Trauma Department, Hannover Medical School (MHH), Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
Arch Orthop Trauma Surg. 2013 Feb;133(2):209-13. doi: 10.1007/s00402-012-1639-8. Epub 2012 Nov 9.
Patellar dislocation is a common knee injury with mainly lateral dislocations, leading to ruptures of the medial patellofemoral ligament in most of the cases. Even though several prognostic factors for patellofemoral instability have been identified so far, the appropriate therapy for patients with patellar dislocation remains a controversial issue. The purpose of this study was to compare the outcome after conservative or operative treatment in patients after first-time patellar dislocation.
This randomized controlled clinical trial was designed multicentric including patients from six German orthopaedic and trauma departments. Twenty patients with a mean age of 24.6 years with first-time traumatic patella dislocation were included and randomized into either a conservative arm or an operative arm. Plain X-ray images of the knee joint (a.p. and lateral view and tangential view of both patellae) were performed in all cases prior to therapy to exclude osteochondral fragments requiring refixation. An MRI was recommended, but not compulsory. Patients were consulted after 6, 12, and 24 months with a questionnaire including the criteria of the Kujala score, recurrent dislocation, and satisfaction.
The mean Kujala score of the conservative vs operative treatment group was 78.6 vs 80.3 after 6 months (p = 0.842), 79.9 vs 88.9 after 12 months (p = 0.165), and 81.3 vs 87.5 after 24 months (p = 0.339). Redislocation rate after 24 months was 37.5 % in the conservative group and 16.7 % in the operative group (p = 0.347). Due to the small number of patients that could be included, no significant difference between the groups could be detected. We see a tendency towards better results after operative treatment.
Our multicentric prospective randomized controlled trial revealed no significant difference between conservative and operative treatment for patients after first-time traumatic patellar dislocation. However, a tendency towards a better Kujala score and lower redislocation rates for patients with operative treatment was observed. The small number of patients is a limiting factor of the study, leading to results without statistical significance. A meta-analysis including other study's level I data is desirable for the future.
髌骨脱位是一种常见的膝关节损伤，主要为外侧脱位，导致内侧髌股韧带在大多数情况下断裂。尽管迄今为止已经确定了几个髌股不稳定的预后因素，但髌骨脱位患者的适当治疗仍然是一个有争议的问题。本研究的目的是比较初次髌骨脱位患者保守治疗与手术治疗的结果。
这项多中心随机对照临床试验设计包括来自德国六个骨科和创伤科的患者。纳入了 20 名平均年龄为 24.6 岁的初次创伤性髌骨脱位患者，并随机分为保守治疗组或手术治疗组。所有患者在治疗前均进行膝关节的普通 X 射线检查（前后位和侧位以及双侧髌骨切线位），以排除需要重新固定的骨软骨碎片。建议进行 MRI 检查，但不是强制性的。患者在 6、12 和 24 个月时接受问卷调查，包括 Kujala 评分、复发性脱位和满意度的标准。
保守治疗组和手术治疗组的平均 Kujala 评分分别为 6 个月时 78.6 分对 80.3 分（p = 0.842），12 个月时 79.9 分对 88.9 分（p = 0.165），24 个月时 81.3 分对 87.5 分（p = 0.339）。24 个月时保守组的再脱位率为 37.5%，手术组为 16.7%（p = 0.347）。由于纳入的患者数量较少，两组之间没有显著差异。我们观察到手术治疗后结果更好的趋势。
我们的多中心前瞻性随机对照临床试验显示，初次创伤性髌骨脱位患者的保守治疗与手术治疗之间没有显著差异。然而，观察到手术治疗患者的 Kujala 评分更高和再脱位率更低的趋势。患者数量少是该研究的一个限制因素，导致结果没有统计学意义。未来需要进行包括其他研究水平 I 数据的荟萃分析。
