Clinical validation of the Oswestry-Bristol Classification as part of a decision algorithm for trochlear dysplasia surgery.
Bone Joint J
; 103-B(10): 1586-1594, 2021 Oct.
Article
en En
| MEDLINE
| ID: mdl-34587807
ABSTRACT
AIMS:
The Oswestry-Bristol Classification (OBC) is an MRI-specific assessment tool to grade trochlear dysplasia. The aim of this study is to validate clinically the OBC by demonstrating its use in selecting treatments that are safe and effective.METHODS:
The OBC and the patellotrochlear index were used as part of the Oswestry Patellotrochlear Algorithm (OPTA) to guide the surgical treatment of patients with patellar instability. Patients were assigned to one of four treatment groups medial patellofemoral ligament reconstruction (MPFLr); MPFLr + tibial tubercle distalization (TTD); trochleoplasty; or trochleoplasty + TTD. A prospective analysis of a longitudinal patellofemoral database was performed. Between 2012 and 2018, 202 patients (233 knees) with a mean age of 24.2 years (SD 8.1), with recurrent patellar instability were treated by two fellowship-trained consultant sports/knee surgeons at The Robert Jones and Agnes Hunt Orthopaedic Hospital. Clinical efficacy of each treatment group was assessed by Kujala, International Knee Documentation Committee (IKDC), and EuroQol five-dimension questionnaire (EQ-5D) scores at baseline, and up to 60 months postoperatively. Their safety was assessed by complication rate and requirement for further surgery. The pattern of clinical outcome over time was analyzed using mixed regression modelling.RESULTS:
In all, 135 knees (mean age 24.9 years (SD 9.4)) were treated using a MPFLr. Ten knees (7.4%) required additional surgery. A total of 50 knees (mean age 24.4 years (SD 6.3)) were treated using MPFLr + TTD. Ten (20%) required additional surgery. A total of 20 knees (mean age 19.5 years (SD 3.0)) were treated using trochleoplasty + TTD. Three patients (15%) required additional surgery. In each treatment group, there was a significant improvement in Kujala, IKDC, and EQ-5D at one year postoperatively (p < 0.001) with a recognized level of overall complication rate.CONCLUSION:
The OBC is a valid assessment tool to grade patients with trochlear dysplasia and, when used as part of the OPTA, helps to determine treatments that are safe and effective. This fulfils the requirements for its application in mainstream clinical practice. Cite this article Bone Joint J 2021;103-B(10)1586-1594.Palabras clave
Dejour classification; IKDC; MRI; Oswestry-Bristol classification; Patellofemoral instability; Patellotrochlear index; Recurrent patellar instability; Trochlear dysplasia; Trochleoplasty; clinical outcomes; knees; medial patellofemoral ligament reconstruction; surgical treatment; tibial tuberosity; trochlear dysplasia
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Índice de Severidad de la Enfermedad
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Algoritmos
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Imagen por Resonancia Magnética
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Procedimientos Ortopédicos
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Articulación Patelofemoral
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Toma de Decisiones Clínicas
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Inestabilidad de la Articulación
Tipo de estudio:
Observational_studies
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Prognostic_studies
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Qualitative_research
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Risk_factors_studies
Aspecto:
Patient_preference
Límite:
Adolescent
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Adult
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Child
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Bone Joint J
Año:
2021
Tipo del documento:
Article
País de afiliación:
Reino Unido