ANALYSIS OF FAILURES FOLLOWING MEDIAL PATELLOFEMORAL LIGAMENT (MPFL) RECONSTRUCTION AND IMBRICATION
Notice bibliographique
Résumé
Patellofemoral instability is common injury and proximal soft tissue stabilisation via MPFL reconstruction or imbrication is the mainstay of treatment. The contribution of certain pathoanatomies to the failure of patellofemoral stabilisation is unknown. The purpose of this study was to analyse the failure rate of patellar stabilisation procedures in a large cohort as measured by re-dislocation of the patella. A secondary purpose was to identify the pathoantomical features that may have predisposed these patients to failure. Between May 2008 and March 2014, 207 MPFL reconstructions and 70 MPFL imbrications were performed by a single surgeon. Post-operative assessment included clinical examination to assess the integrity of the MPFL graft, plain radiographs and the Banff Patellofemoral Instability Instrument (BPII), a disease-specific outcome measure. Failures were identified and risk factors including trochlear dysplasia, patella alta, generalised ligamentous laxity (GLL), femoral tunnel position and rotational abnormalities were evaluated as contributing factors. There were 48 male and 178 female patients. The mean duration of follow-up was 24.1 months (SD 9.4, range 12–74). The average age at time of surgery was 24.81 years (SD 8.87, range 50.35–8.99). The average BMI was 23.75 (SD 3.62, range 36.70–14.90). There were 10 failures in the MPFL reconstruction group (4.8%), 1 male and 9 females. Femoral tunnel position was assessed in relation to Schottle9s point as good or excellent in all 10 cases. In terms of pathoanotomy, 8/10 failures had high-grade trochlear dysplasia, 1/10 had patella alta, 6/10 had a Beighton score of >/= 4, and 3/10 had clinically significant rotational abnormalities of the lower extremity. The primary cause attributed to the 10 failure cases was trauma in two, trochlear dysplasia in three, rotational abnormalities in one, combined femoral anteversion and GLL in two, and combined trochlear dysplasia and GLL in two. There were 13 failures in the MPFL imbrication group (18.6%), 2 males and 11 females. Among these failures, 4/13 had high-grade trochlear dysplasia, 3/13 had patella alta, 10/13 had a Beighton score of >/= 4, and one had clinically significant rotational abnormalities of the lower extremity. The primary pathology that was considered to contribute to the imbrication failure cases was trochlear dysplasia in four, generalised ligamentous laxity in six, rotational abnormalities in one, patella alta with trochlear dysplasia in one, and generalised ligamentous laxity with trochlear dysplasia in one. Prior to surgical failure the mean BPII score for the failure group was 71.5/100, compared with 74.6/100 for the remainder of the cohort. MPFL reconstruction is highly successful surgical procedure for stabilising the unstable patella with a failure rate of only 4.8%. Higher failure rates are seen in patients undergoing imbrication of the MPFL compared to a reconstruction. Pathoanatomies that contribute to failure vary between patients with the most common being trochlear dysplasia and generalised ligamentous laxity.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,005 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,002 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».