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Poster 234: Radiographic Predictors of Failure of Patellar Instability Surgery in Adolescents

OBJECTIVES: Adolescents often benefit from surgical management of recurrent patellofemoral instability (PFI). However, the debate continues as to which preoperative radiographic factors can be used to predict the risk of failure of patellar stabilization surgery. The purpose of this study was to det...

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Autores principales: Zheng, Evan, Cook, Danielle, Hussain, Zaamin, Nunally, Kianna, Heyworth, Benton, Micheli, Lyle, Yen, Yi-Meng, Kramer, Dennis, Kocher, Mininder, Wilson, Benjamin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9344290/
http://dx.doi.org/10.1177/2325967121S00795
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author Zheng, Evan
Cook, Danielle
Hussain, Zaamin
Nunally, Kianna
Heyworth, Benton
Micheli, Lyle
Yen, Yi-Meng
Kramer, Dennis
Kocher, Mininder
Wilson, Benjamin
author_facet Zheng, Evan
Cook, Danielle
Hussain, Zaamin
Nunally, Kianna
Heyworth, Benton
Micheli, Lyle
Yen, Yi-Meng
Kramer, Dennis
Kocher, Mininder
Wilson, Benjamin
author_sort Zheng, Evan
collection PubMed
description OBJECTIVES: Adolescents often benefit from surgical management of recurrent patellofemoral instability (PFI). However, the debate continues as to which preoperative radiographic factors can be used to predict the risk of failure of patellar stabilization surgery. The purpose of this study was to determine the rate of failure, defined as recurrence of instability, in a large cohort of adolescent athletes undergoing primary surgery for PFI, and to identify preoperative radiographic risk factors for recurrence. METHODS: We retrospectively reviewed patients aged 19 years and younger who underwent primary surgery for PFI at our institution between 2008 and 2017. Patients underwent surgical procedures including medial retinacular plication (MRP), medial patellofemoral ligament reconstruction (MPFLR), tibial tubercle osteotomy (TTO), or a combination thereof. Preoperative magnetic resonance imaging (MRI) studies were reviewed and radiographic parameters were recorded. We excluded patients with incomplete imaging data, BMI >30kg/m(2), those that underwent surgery for fixation of a chondral fracture >1cm, and patients with a diagnosis of syndromic disorder. Demographic and radiographic variables were compared between patients who experienced recurrence of instability and those that did not. Logistic regression was utilized to determine if any imaging characteristics were associated with recurrent instability while controlling for age and sex. RESULTS: Three-hundred three patients, average age 15.1 years, underwent primary surgical stabilization for PFI with median follow up time of 3.0 years. At final follow-up, 25% of patients (76/303) experienced recurrent instability with 41 patients (14%) requiring additional surgery because of this instability. Patients who had recurrent instability were younger (14.3vs15.4 years; p<0.001) and were more likely to have undergone MRP surgery alone (66% vs 35%; p<0.001) (Table 1). They were also more likely to have an open physeal status (62% vs 49%; p<0.001), a larger sulcus angle (163.9 vs 159.2; p<0.001), a larger patellar tilt angle (26.3 vs 23.6; p=0.04), and larger Caton-Deschamps ratio (1.3 vs 1.2; p=0.03) (Table 2). Each additional degree of sulcus angle increased the odds of recurrent instability by 5% (OR=1.05; p=0.002). Notably, each additional year of age at the time of surgery, decreased the odds of failure by 23% (OR=0.77; p<0.001). CONCLUSIONS: In conclusion, 25% of adolescents experienced recurrent instability after primary patellar stabilization surgery. These patients who failed initial surgical treatment were younger and had more MRP procedures. Radiographically, they had more open physes, flatter trochleae, more patellar tilt, and larger patellar height. This information can be used to guide treatment decisions and inform the risk of failure of surgical stabilization procedures in adolescents with PFI.
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spelling pubmed-93442902022-08-03 Poster 234: Radiographic Predictors of Failure of Patellar Instability Surgery in Adolescents Zheng, Evan Cook, Danielle Hussain, Zaamin Nunally, Kianna Heyworth, Benton Micheli, Lyle Yen, Yi-Meng Kramer, Dennis Kocher, Mininder Wilson, Benjamin Orthop J Sports Med Article OBJECTIVES: Adolescents often benefit from surgical management of recurrent patellofemoral instability (PFI). However, the debate continues as to which preoperative radiographic factors can be used to predict the risk of failure of patellar stabilization surgery. The purpose of this study was to determine the rate of failure, defined as recurrence of instability, in a large cohort of adolescent athletes undergoing primary surgery for PFI, and to identify preoperative radiographic risk factors for recurrence. METHODS: We retrospectively reviewed patients aged 19 years and younger who underwent primary surgery for PFI at our institution between 2008 and 2017. Patients underwent surgical procedures including medial retinacular plication (MRP), medial patellofemoral ligament reconstruction (MPFLR), tibial tubercle osteotomy (TTO), or a combination thereof. Preoperative magnetic resonance imaging (MRI) studies were reviewed and radiographic parameters were recorded. We excluded patients with incomplete imaging data, BMI >30kg/m(2), those that underwent surgery for fixation of a chondral fracture >1cm, and patients with a diagnosis of syndromic disorder. Demographic and radiographic variables were compared between patients who experienced recurrence of instability and those that did not. Logistic regression was utilized to determine if any imaging characteristics were associated with recurrent instability while controlling for age and sex. RESULTS: Three-hundred three patients, average age 15.1 years, underwent primary surgical stabilization for PFI with median follow up time of 3.0 years. At final follow-up, 25% of patients (76/303) experienced recurrent instability with 41 patients (14%) requiring additional surgery because of this instability. Patients who had recurrent instability were younger (14.3vs15.4 years; p<0.001) and were more likely to have undergone MRP surgery alone (66% vs 35%; p<0.001) (Table 1). They were also more likely to have an open physeal status (62% vs 49%; p<0.001), a larger sulcus angle (163.9 vs 159.2; p<0.001), a larger patellar tilt angle (26.3 vs 23.6; p=0.04), and larger Caton-Deschamps ratio (1.3 vs 1.2; p=0.03) (Table 2). Each additional degree of sulcus angle increased the odds of recurrent instability by 5% (OR=1.05; p=0.002). Notably, each additional year of age at the time of surgery, decreased the odds of failure by 23% (OR=0.77; p<0.001). CONCLUSIONS: In conclusion, 25% of adolescents experienced recurrent instability after primary patellar stabilization surgery. These patients who failed initial surgical treatment were younger and had more MRP procedures. Radiographically, they had more open physes, flatter trochleae, more patellar tilt, and larger patellar height. This information can be used to guide treatment decisions and inform the risk of failure of surgical stabilization procedures in adolescents with PFI. SAGE Publications 2022-07-28 /pmc/articles/PMC9344290/ http://dx.doi.org/10.1177/2325967121S00795 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by-nc-nd/4.0/This open-access article is published and distributed under the Creative Commons Attribution - NonCommercial - No Derivatives License (https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits the noncommercial use, distribution, and reproduction of the article in any medium, provided the original author and source are credited. You may not alter, transform, or build upon this article without the permission of the Author(s). For article reuse guidelines, please visit SAGE’s website at http://www.sagepub.com/journals-permissions.
spellingShingle Article
Zheng, Evan
Cook, Danielle
Hussain, Zaamin
Nunally, Kianna
Heyworth, Benton
Micheli, Lyle
Yen, Yi-Meng
Kramer, Dennis
Kocher, Mininder
Wilson, Benjamin
Poster 234: Radiographic Predictors of Failure of Patellar Instability Surgery in Adolescents
title Poster 234: Radiographic Predictors of Failure of Patellar Instability Surgery in Adolescents
title_full Poster 234: Radiographic Predictors of Failure of Patellar Instability Surgery in Adolescents
title_fullStr Poster 234: Radiographic Predictors of Failure of Patellar Instability Surgery in Adolescents
title_full_unstemmed Poster 234: Radiographic Predictors of Failure of Patellar Instability Surgery in Adolescents
title_short Poster 234: Radiographic Predictors of Failure of Patellar Instability Surgery in Adolescents
title_sort poster 234: radiographic predictors of failure of patellar instability surgery in adolescents
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9344290/
http://dx.doi.org/10.1177/2325967121S00795
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