Background The aim of the study was to conduct a comprehensive functional and radiological follow-up assessment in patients at least 10 years after adductor magnus MPFL reconstruction, and to assess the presence of early degenerative changes. Methods The mean age at the time of surgery was 16 years (range: 8 to 18 years, SD 2.5). The follow-up examination was performed at least 10 years following adductor magnus MPFL reconstruction (mean 11 years). Twenty-one patients (26 operated knees) attended the follow-up. The mean age at follow-up was 25.1 years (range 20–29 years). Results The significant improvement observed at 3 years, indicated by the Kujala and Lysholm scores, was maintained after 10 years of follow-up (p < 0.001). A single recurrence of dislocation was noted in three patients. A significant improvement in radiological parameters was noted. No significant difference in the incidence of chondromalacia, of any degree, was observed compared to controls. Significantly higher quadriceps peak torque was noted for both angular velocities (60 and 180°/sec) compared to the preoperative readings (p < 0.001). Knee flexors were found to be significantly stronger at both 60 and 180°/sec at 10 years follow-up examination (p = 0.008 and p < 0.001 respectively). Conclusion The use of MPFL reconstruction according to Avikainen yields improvements in clinical and radiological results which are maintained throughout the observation period. No significantly greater articular cartilage degeneration was noted in patients after surgical treatment for recurrent patellar dislocation compared to healthy peers. Trial registration Registered on Clinical Trails.gov with ID: PMMHRI-BCO.67/2021-A.
PurposeThe aim of this prospective study is to perform a clinical and radiological assessment of the results of surgical treatment in a homogenous group of adolescents with recurrent patellar dislocation (RPD), using medial patellofemoral ligament (MPFL) reconstruction as the basic technique. MethodsTwenty-two patients reported to the follow-up examination after at least three years, including four patients who underwent bilateral surgery (26 knees). The mean age at the time of the surgery was 15.4 years. The subjects were asked to complete the Lysholm-Tegner Knee Scale and the Kujala Anterior Knee Pain Scale before surgery and after follow-up. Based on the imaging results, the Caton-Deschamps Index (CDI), congruence angle (CA), patellofemoral angle (PFA) and Wiberg classification of the patella shape were assessed. ResultsTwo incidents of patellar redislocation was noted. Both the Lysholm-Tegner and Kujala Scale scores significantly improved after follow-up (p<0.001). CDI did not change significantly (p=0.681). The values of both PFA and CA significantly decreased after surgery (p<0.001). An incorrect congruence angle (patellar shift) was present in 22 knees pre-op and ten post-op (p=0.002). Increased patellofemoral angle (patellar tilt) was present in 21 knees pre-op and seven post-op (p<0.001). A statistically significant correlation was demonstrated between PFA and both Lyscholm-Tegner and Kujala score (in both p<0.001, r=-0.5). A slight, but significant, correlation was found between CA and Kujala score (p=0.008, r= -0.036). ConclusionSurgical treatment causes a considerable improvement in the functional assessment of patients, as well as anatomical conditions within the patellofemoral joint.ClinicalTrials.gov record No PMMHRI-BCO.34/2019ClinicalTrials.gov Identifier: NCT03983213https://clinicaltrials.gov/ct2/show/NCT03983213Registered 06/12/2019 - Retrospectively registered
The present study analyses the outcome of open reduction and internal fixation (ORIF) of humerus medial epicondyle fracture with the use of Kirschner (K) wires, and determine the effect of elbow dislocation. The study included 112 patients operated on in 2005–2016. Of these, 81presented with an isolated medial epicondyle fracture (mean age 11.6 years), and 31 with an elbow dislocation (mean age 11.9 years). Out of 112 patients tested, 98 achieved an excellent treatment result, ten good and a mean Mayo Elbow Performance Score (MEPS); no significant differences were observed between dislocated and non-dislocated elbow groups. Those with an isolated medial epicondyle fracture demonstrated a mean flexion of 140.7° and extension deficit of 3.0°, while those with an elbow dislocation displayed a mean flexion of 134.5° and extension deficit 6.1°. The dislocation group demonstrated significantly greater extension and flexion deficits (p = 0.019, p < 0.001, respectively). One patient required revision surgery due to nonunion. Ulnar nerve function was normal in 110 patients: in the other two, it resolved spontaneously in one, and the nerve was transposed in the other. Medial elbow instability was found in seven patients: two with elbow dislocation and five without. ORIF with K wires is a safe procedure for treating medial epicondyle humeral fractures that yields good or very good results. Similar outcomes are observed between patients with and without dislocation according to MEPS; however, flexion and extension are more limited in the former group.
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