BPI:P <.001,ρ= 0.48)。结论术前pa骨高度越高,使用绳肌进行FL骨不稳定降低MPFLr的作用越重要。pa骨不稳且CDI在1.20和1.40之间的患者不宜采用Bony手术。001,ρ= 0.48)。结论术前pa骨高度越高,使用the绳肌进行for骨不稳定降低MPFLr的作用越重要。pa骨不稳且CDI在1.20和1.40之间的患者不宜采用Bony手术。001,ρ= 0.48)。结论术前pa骨高度越高,使用the绳肌进行for骨不稳定降低MPFLr的作用越重要。pa骨不稳且CDI在1.20和1.40之间的患者不宜采用Bony手术。
更新日期:2020-03-16
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