共 共 髌 髌 髌 来自 — the consensus consensus from the British Knee Surgery Association

Original quotation:

Morgan e.a. Bailey, Andrew Metcalfe, Caroline B. Hing, Jonathan Eldridge,

Consensus Guidelines for Management of Patellofemral Instability,

The knee,

Volume 29,

2021,

PAGES 305-312,

ISSN 0968-0160,

https://doi.org/10.1016/j.knee.2021.02.018.

There are many surgical schemes to treat the shaped joints, including soft tissue and osteotomy surgery. There are three key operations: the reconstruction of the inner tadpole ligament (MPFL), the tibial nodule reunion, and the formation of the car.

This consensus was established by the British Knee Surgery Association to convene domestic surgeons, rehabilitation physicians, basic medicalists, and radiologists. The Executive Committee was finally reviewed and authorized by the Executive Committee, and was approved by the British Orthopedics Association.

1. Literature review

Bone measurement and critical point

The system retrospective of Biedert et al. Define the height of the bone as Insall Salvati (IS) ratio than 1.2 and/or Caton Dechamps (CD) index greater than 1.2-1.3, and the sagittal bone index in MRI, which is less than 0.125-0.28.

Magnussen and others conducted a systematic review of the surgical treatment of the recurrence of the bone, and evaluated the high position of the bone. They found that the remote shift of the tibial nodule is the main treatment plan, and the CD index or IS ratio is the main measurement method used. Essence

Recurrent outer unstable surgical treatment

A paper from NWACHUKWU et al. Found that the non -surgical treatment of adolescents and children was slightly higher than surgical therapy. Mackay et al. Utilly using summary data shows that the reconstruction of the inner side ligament (MPFL) in the stocks is more advantageous than other treatment methods.

Smith et al. COCHRANE's review tend to perform surgery after the dislocation of primary cymbals to reduce the risk of future dislocation.

No study found the comparison of surgery and conservative treatment of unstable recurrence.

MPFL reconstruction as the preferred soft tissue surgery

The analysis of Schneider and others found that the postoperative recurrence dislocation rate was 1.2%.

Weinberger's conclusion is that autologous transplantation is related to better knee joint scores.

Composite of the tibia nodule (TTT) and MPFL

Boutefnouchet and others systematically review. The TTT/MPFL joint reconstruction and MPFL reconstruction alone. The reports of pre -operation and postoperative variables are inconsistent, limiting the applicability of these studies for PFI treatment. This paper emphasizes the lack of high -quality control research to study this combination of surgery.

The role of carbon forming in unstable recurrence

Balcarek et al. System reviews and furniture analysis showed that compared with the separate MPFL reconstruction, the reconstruction of Baltic forming and MPFL reconstruction is more popular. The summary of the data of 10 IV -level studies was brought together.

TESTA et al. Research 25 studies on MPFL reconstruction and 15 research on III -to -IV -level firing techniques. It was found that there was no difference between the Kujala score and dislocation rate.

2. Consensus Agreement

Diagnosis and clinical evaluation

It is believed that the main points that need to be paid attention to in the history of the medical history are: more than one out of one or more, parameters related to the risk of unstable bones, related pathological changes and previous treatment history, including surgery.

In addition, the initial medical history should include evaluating whether there are acute and chronic pain, and pay attention to distinguishing between the two pains, as well as signs of whether there are comprehensive chronic pain syndrome.

For unstable symptoms, it should be clear whether it is true or false.

When checking the patient, clinicians should find signs and signs of specific developmental dysplasia, and use the Beighton score to evaluate over -activities. Patients should conduct rotating parameters to evaluate their three -dimensional arrangement.

The initial clinical evaluation should include the possibility of non -surgical measures, including physical therapy to improve the results of patients. The group recommends that clinicians should be particularly cautious when recommending surgery to patients with chronic pain and patients with excessive activity.

Imaging examination before surgery

The most suitable imaging test includes three radiation sheets with knee flexion 20-30 degrees, as well as a magnetic resonance image (MRI). The purpose of imaging testing is to detect high levels, degenerative changes, fragmented fragments, and dysplasia of bone cartilage. It is not advocated to make a film under the condition that the assessment of the bone is considered to be more reliable under the bend of smaller knee joints.

Everyone agrees that high -level indicators based on imaging and MRI are valuable. Although nodule offset is considered a certain value, the committee clearly identified that it should be explained carefully.

operation treatment

MPFL reconstruction is considered to be the most suitable soft tissue surgery. If there are no obvious dysplasia of car development, high -level or severe cymbal bone, or severe bay development. Because there is no recognized critical value, the group agrees with irregularities, but believes that the clinicians who should be treated should be decided based on clinical evaluation of individual patients. The expert group agreed that there is no indication with the outer outer support with pine solution. Only in a very small number of serious cases, this method can be used when complex soft tissues need to be balanced.

They believe that in the case of unstable bones, it should not be recommended that the inner side of the tibial nodules should not be recommended, but it should be combined with other appropriate surgery, such as MPFL reconstruction or other soft tissue balance.

Patients with severe bike development are characterized by protruding or turning on the outer side of the boat to face the outer side, or dejour B and D grading. The group believes that it should be handled by good training and experienced surgeons. The committee is very hoped not to encourage surgeons to use boat forming.

Postoperative physical therapy

The expert group believes that the physical therapy after the unstable surgery of the bone should be performed by an experienced physical therapist (or under its supervision). The purpose of physical therapy is considered to include education and suggestions, restore the scope of movement, evaluate functional movement mode, and lower limb control. They believe that the treatment plan should be personalized. Finally, some people emphasize that solving patients' expectations is important, including their career, sports and social goals.

The group acknowledged when it provided surgery instead of physical therapy lack of clearness, but the formulation guidelines were to support the process of determining the process after surgery. Due to the increase in unknown variables when treating patients with immature bones, everyone agrees to include only patients with mature bones.

Diagnosis and clinical evaluation

Participants strongly supported patients with semi -dislocations and unstable are deemed to be dislocated patients.

Imaging examination before surgery

It is recommended to use clinical and radiology parameters at the same time, including indexes based on the published normal range, such as the overlap of the bone bay bay, Caton-Dechamps or BlackBurne-Peel. Some people suggest that X -rays also use X -ray to evaluate the dysplasia, tilt and dislocation of the bone. There are also some controversy on the effectiveness of various measurement methods of tibial sodules, and it is called to use a unified measurement method to help standardize practice. None of them are included in the final documents, but it is admitted that it will be done in the future.

Operation

It should be emphasized that although these guidelines are designed to deal with patients with mature bones, they need to be limited to these surgery are limited to the patient's bone closure. It is recommended that patients with unstained bones receive conservative treatment first.

Postoperative physical therapy

The postoperative physical therapy guide was widely accepted, but in the process, we clearly see that evidence of postoperative physical therapy with unstable recurrence is very limited.

The initial working group and the majority of members believe that clinicians who treat complex bones in the treatment of complex bones should have a multi -disciplinary team and a team to discuss these cases and communicate with their peers.

The final document is submitted to the British Orthopedic Association for the final approval before the publication. Their editor is also based on formats, rather than making any modification suggestions for the content of the guide. Their main suggestion is to divide them into two separate guidelines, one aimed at evaluating the unstable recurrence of cymbal bone, and the other was used to guide surgical treatment. This is the final format of the guide, which has now been announced on the website of BASK and BOA.

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