Camathias Carlo, Studer Katrin, Kiapour Ata, Rutz Erich, Vavken Patrick
Paediatric Orthopedic Department, University Children's Hospital Basel (UKBB), Basel, Switzerland
Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Am J Sports Med. 2016 Nov;44(11):2855-2863. doi: 10.1177/0363546516652894. Epub 2016 Jul 19.
The essential static patellar stabilizer is a normal-shaped trochlear groove. A dysplastic groove destabilizes the patella. Trochleoplasty approaches this underlying condition and reshapes the trochlea. However, studies have reported on trochleoplasty for revision cases or as accompanied by other interventions. The effect of trochleoplasty alone remains unexplained.
To introduce trochleoplasty as a stand-alone treatment for recurrent patellar dislocation and to compare its pre- to postoperative functional and clinical variables.
Case series; Level of evidence, 4.
A trochleoplasty was performed in 50 knees (27 right) in 44 patients (30 females; mean ± SD age, 15.6 ± 2.0 years). The indication for surgery was recurrent patellar dislocation not responding to nonoperative treatment (>6 months), with types B through D dysplasia and closed or closing physes in adolescents aged 10 to 20 years. Assessment included J-sign and apprehension test, Kujala and Lysholm scores, patients' subjective assessment and activity level according to the International Knee Documentation Committee questionnaire, and patients' overall satisfaction. The Caton-Deschamps ratio and the lateral condyle index were measured. Pre- versus postoperative values were compared with a paired Wilcoxon signed-rank test. The minimum follow-up was 24 months (33 ± 10.6 months).
The Kujala score improved from 71 preoperatively to 92 postoperatively (P < .001) and the Lysholm score from 71 to 95 (P < .001). Patients' subjective assessment improved at the final follow-up as compared with that preoperatively (P < .001). Most patients enhanced their activity (P < .001), and their overall satisfaction increased postoperatively (P < .001). Preoperatively, there was a positive J-sign in 45 knees and a positive apprehension test in 41 knees. Both markers disappeared postoperatively in 39 and 33 knees, respectively, leaving 6 knees with a positive J-sign and 8 knees with a positive apprehension test (P < .001). One patella redislocated postoperatively after 38 months. Four patients required a single arthroscopic debridement.
In this study, trochleoplasty as a solitary treatment for recurrent patellofemoral dislocations in patients with trochlear dysplasia resulted in good clinical outcomes if severe torsional and axial malalignment was excluded. Kujala and Lysholm scores increased postoperatively, as well as subjective International Knee Documentation Committee assessment of outcomes, activity level, and overall satisfaction.
基本的静态髌骨稳定器是形状正常的滑车沟。发育异常的滑车沟会使髌骨不稳定。滑车成形术针对这一潜在情况重塑滑车。然而，已有研究报道了用于翻修病例或伴有其他干预措施的滑车成形术。单独进行滑车成形术的效果仍不明确。
介绍滑车成形术作为复发性髌骨脱位的独立治疗方法，并比较其术前与术后的功能和临床变量。
病例系列；证据等级，4级。
对44例患者（30例女性；平均年龄±标准差，15.6±2.0岁）的50个膝关节（27个右侧）进行了滑车成形术。手术指征为非手术治疗（>6个月）无效的复发性髌骨脱位，B至D型发育异常，年龄在10至20岁的青少年，骨骺闭合或正在闭合。评估包括J征和恐惧试验、Kujala和Lysholm评分、根据国际膝关节文献委员会问卷进行的患者主观评估和活动水平，以及患者的总体满意度。测量了Caton-Deschamps比率和外侧髁指数。术前与术后的值采用配对Wilcoxon符号秩检验进行比较。最短随访时间为24个月（33±10.6个月）。
Kujala评分从术前的71分提高到术后的92分（P<.001），Lysholm评分从71分提高到95分（P<.001）。与术前相比，患者的主观评估在末次随访时有所改善（P<.001）。大多数患者的活动能力增强（P<.001），术后总体满意度提高（P<.001）。术前，45个膝关节有阳性J征，41个膝关节有阳性恐惧试验。术后，这两个指标分别在39个和33个膝关节中消失，6个膝关节有阳性J征，8个膝关节有阳性恐惧试验（P<.001）。1例髌骨在术后38个月再次脱位。4例患者需要进行一次关节镜清理术。
在本研究中，如果排除严重的扭转和轴向排列不齐，滑车成形术作为滑车发育异常患者复发性髌股关节脱位的单独治疗方法可取得良好的临床效果。术后Kujala和Lysholm评分提高，国际膝关节文献委员会对结果、活动水平和总体满意度的主观评估也有所提高。
