Recurrent Patellofemoral Instability in the Pediatric Patient: Management and Pitfalls
Recurrent Patellofemoral Instability in the Pediatric Patient: Management and Pitfalls
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DOI：
10.1007/s12178-020-09607-1
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发表时间：
2020-02-01
影响因子：
4.1
通讯作者：
Beck, Jennifer J.
中科院分区：
文献类型：
--
作者：
Vellios, Evan E.;Trivellas, Myra;Beck, Jennifer J.
综述的目的综述的目的是讨论儿科人群中复发性髌股不稳定（PFI）的相关病理解剖、治疗、并发症和技术考虑。特别考虑到最近的文献和管理的病人反复不稳定手术后。髌骨稳定手术原则上依赖于恢复正常髌股解剖结构和动态对线。从历史上看，治疗选择有很多，包括伸肌机制重新对准、髌股成形术，以及最近的内侧髌股韧带（MPFL）修复和/或重建，作为初始膝关节屈曲期间的动态控制。在尿道未成熟的患者中，优先考虑保留骺板的软组织手术。虽然内侧髌股韧带重建已成为一种流行的选择，但术后失败是一个持续存在的问题，一般来说，PFI手术的失败率为5 - 30%，而无需任何单一手术（例如，远端重新对准，MPFL重建），显示出明显的优越性。手术髌骨稳定失败被广泛认为有三个主要原因：（1）初次稳定方法的技术失败，（2）初次稳定过程中未解决的静态和动态病理解剖结构，以及（3）内在风险因素（例如，胶原紊乱、韧带松弛）。PFI是影响儿童和青少年人群的常见骨科疾病。PFI患者手术后重复不稳定的治疗需要了解和解决潜在的病理解剖风险因素以及失败的风险和原因。
Purpose of Review The purpose of the review is to discuss the relevant pathoanatomy, management, complications, and technical considerations for recurrent patellofemoral instability (PFI) in the pediatric population. Special consideration is given to recent literature and management of the patient with repeat instability following surgery. Recent Findings Patellar stabilization surgery is in principle dependent upon restoration of normal patellofemoral anatomy and dynamic alignment. Historically, treatment options have been numerous and include extensor mechanism realignment, trochleoplasty, and more recently repair and/or reconstruction of the medial patellofemoral ligament (MPFL) as a dynamic check rein during initial knee flexion. In skeletally immature patients, preference is given to physeal-sparing soft tissue procedures. While medial patellofemoral ligament reconstruction has become a popular option, postoperative failure is a persistent issue with rates ranging from 5 to 30% for PFI surgery in general without any single procedure (e.g., distal realignment, MPFL reconstruction) demonstrating clear superiority. Failure of surgical patellar stabilization is broadly believed to occur for three main reasons: (1) technical failure of the primary stabilization method, (2) unaddressed static and dynamic pathoanatomy during the primary stabilization, and (3) intrinsic risk factors (e.g., collagen disorders, ligamentous laxity). PFI is a common orthopedic condition affecting the pediatric and adolescent population. Treatment of repeat instability following surgery in the PFI patient requires understanding and addressing underlying pathoanatomic risk factors as well as risks and reasons for failure.