Royal Liverpool University Hospital, Prescot Road, Liverpool L7 8XP, UK.
Bone Joint J. 2013 Apr;95-B(4):478-85. doi: 10.1302/0301-620X.95B4.29681.
We present the ten- to 15-year follow-up of 31 patients (34 knees), who underwent an Elmslie-Trillat tibial tubercle osteotomy for chronic, severe patellar instability, unresponsive to non-operative treatment. The mean age of the patients at the time of surgery was 31 years (18 to 46) and they were reviewed post-operatively, at four years (2 to 8) and then at 12 years (10 to 15). All patients had pre-operative knee radiographs and Cox and Insall knee scores. Superolateral portal arthroscopy was performed per-operatively to document chondral damage and after the osteotomy to assess the stability of the patellofemoral joint. A total of 28 knees (82%) had a varying degree of damage to the articular surface. At final follow-up 25 patients (28 knees) were available for review and underwent clinical examination, radiographs of the knee, and Cox and Insall scoring. Six patients who had no arthroscopic chondral abnormality showed no or only early signs of osteoarthritis on final radiographs; while 12 patients with lower grade chondral damage (grade 1 to 2) showed early to moderate signs of osteoarthritis and six out of ten knees with higher grade chondral damage (grade 3 to 4) showed marked evidence of osteoarthritis; four of these had undergone a knee replacement. In the 22 patients (24 knees) with complete follow-up, 19 knees (79.2%) were reported to have a good or excellent outcome at four years, while 15 knees (62.5%) were reported to have the same at long-term follow-up. The functional and radiological results show that the extent of pre-operatively sustained chondral damage is directly related to the subsequent development of patellofemoral osteoarthritis.
我们报告了 31 例（34 膝）慢性、严重髌股关节不稳定患者的 10-15 年随访结果，这些患者均对非手术治疗无反应而行 Elmslie-Trillat 胫骨结节截骨术。患者的平均手术年龄为 31 岁（18-46 岁），术后 4 年（2-8 年）和 12 年（10-15 年）进行了随访。所有患者均有术前膝关节 X 线片和 Cox 和 Insall 膝关节评分。术中行外侧髌上入路关节镜检查以记录软骨损伤，并在截骨术后评估髌股关节稳定性。总共 28 个膝关节（82%）有不同程度的关节面损伤。末次随访时，25 例（28 膝）患者可进行评估，行体格检查、膝关节 X 线片和 Cox 和 Insall 评分。6 例无关节镜下软骨异常的患者在最终 X 线片上无或仅有早期骨关节炎表现；而 12 例软骨损伤程度较低（1-2 级）的患者有早期至中度骨关节炎表现，10 例软骨损伤程度较高（3-4 级）的患者中有 6 例有明显骨关节炎表现；其中 4 例已行膝关节置换术。在 22 例（24 膝）有完整随访的患者中，19 膝（79.2%）在 4 年时报告有良好或优秀的结果，而 15 膝（62.5%）在长期随访时报告有相同的结果。功能和影像学结果表明，术前持续软骨损伤的程度与随后髌股关节炎的发展直接相关。
