Bayar Ahmet, Turhan Egemen, Ozer Tülay, Keser Selçuk, Ege Ahmet, Erdem Zuhal
Department of Orthopaedics and Traumatology, Faculty of Medicine, Zonguldak Karaelmas University, 67600, Kozlu, Zonguldak, Turkey.
Knee Surg Sports Traumatol Arthrosc. 2008 Dec;16(12):1114-20. doi: 10.1007/s00167-008-0612-0. Epub 2008 Sep 9.
Central patellar (CP) portal is an accessory portal in arthroscopic knee surgery, which generally is considered to be safe. In this cross sectional study, we aimed to delineate the clinical and radiological outcome of patellar tendon (PT) and Hoffa's fat pad after the use of this approach. From our hospital records, patients who underwent arthroscopy via CP portal were identified and were invited for the study. There were16 men and 4 women with a mean age of 32 years. Mean follow-up time was 28 months. Meniscectomy had been performed for irreparable bucket-handle type medial meniscal tears in all patients. At the latest follow-up, no patients had anterior knee pain and physical examination was normal. Mean PT thickness of operated knees measured with Ultrasonography was 5.63+/-1.56, while it was 3.76+/-0.46 mm in contralateral knees and the difference was significant. Contour irregularity of PT and focal hypoechoic areas were found in 17 patients, two of which also had hyperechogenic calcification focuses. Abnormal signal intensity of PT was also found in 17 patients with Magnetic Resonance Imaging (MRI). Eleven of these had decreased signal intensity within the tendon which was interpreted as fibrosis. In six patients, increased signal intensity, radiologically similar to chronic tendinitis, was detected. Four patients had decreased signal intensity in the Hoffa's fat pad. Local fibrous tissues in patellar tendon might cause weakness in the tendon. This study showed that although CP portal did not cause any clinical problems in a low demand group of patients, it leads to a significant radiological sequela in the tendon, biomechanical significance of which needs to be clarified.
髌中央（CP）入路是膝关节镜手术中的一个辅助入路，一般认为是安全的。在这项横断面研究中，我们旨在描绘使用该入路后髌腱（PT）和Hoffa脂肪垫的临床和影像学结果。从我们医院的记录中，识别出通过CP入路接受关节镜检查的患者并邀请他们参与研究。共有16名男性和4名女性，平均年龄32岁。平均随访时间为28个月。所有患者均因不可修复的桶柄样内侧半月板撕裂而进行了半月板切除术。在最近的随访中，没有患者出现膝前疼痛，体格检查正常。用超声测量的手术侧膝关节髌腱平均厚度为5.63±1.56mm，而对侧膝关节为3.76±0.46mm，差异有统计学意义。17例患者发现髌腱轮廓不规则和局灶性低回声区，其中2例还伴有高回声钙化灶。磁共振成像（MRI）检查还发现17例患者髌腱信号强度异常。其中11例肌腱内信号强度降低，被解释为纤维化。6例患者检测到信号强度增加，影像学表现类似于慢性肌腱炎。4例患者Hoffa脂肪垫信号强度降低。髌腱局部纤维组织可能导致肌腱薄弱。本研究表明，虽然CP入路在低需求患者组中未引起任何临床问题，但它会导致肌腱出现明显的影像学后遗症，其生物力学意义有待阐明。
