Departments of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Knee Surg Sports Traumatol Arthrosc. 2018 Apr;26(4):1037-1043. doi: 10.1007/s00167-017-4505-y. Epub 2017 Mar 15.
Patellar dislocation can occur in isolation or be associated with chronic instability. The goals of this study are to describe the rate and factors associated with additional patellar instability events (ipsilateral recurrence and contralateral dislocation), as well as the development of patellofemoral arthritis in patients who are skeletally immature at the time of first patellar dislocation.
The study included a population-based cohort of 232 skeletally immature patients who experienced a first-time lateral patellar dislocation between 1990 and 2010. A chart review was performed to collect information related to the initial injury, treatment, and outcomes. Subjects were followed for a mean of 12.1 years to determine the rate of subsequent patellar dislocation (ipsilateral recurrence or contralateral dislocation) as well as clinically significant patellofemoral arthritis.
104 patients had ipsilateral recurrent patellar dislocation. The cumulative incidence of recurrent dislocation was 11% at 1 year, 21.1% at 2 years, 37.0% at 5 years, 45.1% at 10 years, 54.0% at 15 years, and 54.0% at 20 years. Patella alta (HR 10.6, 95% CI 3.6, 36.1), TT-TG ≥ 20 mm (HR 18.7, 95% CI 1.7, 228.2), and trochlear dysplasia (HR 23.7, 95% CI 1.0, 105.2) were associated with recurrence. Similarly, 18 patients (7.8%) had contralateral patellar dislocation. The cumulative incidence of patellofemoral arthritis was 0% at 2 years, 1.0% at 5 years, 2.0% at 10 years, 10.1% at 15 years, 17% at 20 years, and 39.0% at 25 years. Osteochondral injury was associated with arthritis (HR 25.7, 95% CI 6.2, 143.8). There was no association with trochler dysplasia (HR 1.2, 95% CI 0.2, 5.0), recurrent patellar instability (HR 1.2, 95% CI 0.2, 7.2), gender (HR 1.3, 95% CI 0.3, 5.6), or patellar-stabilizing surgery (HR 0.7, 95% CI 0.2, 3.5) and arthritis.
Skeletally immature patients had a high rate of recurrent patellar instability that was associated with structural abnormalities such as patella alta,TT-TG ≥ 20 mm, and trochlear dysplasia. Approximately 10% of patients experienced a contralateral dislocation and 20% of patients developed arthritis by 20 years following initial dislocation. Osteochondral injury was associated with arthritis.
Retrospective case series, Level IV.
髌骨脱位可单独发生，也可并发慢性不稳定。本研究的目的是描述在初次髌骨脱位时骨骼尚未成熟的患者中，发生额外髌骨不稳定事件（同侧复发和对侧脱位）以及发展为髌股关节炎的发生率和相关因素。
本研究纳入了一个基于人群的队列，共包括 232 名在 1990 年至 2010 年间初次发生外侧髌骨脱位的骨骼尚未成熟的患者。通过病历回顾收集与初次损伤、治疗和结局相关的信息。平均随访 12.1 年，以确定随后发生的髌骨脱位（同侧复发或对侧脱位）以及临床上显著的髌股关节炎的发生率。
104 例患者发生同侧复发性髌骨脱位。1 年时复发性脱位的累积发生率为 11%，2 年时为 21.1%，5 年时为 37.0%，10 年时为 45.1%，15 年时为 54.0%，20 年时为 54.0%。髌骨高位（HR 10.6，95%CI 3.6，36.1）、TT-TG≥20mm（HR 18.7，95%CI 1.7，228.2）和滑车发育不良（HR 23.7，95%CI 1.0，105.2）与复发相关。同样，18 例（7.8%）患者发生对侧髌骨脱位。髌股关节炎的累积发生率为 2 年时 0%，5 年时 1.0%，10 年时 2.0%，15 年时 10.1%，20 年时 17%，25 年时 39.0%。软骨骨损伤与关节炎相关（HR 25.7，95%CI 6.2，143.8）。滑车发育不良（HR 1.2，95%CI 0.2，5.0）、复发性髌骨不稳定（HR 1.2，95%CI 0.2，7.2）、性别（HR 1.3，95%CI 0.3，5.6）或髌骨稳定手术（HR 0.7，95%CI 0.2，3.5）与关节炎均无相关性。
骨骼尚未成熟的患者复发性髌骨不稳定的发生率较高，与髌骨高位、TT-TG≥20mm 和滑车发育不良等结构异常有关。大约 10%的患者发生对侧脱位，20%的患者在初次脱位后 20 年内发展为关节炎。软骨骨损伤与关节炎有关。
回顾性病例系列，IV 级。
