Combined Medial Patellofemoral Ligament and Medial Quadriceps Tendon Femoral Ligament Reconstruction With Semitendinosus Allograft for Pediatric Patients With First-Time Patella Dislocation Yields Low Failure Rates and Improved Functional Outcomes Compared With Nonoperative Treatment.

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Tác giả: Sofia Federico, Brian Grottkau, Chris Jayne, Nikolaos Paschos, Kristen Reikersdorfer, Connor Wright

Ngôn ngữ: eng

Ký hiệu phân loại:

Thông tin xuất bản: United States : Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association , 2025

Mô tả vật lý:

Bộ sưu tập: NCBI

ID: 737562

 PURPOSE: To evaluate the clinical outcomes of nonoperative versus operative treatment, consisting of combined medial patellofemoral ligament and medial quadriceps tendon femoral ligament (MPFL/MQTFL) reconstruction, for first-time patellar dislocation in the skeletally immature population through a standardized, rigorous approach. METHODS: This consecutive retrospective cohort was composed of all skeletally immature patients who sustained a first-time patellofemoral dislocation. Patients were grouped into nonoperative management (bracing and physical therapy) and operative management (MPFL/MQTFL reconstruction) cohorts. The primary outcome, failure, was defined as subsequent dislocation or subluxation. Additional outcomes included demographics, risk factors for patellofemoral instability, functional outcomes (Kujala and Pediatric International Knee Documentation Committee scores), return to sports, and complications. Minimum follow-up was 2 years. A correlation analysis attempted to identify potential associations between failure and risk factors. RESULTS: In total, 142 consecutive patients were included with 90 patients in the nonoperative group and 52 patients in the operative group. Failure rates differed by intervention
  those receiving operative management had significantly lower failure rates than conservative management (15.4% vs 58.8%, P <
  .0002). Kujala and Pediatric International Knee Documentation Committee scores were significantly greater in the operative group compared with the nonoperative group (91.5 ± 7.8 vs 82.5 ± 12.1, P <
  .0002 and 89.0 ± 9.3 vs 78.4 ± 12.9, P <
  .0002, respectively). Tegner activity level was also greater in the operative group (6.0 ± 1.4 vs 4.0 ± 1.4, P <
  .0002). Return to sport was significantly greater for those in the operative group (88.5% vs 66.2%, P <
  .002). Return to same level of activity was achieved in greater percentage of patients treated surgically (91.3% vs 69.6%, P = .0075). Complication rates were more frequent in the operative group compared with the nonoperative group (11.5% vs 1.1%, P <
  .002). CONCLUSIONS: MPFL/MQTFL reconstruction in skeletally immature patients with first-time patellofemoral dislocation demonstrated lower failure rates and improved functional outcomes at a minimum 2-year follow-up compared with nonoperative management. LEVEL OF EVIDENCE: Level III, retrospective cohort study.
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