Neumann M V, Stalder M, Schuster A J
Department of Orthopaedic Surgery and Traumatology, University of Freiburg, Freiburg, Germany.
Department of Orthopaedic Surgery, Hôpital Cantonal Fribourg, Fribourg, Switzerland.
Knee Surg Sports Traumatol Arthrosc. 2016 Mar;24(3):873-8. doi: 10.1007/s00167-014-3397-3. Epub 2014 Oct 31.
A retrospective analysis of a heterogeneous patient cohort was performed to determine the outcome and eligibility of a combined trochleaplasty and soft tissue-balancing technique for repair of patellofemoral joint disorders.
A strict surgical treatment algorithm including trochleaplasty and reconstruction of the medial patellofemoral ligament and vastus medialis oblique muscle was implemented to restore the patellofemoral joint. A heterogeneous patient cohort including 46 consecutively treated symptomatic knees was reviewed. The median follow-up period was 4.7 years (range 24-109 months).
No patellar redislocation occurred post-operatively, and the median Kujala score improved from 62 (9-96) to 88 (47-100) points (p < 0.001) at follow-up. Radiological signs of trochlear dysplasia were corrected, and both patellar height and trochlear depth were significantly restored after surgery. In total, 16% of affected patients with pre-existing patellofemoral degenerative changes showed progression of osteoarthrosis according to the Kellgren and Lawrence classification.
The surgical combination of trochleaplasty and reconstruction of the medial patellofemoral ligament and vastus medialis oblique muscle offers excellent clinical and radiological results. The overall results of the present study showed significant improvement of the Kujala score in patients with Dejour grades C and D dysplasia. These results outline the clinical relevance of trochleaplasty with additional soft tissue balancing as an effective joint-preserving method with satisfying results in patients with pre-existing degenerative changes.
IV.
对一组异质性患者队列进行回顾性分析，以确定联合滑车成形术和软组织平衡技术修复髌股关节疾病的疗效和适用性。
实施了一种严格的手术治疗方案，包括滑车成形术以及重建髌股内侧韧带和股内侧斜肌，以恢复髌股关节。回顾了一组异质性患者队列，其中包括46例连续接受治疗的有症状膝关节。中位随访期为4.7年（范围24 - 109个月）。
术后未发生髌骨再脱位，随访时Kujala评分中位数从62分（9 - 96分）提高到88分（47 - 100分）（p < 0.001）。滑车发育不良的放射学征象得到纠正，术后髌骨高度和滑车深度均显著恢复。根据Kellgren和Lawrence分类，共有16%已存在髌股关节退行性改变的患侧膝关节出现骨关节炎进展。
滑车成形术与重建髌股内侧韧带和股内侧斜肌的联合手术提供了优异的临床和放射学结果。本研究的总体结果显示，Dejour C级和D级发育不良患者的Kujala评分有显著改善。这些结果概述了滑车成形术联合额外软组织平衡作为一种有效的保关节方法在已有退行性改变患者中取得满意结果的临床相关性。
IV级。
