Academic Department of Orthopaedic Surgery and Sports Trauma, CHU de Grenoble Teaching Hospital Center, South district Hospital, avenue de Kimberley, BP 338, 38434 Échirolles cedex, France.
Orthop Traumatol Surg Res. 2012 Apr;98(2):167-72. doi: 10.1016/j.otsr.2011.10.008. Epub 2012 Feb 15.
Numerous procedures may be used in the surgical treatment of patellar instability. We have noticed that certain types of patellar instability result in a bulge (or protrusion) of the distal medial facet of the patella which can hinder recentering in the trochlear groove.
In certain patellofemoral dysplasias, trimming down of this bulge (patelloplasty) as long as it is associated with a "à la carte surgery" program, can improve stability, centering and lateral patellar tilt.
This retrospective series included 23 patients (26 knees), 13 women and 10 men, mean age 25.9±9.01 years old (15-52) operated between 1997-2008. Patellar dislocation had occurred at least once in all knees, and at least twice in 16 knees. The mean preoperative Kujala score was 79.1±6.1 points (68-91). There was a bulge on the medial facet of the patella in all cases, in particular on skyline views associated with the usual criteria for patellofemoral dysplasia. Patelloplasty was associated in all cases with resection of the lateral patellar retinaculum and anteromedialization of the tibial tubercle (7 were lowered) and four Albee trochleoplasties.
Recurrent dislocation occurred in one case (4.7%). Nineteen patients (22 knees) were followed up for a mean 7.53±3.27 years (2-13 years). The mean postoperative Kujala score was 91.8±7.9 points (70-100) and the subjective results in 19/22 (86.5%) knees were satisfactory or very satisfactory. On skyline views, 21 patellae (95.5%) were well centered and one (4.5%) still presented with lateral tilt. There was no osteoarthritis in 15 knees (68%).
In selected cases, patelloplasty of the medial facet of the patella has no particular morbidity at intermediate follow-up. Associated with other surgical procedures, the rate of satisfaction of patients is very high and especially encouraging.
Level IV, retrospective cohort study.
髌骨不稳定的手术治疗方法众多。我们注意到，某些类型的髌骨不稳定会导致髌骨远端内侧关节面膨出（或突出），从而阻碍滑车沟的再中心化。
在某些髌股发育不良中，只要与“点菜式手术”方案相结合，切除这个膨出（髌骨成形术）可以改善稳定性、中心定位和外侧髌骨倾斜。
本回顾性系列研究纳入了 23 名患者（26 膝），13 名女性和 10 名男性，平均年龄 25.9±9.01 岁（15-52 岁），手术时间为 1997-2008 年。所有膝关节均至少发生过一次髌骨脱位，16 个膝关节至少发生过两次。术前 Kujala 评分平均为 79.1±6.1 分（68-91）。所有病例的髌骨内侧关节面均有膨出，特别是在与髌股发育不良的常见标准相关的侧位片上。所有病例均行髌骨成形术，同时行外侧髌骨支持带切除术和胫骨结节前内移（7 例降低）和 4 例 Albee 滑车成形术。
1 例（4.7%）发生复发性脱位。19 名患者（22 膝）平均随访 7.53±3.27 年（2-13 年）。术后平均 Kujala 评分为 91.8±7.9 分（70-100），22 膝中有 19 膝（86.5%）的主观结果为满意或非常满意。在侧位片上，21 个髌骨（95.5%）中心位置良好，1 个（4.5%）仍存在外侧倾斜。15 个膝关节（68%）无骨关节炎。
在选择病例中，髌骨内侧关节面成形术在中期随访中没有特殊的发病率。与其他手术方法相结合，患者的满意度非常高，令人鼓舞。
IV 级，回顾性队列研究。
