Çocuklarda Patellar Dislokasyon Sonrası Osteokondral Kırık Fiksasyonu ile Eşzamanlı Medial Patellofemoral Ligament Rekonstrüksiyonunun Sonuçları.

Öz

ÖZET AMAÇ Bu çalışmanın amacı çocuklarda patellar dislokasyon sonrası OKF fiksasyonu ve eş zamanlı MPFL rekonstrüksiyonu yapılan hastaların sonuçlarını değerlendirmektir. GEREÇ VE YÖNTEM 2018-2021 yılları arasında OKF fiksasyonu ve eş zamanlı MPFL rekonstrüksiyonu yapılan toplam 12 hasta retrospektif olarak değerlendirildi. Demografik bilgiler, cerrahi özellikler ve klinik takip verileri toplandı. Ameliyat sonrası klinik değerlendirmeler Kujala ve Lysholm skorları kullanılarak yapıldı. BULGULAR Ortalama ameliyat yaşı 10,4 yıldı (dağılım, 7-15 yıl). Ortalama takip süresi 36,5 aydı (dağılım, 24-58). Bir (%8) hastada ipsilateral diz için ikinci bir ameliyat gerekti. Parçaların ortalama yüzey alanı 2.5 cm² (SD: 1.4) idi. Ameliyat öncesi Kujala skoru 38.2 (SD: 13.3) ve Lysholm skoru 44.1 (SD: 10.4) idi. Bu skorlar ameliyat sonrasında belirgin iyileşme göstererek en son takipte 87.6 (SD: 11) ve 88.2'ye (SD: 10.3) ulaştı. Röntgen ve MR’lardaki radyolojik incelemelerde OKF'lerde olumlu iyileşme olduğunu gösterdi. SONUÇ Patellofemoral instabilitesi olan çocuklarda osteokondral kırık fiksasyonu, eş zamanlı medial patellofemoral ligament rekonstrüksiyonu ile birlikte fiksasyon yoluyla etkili bir şekilde yönetilebilir. Orta dönem sonuçlar tatmin edici sonuçlar göstermiştir.

Anahtar Kelimeler

• Patellar çıkık
• osteokondral kırık
• medial patellofemoral bağ rekonstrüksiyonu
• çocuklar

Outcomes Of Simultaneous Medial Patellofemoral Ligament Reconstruction With Osteochondral Fracture Fixation After Patellar Dislocation In Children.

Öz

ABSTRACT AIM The aim of this study was to evaluate the outcomes of the patients who underwent OCF fixation and simultaneous MPFL reconstruction after patellar dislocation in children. MATERIAL AND METHOD A total of 12 patients who underwent OCF fixation and simultaneous MPFL reconstruction between 2018 and 2021 were retrospectively evaluated. Demographic information, surgical specifics, and clinical follow-up data were gathered. Postoperative clinical assessments were conducted utilizing Kujala and Lysholm scores. RESULTS The mean age at surgery was 10.4 years (range, 7-15 years). The mean period of follow-up was 36.5 months(range, 24-58). One (8%) patient required a second surgery on the ipsilateral knee. The mean surface area of the fragments was 2.5 cm² (SD: 1.4). Preoperatively, the Kujala score and the Lysholm score were 38.2 (SD: 13.3) and 44.1 (SD: 10.4), respectively. These scores exhibited significant improvement postoperatively, reaching 87.6 (SD: 11) and 88.2 (SD: 10.3) at the latest follow-up. Radiological examinations, including X-ray and MRI, indicated favorable healing of the OCFs. CONCLUSION Osteochondral fracture fixation in children with patellofemoral instability can be effectively managed through fixation combined with simultaneous medial patellofemoral ligament reconstruction. The mid-term results have demonstrated satisfactory outcomes.

Anahtar Kelimeler

• Patellar dislocation
• osteochondral fracture
• medial patellofemoral ligament reconstruction
• children

Kaynakça

1. 1.Nietosvaara Y, Aalto K, Kallio PE. Acute patellar dislocation in children: incidence and associated osteochondral fractures. J Pediatr Orthop. 1994;14(4):513-515.
2. 2.Farr J, Covell DJ, Lattermann C. Cartilage lesions in patellofemoral dislocations: incidents/locations/when to treat. Sports Med Arthrosc Rev. 2012;20(3):181.
3. 3.Vollnberg B, Koehlitz T, Jung T, et al. Prevalence of cartilage lesions and early osteoarthritis in patients with patellar dislocation. Eur Radiol. 2012;22:2347-2356.
4. 4.Khan SA, Baghdadi S, Carey JL, Moores TS, Sheth NP, Ganley T. Osteochondral fractures after patellar dislocation: current concepts. J Am Acad Orthop Surg Glob Res Rev. 2021;5(12):e21.
5. 5.Gesslein M, Merkl C, Bail HJ, Krutsch V, Biber R, Schuster P. Refixa186 tion of large osteochondral fractures after patella dislocation shows better mid-to long-term outcome compared with debridement. Cartilage. 2021;13(1_suppl):966S-973S.
6. 6.Lee BJ, Christino MA, Daniels AH, Hulstyn MJ, Eberson CP. Adolescent patellar osteochondral fracture following patellar dislocation. Knee Surg Sports Traumatol Arthrosc. 2013;21:1856-1861.
7. 7.Pérez GM, Barrow B, Krueger V, Cruz Jr AI. Treatment of Osteochondral Fractures After Acute Patellofemoral Instability: A Critical Analysis Review. JBJS Rev. 2022;10(4):e21.
8. 8.Kühle J, Angele P, Balcarek P, et al. Treatment of osteochondralfractures of the knee: a meta-analysis of available scientific evidence. Int Orthop. 2013;37:2385-2394.

9. 9.Arshi A, Cohen JR, Wang JC, Hame SL, McAllister DR, Jones KJ. Operative management of patellar instability in the United States: an evaluation of national practice patterns, surgical trends, and complications. Orthop J Sports Med. 2016;4(8):2325967116662873.
10. 10.Stefancin JJ, Parker RD. First-time traumatic patellar dislocation: a systematic review. Clin Orthop Relat Res. 2007;455:93-101.
11. 11.Pedowitz JM, Edmonds EW, Chambers HG, Dennis MM, Bastrom T, Pennock AT. Recurrence of patellar instability in adolescents undergoing surgery for osteochondral defects without concomitant ligament reconstruction. Am J Sports Med. 2019;47(1):66-70.
12. 12.Aitchison AH, Hidalgo Perea S, Schlichte LM, Green DW. Medial patellofemoral ligament reconstruction with simultaneous osteochondral fracture fixation is an effective treatment for adolescent patellar dislocation with osteochondral fractures. J Child Orthop. 2022;16(5):393-400.
13. 13.Repo JP, Uimonen MM, Nevalainen MT, et al. Outcomes following the operative treatment of intra-articular fracture combined with medial patellofemoral ligament reconstruction after patellar dislocation. Knee Surg Relat Res. 2022;34(1):21.
14. 14.Özbek EA, Akmeşe R. Single-incision, single patellar tunnel for double-bundle medial patellofemoral ligament reconstruction: A technical note. Arthrosc Tech. 2021;10(9):e2107-e2112.
15. 15.Insall J, Salvati E. Patella position in the normal knee joint. Radiology. 1971;101(1):101-104.
16. 16.Dickens AJ, Morrell NT, Doering A, Tandberg D, Treme G. Tibial tubercle-trochlear groove distance: defining normal in a pediatric population. JBJS. 2014;96(4):318-324.
17. 17.Sillanpää PJ, Mäenpää HM. First-time patellar dislocation: surgery or conservative treatment? Sports Med Arthrosc Rev. 2012;20(3):128- 135.
18. 18.Walsh SJ, Boyle MJ, Morganti V. Large osteochondral fractures of the lateral femoral condyle in the adolescent: outcome of bioabsorbable pin fixation. JBJS. 2008;90(7):1473-1478.
19. 19.Buckwalter JA, Brown TD. Joint injury, repair, and remodeling: roles in post-traumatic osteoarthritis. Clin Orthop Relat Res. 2004;423:7- 16.
20. 20.Buckwalter JA, Martin JA, Olmstead M, Athanasiou KA, Rosenwasser MP, Mow VC. Osteochondral repair of primate knee femoral and patellar articular surfaces: implications for preventing post-traumatic osteoarthritis. Iowa Orthop J. 2003;23:66.
21. 21.Gurusamy P, Pedowitz JM, Carroll AN, et al. Medial patellofemoral ligament reconstruction for adolescents with acute first-time patellar dislocation with an associated loose body. Am J Sports Med. 2021;49(8):2159-2164.
22. 22.Puzzitiello RN, Waterman B, Agarwalla A, et al. Primary medial patellofemoral ligament repair versus reconstruction: rates and risk factors for instability recurrence in a young, active patient population. Arthroscopy. 2019;35(10):2909-2915.
23. 23.Schlichte LM, Aitchison AH, Green DW. Incidence of 2nd surgery after MPFL reconstruction and simultaneous osteochondral fracture fixation in pediatric patients treated for patellar dislocation. Orthop J Sports Med. 2020;8(4_suppl3):2325967120S00283.
24. 24.Liu JN, Steinhaus ME, Kalbian IL, et al. Patellar instability management: a survey of the International Patellofemoral Study Group. Am J Sports Med. 2018;46(13):3299-3306.