PMID- 37714440 OWN - NLM STAT- MEDLINE DCOM- 20240505 LR - 20240505 IS - 1526-3231 (Electronic) IS - 0749-8063 (Linking) VI - 40 IP - 5 DP - 2024 May TI - A Combined Surgical Approach for Recurrent Patellar Dislocation in Adolescents With Patella Alta and Increased Tibial Tuberosity-Trochlear Groove Distance: Improved Clinical Outcomes but Decreased Posterior Tibial Slopes in Skeletally Immature Patients at Minimum 4-Year Follow-Up. PG - 1529-1540 LID - S0749-8063(23)00772-7 [pii] LID - 10.1016/j.arthro.2023.09.001 [doi] AB - PURPOSE: (1) To report the clinical and radiological outcomes of a surgical technique combining anatomic medial patellofemoral ligament reconstruction and tibia tuberosity transfer in adolescents with patella alta and elevated tibial tuberosity-trochlear groove (TT-TG) distance in the treatment of recurrent patellar dislocation; and (2) to investigate the potential risks of growth arrest or developmental deformities associated with this combined technique. METHODS: Medical records of patients who underwent the combined surgery from 2015 to 2019 were reviewed. This study included adolescents aged between 14 and 18 years with a Caton-Deschamps index (CDI) > 1.30 and TT-TG distance >20 mm, with a minimum follow-up of 4 years. Radiological examinations including lateral views and full-length posteroanterior standing radiographs were investigated to assess patella height by CDI, posterior tibial slope (PTS) angle, side-to-side difference in bone length, and lower extremity alignment by hip-knee-ankle angle; computed tomography scans and magnetic resonance imaging profiles were investigated to evaluate TT-TG distance and staging of growth plate closure. Other evaluations included preoperative and postoperative physical examination, Kujala score, and Tegner activity score. The patients were stratified into 3 subgroups according to an magnetic resonance imaging-based staging system of the growth plate closure, and each outcome was analyzed. A cohort-specific minimal clinically important difference estimation was performed using standard error of measurement. RESULTS: The average age at the time of surgery was 16.1 years (range, 14.1-17.8). The average follow-up was 5.6 years (range, 4.0-7.6). No recurrent dislocation occurred, and no clinically significant deformity or axis deviation was encountered. Postoperative patellar height by CDI was 1.00 +/- 0.11 (range, 0.81-1.15). No significant differences were found in the preoperative and postoperative hip-knee-ankle angle or side-to-side difference in femur/tibia length among all subgroups. A significantly decreased PTS angle was found in patients with open growth plates, from 10.2 degrees +/- 1.7 degrees before surgery to 8.1 degrees +/- 1.0 degrees after surgery (P = .015). The Kujala score and Tegner score both significantly improved, from 65.5 +/- 13.9 before surgery to 90.4 +/- 7.2 after surgery in the Kujala score (P < .001) and from 4.0 +/- 1.1 before surgery to 4.7 +/- 1.3 after surgery in the Tegner score (P < .001). Of the whole cohort, 63.1%, 100%, 47.1%, and 94.1% of patients achieved the minimal clinically important difference for PTS angle, CDI, Tegner score, and Kujala score, respectively. CONCLUSIONS: This combined technique is safe and effective in treating recurrent patellar dislocation in skeletally mature adolescents with concurrent patella alta (CDI > 1.30) and TT-TG distance >20 mm, permitting patients to have improved knee function and low complication rates. Nonetheless, patients with open growth plates demonstrated a decrease in PTS, which might predispose the knee to recurvatum and osteoarthritis in the long term. LEVEL OF EVIDENCE: Level IV, controlled case series. CI - Copyright (c) 2023 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved. FAU - Mao, Yunhe AU - Mao Y AD - Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, PR China. FAU - Li, Junqiao AU - Li J AD - Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, PR China. FAU - Li, Yinghao AU - Li Y AD - Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, PR China. FAU - Zhu, Jianwei AU - Zhu J AD - Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, PR China. FAU - Xiong, Yan AU - Xiong Y AD - Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, PR China; Department of Orthopedics, Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, PR China. FAU - Li, Jian AU - Li J AD - Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, PR China; Department of Orthopedics, Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, PR China. Electronic address: hxlijian.china@163.com. LA - eng PT - Journal Article DEP - 20230914 PL - United States TA - Arthroscopy JT - Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association JID - 8506498 SB - IM MH - Humans MH - Adolescent MH - *Patellar Dislocation/surgery/diagnostic imaging MH - Male MH - Female MH - *Tibia/surgery/diagnostic imaging MH - Follow-Up Studies MH - *Recurrence MH - *Patella/surgery/diagnostic imaging MH - Treatment Outcome MH - Retrospective Studies EDAT- 2023/09/16 05:41 MHDA- 2024/05/06 00:52 CRDT- 2023/09/15 19:17 PHST- 2023/05/12 00:00 [received] PHST- 2023/09/01 00:00 [revised] PHST- 2023/09/02 00:00 [accepted] PHST- 2024/05/06 00:52 [medline] PHST- 2023/09/16 05:41 [pubmed] PHST- 2023/09/15 19:17 [entrez] AID - S0749-8063(23)00772-7 [pii] AID - 10.1016/j.arthro.2023.09.001 [doi] PST - ppublish SO - Arthroscopy. 2024 May;40(5):1529-1540. doi: 10.1016/j.arthro.2023.09.001. Epub 2023 Sep 14.