van Duren B H, Pandit H, Hamilton T W, Fievez E, Monk A P, Dodd C A F, Murray D W
Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK,
Knee Surg Sports Traumatol Arthrosc. 2014 Aug;22(8):1887-94. doi: 10.1007/s00167-014-3065-7. Epub 2014 Jun 12.
Shortening of the patella tendon has been noted after total knee arthroplasty and has been associated with diminished functional outcomes. Traumatic and/or ischaemic injury peri-operatively are suggested causes. The Oxford domed lateral unicompartmental knee arthroplasty (UKA) requires a vertical incision through the patella tendon to facilitate orientation of the proximal tibial saw cut; this may induce scarring or impair vascularity of the tendon and can cause shortening. This study investigated the hypothesis that the trans-patella tendon incision increases the incidence of patella tendon shortening after domed lateral UKA when compared to flat lateral UKA performed without the trans-patella tendon incision.
The radiographs of 50 patients who underwent domed lateral UKA, using the trans-patella tendon approach, and a cohort of 30 patients who underwent flat lateral UKA, in which an incision through the patella tendon was not employed, were reviewed retrospectively. The patella tendon length (PTL) and the Insall-Salvati ratio were measured. In addition, pre-operative and post-operative clinical scores were recorded using both the OKS and AKSS. A change in PTL of greater than or equal to 10 % was considered to be significant.
In the domed lateral UKA group, 13 patients demonstrated a >10 % change in the PTL at 1-year post-surgery (2 shortened and 11 lengthened). In the flat lateral UKA group, nine patients demonstrated a significant change in the PTL at 1-year post-surgery (2 shortened and 7 lengthened).
This study demonstrated that using a trans-patella approach during lateral domed UKA surgery did not significantly increase patella tendon shortening and did not result in reduced clinical outcomes.
全膝关节置换术后已观察到髌腱缩短，且与功能结果下降有关。手术期间的创伤性和/或缺血性损伤被认为是其原因。牛津圆顶外侧单髁膝关节置换术（UKA）需要通过髌腱做垂直切口，以利于胫骨近端锯切的定位；这可能会导致瘢痕形成或损害腱的血管供应，并可引起缩短。本研究调查了这样一个假设：与不通过髌腱切口进行的平外侧UKA相比，圆顶外侧UKA经髌腱切口会增加髌腱缩短的发生率。
回顾性分析50例行圆顶外侧UKA且采用经髌腱入路患者以及30例行平外侧UKA（未采用经髌腱切口）患者的X线片。测量髌腱长度（PTL）和Insall-Salvati比率。此外，使用OKS和AKSS记录术前和术后的临床评分。PTL变化大于或等于10%被认为具有显著性。
在圆顶外侧UKA组中，13例患者术后1年PTL变化>10%（2例缩短，11例延长）。在平外侧UKA组中，9例患者术后1年PTL有显著变化（2例缩短，7例延长）。
本研究表明，在外侧圆顶UKA手术中采用经髌腱入路不会显著增加髌腱缩短，也不会导致临床结果降低。
