Peters T A, McLean I D
Prahran Sports Medicine Centre, Victoria, Australia.
Am J Sports Med. 2000 Jan-Feb;28(1):63-7. doi: 10.1177/03635465000280012201.
Osteochondritis dissecans of the patellofemoral joint is an uncommon condition that may be the cause of anterior knee pain or crepitus. We present the clinical features of 37 patients with osteochondritis dissecans lesions of the patellofemoral joint (24 on the patella, 13 on the trochlear groove), including two patients with medial trochlear groove lesions, which have not, to our knowledge, been previously reported. The osteochondral lesions involved the convex articular surfaces. The median age of patients when first examined was 15 years, and 54% of patients had open epiphyses. These lesions were more common in male patients than in female patients (four-to-one ratio). Osteochondritis dissecans of the patellofemoral joint can be overlooked unless quality radiographs are viewed with care and, at arthroscopy, both the patella and trochlear groove are assessed. Treatment depends on the symptoms, site, and nature of the lesion and the patient's age. Nonoperative management includes patellar taping and vastus medialis obliquus muscle exercises. Operative intervention is indicated for patients with mechanical symptoms and includes arthroscopy, consisting of chondroplasty and removal of loose bodies, and lateral retinacular release. In this study treatment generally improved the symptoms, but patients with articular cartilage loss had persistent patellofemoral crepitus and discomfort.
髌股关节剥脱性骨软骨炎是一种罕见的疾病，可能是前膝痛或膝关节弹响的原因。我们报告了37例髌股关节剥脱性骨软骨炎病变患者的临床特征（24例位于髌骨，13例位于滑车沟），其中包括2例内侧滑车沟病变患者，据我们所知，此前尚未有相关报道。骨软骨病变累及凸关节面。首次检查时患者的中位年龄为15岁，54%的患者骨骺未闭合。这些病变在男性患者中比女性患者更常见（比例为4:1）。除非仔细查看高质量的X线片，并且在关节镜检查时对髌骨和滑车沟都进行评估，否则髌股关节剥脱性骨软骨炎可能会被忽视。治疗取决于病变的症状、部位、性质以及患者的年龄。非手术治疗包括髌骨贴扎和股内侧斜肌锻炼。有机械性症状的患者需要进行手术干预，包括关节镜检查，即软骨成形术和清除游离体，以及外侧支持带松解。在本研究中，治疗总体上改善了症状，但关节软骨受损的患者仍有持续的髌股关节弹响和不适。
