约翰·英索尔奖：全膝关节置换术后髌股关节弹响的配对控制评估。
The John Insall Award: control-matched evaluation of painful patellar Crepitus after total knee arthroplasty.
机构信息
Colorado Joint Replacement, 2535 S Downing Street, #100, Denver, CO 80210, USA.
出版信息
Clin Orthop Relat Res. 2011 Jan;469(1):10-7. doi: 10.1007/s11999-010-1485-3.
BACKGROUND
Patellar crepitus (PC) is reported in up to 14% of subjects implanted with cruciate-substituting total knee arthroplasty (TKA). Numerous etiologies of PC have been proposed.
QUESTIONS/PURPOSES: We determined when painful PC typically occurs postoperatively and compared patients undergoing primary TKA who developed painful PC requiring subsequent surgery with a matched group without this complication to identify clinical, radiographic, and surgical variables associated with this complication.
METHODS
From the databases of two institutions (greater than 4000 TKAs), we identified 60 patients who required surgery for painful PC from 2002 to 2008. This group was then compared with an identified control group of 60 TKA subjects without PC who were matched for the key variables of age, gender, and body mass index to determine clinical, radiographic, and surgical factors associated with the development of PC.
RESULTS
The mean time to presentation of PC was 10.9 months. The incidence of PC correlated with a greater number of previous knee surgeries, decreased patellar component size, decreased composite patellar thickness, shorter preoperative and postoperative patellar tendon length, increased posterior femoral condylar offset, use of smaller femoral components and thicker tibial polyethylene inserts, and placement of the femoral component in a flexed posture.
CONCLUSIONS
Many of the factors associated with an increased incidence of postoperative PC such as shortened patellar tendon length, use of smaller patellar components, decreased patellar composite thickness, and increased posterior femoral condylar offset may all increase quadriceps tendon contact forces against the superior aspect of the intercondylar box, increasing the risk of fibrosynovial proliferation and entrapment within the intercondylar region of the femoral component. Based on these findings, the authors recommend use of larger patellar components when possible, avoid oversection of the patella or increasing posterior femoral condylar offset, and advising patients preoperatively who have had previous knee surgery or demonstrate a shortened patellar tendon length of an increased risk of development of postoperative patellar crepitus.
LEVEL OF EVIDENCE
Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
背景
髌股关节弹响（PC）在接受交叉韧带替代型全膝关节置换术（TKA）的患者中发生率高达 14%。PC 有许多病因。
问题/目的：我们确定了术后出现疼痛性 PC 的典型时间，并将接受初次 TKA 后发生需要后续手术的疼痛性 PC 的患者与无此并发症的匹配组进行比较，以确定与该并发症相关的临床、影像学和手术变量。
方法
我们从两个机构的数据库（超过 4000 例 TKA）中确定了 60 例因疼痛性 PC 而需要手术的患者，这些患者来自 2002 年至 2008 年。然后，将这组患者与 60 例无 PC 的 TKA 患者进行匹配，这些患者在年龄、性别和体重指数等关键变量上相匹配，以确定与 PC 发展相关的临床、影像学和手术因素。
结果
PC 出现的平均时间为 10.9 个月。PC 的发生率与更多的膝关节既往手术史、髌骨组件尺寸减小、髌股复合厚度减小、术前和术后髌腱长度缩短、股骨髁后偏移增加、使用较小的股骨组件和较厚的胫骨聚乙烯插入物以及股骨组件的放置在弯曲位置有关。
结论
许多与术后 PC 发生率增加相关的因素，如髌腱长度缩短、使用较小的髌骨组件、髌股复合厚度减小以及股骨髁后偏移增加，都可能增加股四头肌肌腱对髁间盒上表面的接触力，增加纤维滑膜增生和在股骨组件的髁间区域嵌顿的风险。基于这些发现，作者建议在可能的情况下使用较大的髌骨组件，避免髌骨过度切除或增加股骨髁后偏移，并在术前告知有膝关节既往手术史或髌腱长度缩短的患者，他们发生术后髌骨弹响的风险增加。
证据水平
III 级，治疗研究。有关证据水平的完整描述，请参见作者指南。
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