内侧髌股韧带重建术后股骨隧道位置阈值与功能预后的关联
简介
该研究回顾分析了50例内侧髌股韧带重建术（MPFLR）患者，通过术后CT三维成像和患者报告结局指标（PROMs）确定股骨隧道位置的临床可接受阈值。结果显示，股骨隧道偏离解剖止点超过7.2 mm会显著影响功能改善，其中远端偏移>4.5 mm对IKDC、KOOS等评分的不良影响尤为突出。这一量化阈值对术中精准定位股骨隧道具有直接指导意义。
英文摘要
BACKGROUND: While numerous studies have examined the effects of femoral tunnel malposition in medial patellofemoral ligament (MPFL) reconstruction (MPFLR), the extent to which deviation from the anatomic femoral insertion can be tolerated before patient-reported outcome measures (PROMs) are adversely affected has not been clearly established. PURPOSE: To evaluate postoperative improvements in PROMs after MPFLR, determine outcome-based cutoffs for femoral tunnel placement using 3-dimensional imaging, and assess the effects of directional deviations. STUDY DESIGN: Cohort study, Level of evidence 3. METHODS: This retrospective study included 50 knees that underwent MPFLR between 2011 and 2023, with or without concomitant tibial tubercle osteotomy. PROMs (Lysholm, Tegner, International Knee Documentation Committee [IKDC], Knee injury and Osteoarthritis Outcome Score [KOOS], and Kujala) were collected pre- and postoperatively, and minimal clinically important differences (MCIDs) were calculated using a distribution-based method. Femoral tunnel positions were analyzed in 37 knees using postoperative computed tomography. Pearson correlation and receiver operating characteristic (ROC) curve analyses identified tunnel deviation thresholds associated with clinically meaningful improvements, and directional analyses assessed anterior-posterior and proximal-distal variations. RESULTS: All PROMs significantly improved after surgery, with MCID achievement rates of up to 68%. Femoral tunnel deviation was negatively correlated with the IKDC, KOOS, and Kujala scores. ROC analysis identified a 7.2-mm cutoff for predicting meaningful IKDC improvement (area under the curve = 0.892). Directional analysis showed no significant differences between anterior and posterior placements; however, a distal deviation >4.5 mm was associated with significantly poorer IKDC, KOOS pain, and KOOS sports outcomes. CONCLUSION: This study establishes a PROM-based cutoff for femoral tunnel positioning in MPFLR. A deviation of >7.2 mm from the anatomic insertion significantly compromises functional improvement, and excessive distal displacement has a particularly detrimental effect on outcomes.