Department of Orthopedic Sports Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany,
Knee Surg Sports Traumatol Arthrosc. 2014 Nov;22(11):2591-8. doi: 10.1007/s00167-013-2603-z. Epub 2013 Jul 14.
Excessive trochlear dysplasia may be responsible for recurrent patellofemoral instability (PFI) due to a missing bony guidance for the patella in early flexion. Thus, an isolated medial patellofemoral ligament reconstruction (MPFLR) can be insufficient, since it mainly addresses instability close to extension and additionally can increase patellofemoral pressure leading to pain in flat or convex trochlear dysplasia. Therefore, in combination with a trochleoplasty, an anatomical trochlear groove is created, resulting in patellofemoral stability also in flexion, while patellofemoral pressure is normalized. In this prospective study, we evaluated the outcome of open trochleoplasty in combination with MPFLR with a minimum follow-up of 2 years for treatment of excessive PFI.
In between 2007 and 2009, 18 knees of 17 consecutive patients (mean age of 22.2 ± 4.9 years) with trochlear dysplasia type B, C or D according to Dejour et al. and positive apprehension from 0 to 60° of flexion were included. Tegner, Kujala and IKDC scores, apprehension and pain, trochlear dysplasia, sulcus angle, tibial tuberosity trochlear groove, patellar tilt and shift, Caton-Deschamps index as well as patellofemoral arthrosis according to the classification of Iwano et al. were assessed pre- and postoperatively.
At a mean of 30.5 ± 5.9 months, all but one patient were subjectively satisfied with the outcome of the procedure, all showing absence of positive apprehension or redislocation. Significant (p < 0.001) reduction in pain (5.6 to 2.5 ± 2.8 points, VAS) and increase in Tegner (2, range 0-4 points to 6, range 3-8 points), Kujala (51.1 to 87.9 ± 20.0 points) and IKDC (49.5 to 80.2 ± 21.0%) scores could be achieved. Radiologically significant (p < 0.02) improvement of patellofemoral positional parameters leading to more normal anatomy was recorded, while short-term arthrosis was absent.
Combined treatment for trochleoplasty with MPFLR serves as a successful therapy for chronic PFI. This combinatory treatment concept is a reliable option not only as salvage therapy but also as primary procedure regarding treatment for excessive PFI.
Prospective case series, Level IV.
由于滑车发育过度，在早期弯曲时，髌骨缺乏骨性引导，可能导致复发性髌股关节不稳定（PFI）。因此，单纯内侧髌股韧带重建（MPFLR）可能不够，因为它主要解决接近伸展的不稳定问题，此外还会增加髌股关节压力，导致在平坦或凸面滑车发育不良时出现疼痛。因此，与滑车成形术相结合，可以创建解剖学滑车沟，从而在弯曲时也能稳定髌股关节，同时使髌股关节压力正常化。在这项前瞻性研究中，我们评估了开放性滑车成形术结合 MPFLR 的治疗效果，17 例连续患者的 18 个膝关节（平均年龄 22.2 ± 4.9 岁）均存在滑车发育不良 B、C 或 D 型，根据 Dejour 等的分类，并且在 0 到 60°屈曲时存在阳性恐惧试验。术前和术后评估包括 Tegner、Kujala 和 IKDC 评分、恐惧和疼痛、滑车发育不良、滑车沟角、胫骨结节滑车沟、髌骨倾斜和移位、Caton-Deschamps 指数以及髌股关节炎，根据 Iwano 等人的分类。
2007 年至 2009 年期间，我们纳入了 17 例连续患者的 18 个膝关节（平均年龄 22.2 ± 4.9 岁），根据 Dejour 等人的分类，这些患者均存在滑车发育不良 B、C 或 D 型，并且在 0 到 60°屈曲时存在阳性恐惧试验。所有患者术前和术后均进行了 Tegner、Kujala 和 IKDC 评分、恐惧和疼痛、滑车发育不良、滑车沟角、胫骨结节滑车沟、髌骨倾斜和移位、Caton-Deschamps 指数以及髌股关节炎的评估，根据 Iwano 等人的分类。
平均随访 30.5 ± 5.9 个月，除 1 例患者外，其余患者均对手术结果主观满意，所有患者均无阳性恐惧试验或再脱位。疼痛明显（p < 0.001）减轻（5.6 分至 2.5 ± 2.8 分，VAS），Tegner（2 分，范围 0-4 分至 6 分，范围 3-8 分）、Kujala（51.1 分至 87.9 ± 20.0 分）和 IKDC（49.5 分至 80.2 ± 21.0%）评分显著提高。影像学上记录到髌股位置参数明显（p < 0.02）改善，导致解剖结构更正常，而短期关节炎不存在。
滑车成形术结合 MPFLR 的联合治疗是慢性 PFI 的有效治疗方法。这种联合治疗方案不仅是治疗复发性 PFI 的一种可靠选择，也是一种可作为首选治疗方案的治疗方法。
前瞻性病例系列，IV 级。
