关节镜下髌腱松解术治疗对非手术治疗无反应的髌腱病的中远期疗效。
Mid- and long-term efficacy of the arthroscopic patellar release for treatment of patellar tendinopathy unresponsive to nonoperative management.
机构信息
Department of Orthopedic and Trauma Surgery, University Medical Center Freiburg, Freiburg, Germany.
出版信息
Arthroscopy. 2013 Aug;29(8):1338-45. doi: 10.1016/j.arthro.2013.05.004. Epub 2013 Jul 3.
PURPOSE
The purpose of this study was to evaluate the mid- and long-term efficacy of the arthroscopic patellar release (APR) in a representative number of competitive athletes.
METHODS
This prospective study included 35 competitive athletes who underwent APR for treatment of chronic refractory patellar tendinopathy. The minimum follow-up period was 24 months. Preoperatively and at follow-up, we measured the Swedish Victorian Institute of Sport Assessment for Patella (VISA-P) and modified Blazina score for assessment of functional outcome. The patients rated their subjective knee function (0% to 100%) and maximum pain during exercise on a visual analog scale (0 to 10 points). We inquired about time required for full return to sports.
RESULTS
Thirty athletes (27 male individuals, 3 female individuals) were available for clinical examination after a mean follow-up period of 4.4 years (σ = 3.0 years). The follow-up rate was 30 of 35 (86%). Mean age at surgery was 27.6 years (σ = 7.4). The mean VISA-P score improved from 57.3 (σ = 11.4) to 95.1 (σ = 8.2) and the mean Blazina score improved from 4.0 (σ = 0.8) to 0.3 (σ = 0.7). Average subjective knee function improved from 48.8% (σ = 18.5%) to 90.5% (σ = 9.8%). The mean pain level decreased from 5.7 (σ = 1.1) to 0.6 (σ = 1.2%). All changes were significant (P < .01). Twenty-three (76.7%) athletes were able to perform sports at previous levels without any symptoms. The mean time required for full return to sports was 4.4 months (1.5 to 12.0 months; σ = 3.3). Less pronounced symptoms recurred in 3 (10%) athletes.
CONCLUSIONS
After APR, 97% of patients obtained excellent or good functional outcomes with a mean follow-up of 4.4 years. Three of 4 athletes achieved asymptomatic previous sports levels, returning to full sports at an average of 4.4 months. Symptoms partially recurred in 10% of participants.
LEVEL OF EVIDENCE
Level IV: prospective therapeutic case series.
目的
本研究的目的是评估关节镜下髌腱松解术（APR）在大量竞技运动员中的中远期疗效。
方法
本前瞻性研究纳入了 35 名接受 APR 治疗慢性难治性髌腱病的竞技运动员。随访时间至少 24 个月。术前和随访时，我们使用瑞典维多利亚运动评估髌腱（VISA-P）和改良 Blazina 评分评估功能结果。患者通过视觉模拟评分（0 至 10 分）自评膝关节功能（0%至 100%）和运动时最大疼痛程度。我们询问了患者完全恢复运动所需的时间。
结果
平均随访 4.4 年后（σ=3.0 年），30 名运动员（27 名男性，3 名女性）可进行临床检查，随访率为 30/35（86%）。手术时的平均年龄为 27.6 岁（σ=7.4）。VISA-P 评分从 57.3（σ=11.4）提高到 95.1（σ=8.2），Blazina 评分从 4.0（σ=0.8）提高到 0.3（σ=0.7）。平均膝关节功能自评从 48.8%（σ=18.5%）提高到 90.5%（σ=9.8%）。平均疼痛水平从 5.7（σ=1.1）降至 0.6（σ=1.2）。所有变化均具有统计学意义（P＜0.01）。23 名（76.7%）运动员能以前无症状的状态进行以前的运动。完全恢复运动所需的平均时间为 4.4 个月（1.5 至 12.0 个月；σ=3.3）。3 名（10%）运动员出现症状程度较轻的复发。
结论
APR 后，97%的患者在平均 4.4 年的随访中获得了极好或良好的功能结果。4 名运动员中有 3 名达到了无症状的既往运动水平，平均 4.4 个月即可完全恢复运动。10%的参与者出现部分症状复发。
证据等级
IV 级：前瞻性治疗病例系列。
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