Otsuki Shuhei, Nakajima Mikio, Fujiwara Kenta, Okamoto Yoshinori, Iida Go, Murakami Tomohiko, Neo Masashi
Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Osaka, Japan.
Knee Surg Sports Traumatol Arthrosc. 2017 Aug;25(8):2392-2396. doi: 10.1007/s00167-015-3825-z. Epub 2016 Feb 2.
To evaluate the clinical outcomes of three-dimensional (3D) transfer of the tibial tuberosity for patellar instability with patella alta, with a focus on the influence of age at initial surgery.
Three-dimensional surgery was performed on 28 knees with a mean follow-up of 46 months. Patients were separated into three groups based on the age at initial surgery: group A, 10 knees and an average age of 16.3 ± 1.8 (14-19) years; group B, 10 knees and an average age of 22.1 ± 2.5 (20-28) years; and group C, eight knees and an average age of 44.0 ± 2.2 (40-46) years. Patellofemoral geometry improvement focused on patella alta by determining the Insall-Salvati ratio and Caton-Deschamps index, rotational malalignment by measuring the tibial tubercle-trochlear groove (TT-TG) distance, and lateral patellar subluxation by measuring the patellar tilt. Clinical outcomes were evaluated by the Lysholm and Kujala scores, which were compared before and after surgery. Cartilage degeneration was evaluated by the International Cartilage Repair Society grading system at initial arthroscopy.
The patellar height, TT-TG, and patellar tilt significantly improved in all groups postoperatively (p < 0.05). The Lysholm and Kujala scores also significantly improved postoperatively; however, both scores were lower in group C than in the other groups (p < 0.05). Particularly, pain scores were more severe in group C than in the other groups, and the severity of cartilage degeneration correlated with the pain scores (p < 0.05). Cartilage damage differed significantly between the groups at initial arthroscopy; particularly, group C included grades III and IV cartilage degeneration (p < 0.05).
Age at initial surgery may be the predicting factor for poor clinical outcomes of 3D transfer surgery. The clinical outcome may depend on the age at surgery, which correlated with cartilage damage; thus, surgeons should be given this information when patients are considered undergoing patella surgery.
Therapeutic case series, Level IV.
评估胫骨结节三维转移术治疗高位髌骨所致髌股关节不稳的临床疗效，重点关注初次手术时年龄的影响。
对28例膝关节进行三维手术，平均随访46个月。根据初次手术时的年龄将患者分为三组：A组，10例膝关节，平均年龄16.3±1.8（14 - 19）岁；B组，10例膝关节，平均年龄22.1±2.5（20 - 28）岁；C组，8例膝关节，平均年龄44.0±2.2（40 - 46）岁。髌股关节几何形态改善通过确定Insall - Salvati比率和Caton - Deschamps指数来评估高位髌骨情况，通过测量胫骨结节 - 滑车沟（TT - TG）距离评估旋转对线不良，通过测量髌骨倾斜度评估髌骨外侧半脱位。临床疗效采用Lysholm和Kujala评分进行评估，并在手术前后进行比较。软骨退变情况于初次关节镜检查时采用国际软骨修复协会分级系统进行评估。
所有组术后髌骨高度、TT - TG和髌骨倾斜度均显著改善（p < 0.05）。Lysholm和Kujala评分术后也显著提高；然而，C组的这两个评分均低于其他组（p < 0.05）。特别是，C组的疼痛评分比其他组更严重，且软骨退变程度与疼痛评分相关（p < 0.05）。初次关节镜检查时，各组间软骨损伤存在显著差异；特别是，C组包括III级和IV级软骨退变（p < 0.05）。
初次手术时的年龄可能是三维转移手术临床疗效不佳的预测因素。临床疗效可能取决于手术时的年龄，而年龄与软骨损伤相关；因此，在考虑为患者进行髌骨手术时，应向外科医生提供这一信息。
治疗性病例系列，IV级。
