Sarrus Teinturiers Private Hospital, 49, allée Charles-de-Fitte, 31300 Toulouse, France.
Orthop Traumatol Surg Res. 2009 Feb;95(1):36-9. doi: 10.1016/j.otsr.2008.09.001. Epub 2009 Feb 3.
Anterior knee instability caused by anterior cruciate ligament (ACL) deficiency results in meniscal as well as chondral femorotibial and/or femoropatellar damages over a more or less long duration delay. This study's objectives were, in chronically deficient ACL patients, to assess onset delay for developing chondral patella lesions and also analyse these lesions characteristics in relation to laxity duration.
Chondral patellar lesions in ACL deficient knees get worse with time.
We reviewed 250 charts of patients who had undergone arthroscopically assisted surgery for knee anterior laxity. The arthroscopic procedures were conducted between January 1995 and January 2005. Chondral damages were evaluated at surgery according both to International Cartilage Repair Society (ICRS) and Bauer and Jackson classifications. The data were analyzed using the Kruskal-Wallis test and the Fisher exact test.
Of the 250 analysed charts, 72 patients (28.8%) were found to present chondral patella lesions. The majority of these lesions were superficial and involved the lateral facet area. We observed a statistically significant ICRS worsening grade in relation to laxity duration.
Few publications in the literature report patellar involvement in anterior laxity of the knee. However, our results are comparable to those of the rare series found. The pathomechanics of these lesions has not yet been precisely identified and requires further biomechanical studies.
Patellar damage is frequent with anterior laxity (28.8% in our series) and duration is correlated with statistically significant aggravation of these lesions. Currently, the assessment of these patellar lesions is considered less important than meniscal and femorotibial lesions, even though the natural history of ACL disruption seems to be evolving toward degeneration of all the compartments of the knee, including the femoropatellar compartment.
由于前交叉韧带（ACL）缺失导致的前膝不稳定，会导致半月板以及股骨胫骨和/或股骨髌骨关节软骨的损伤，且这种损伤会随着时间的推移而逐渐加重。本研究的目的是在慢性 ACL 缺失的患者中，评估发生髌骨关节软骨损伤的延迟时间，并分析这些损伤的特征与松弛持续时间的关系。
ACL 缺失的膝关节中的髌骨关节软骨损伤会随着时间的推移而恶化。
我们回顾了 250 例接受关节镜辅助手术治疗膝关节前松弛的患者的病历。关节镜手术于 1995 年 1 月至 2005 年 1 月期间进行。根据国际软骨修复学会（ICRS）和鲍尔和杰克逊分类法，在手术中评估软骨损伤。使用 Kruskal-Wallis 检验和 Fisher 精确检验对数据进行分析。
在分析的 250 份病历中，发现 72 例（28.8%）患者存在髌骨关节软骨损伤。这些损伤大多数为浅表性，累及外侧关节面区域。我们观察到松弛持续时间与 ICRS 恶化程度之间存在统计学显著相关性。
文献中很少有关于髌骨关节受累与膝关节前松弛的报道。然而，我们的结果与少数发现的罕见系列结果相似。这些损伤的发病机制尚未被精确确定，需要进一步的生物力学研究。
在我们的系列研究中，髌骨关节损伤在膝关节前松弛中很常见（占 28.8%），且松弛持续时间与这些损伤的严重程度呈统计学显著相关。目前，与半月板和股骨胫骨损伤相比，这些髌骨关节损伤的评估被认为不太重要，尽管 ACL 断裂的自然史似乎正在向膝关节所有关节腔（包括股骨髌骨关节腔）的退行性变演变。
