Christensen Tyson C, Sanders Thomas L, Pareek Ayoosh, Mohan Rohith, Dahm Diane L, Krych Aaron J
Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Am J Sports Med. 2017 Jul;45(9):2105-2110. doi: 10.1177/0363546517704178. Epub 2017 May 2.
Previous studies have reported variable rates of recurrent lateral patellar instability mainly because of limited cohort sizes. In addition, there is currently a lack of information on contralateral patellar instability.
To evaluate the rate of recurrent ipsilateral patellar dislocations and contralateral patellar dislocations after a first-time lateral patellar dislocation. Additionally, risk factors associated with recurrent dislocations (ipsilateral or contralateral) and time to recurrence were investigated.
Cohort study; Level of evidence, 3.
This population-based study included 584 patients with a first-time lateral patellar dislocation occurring between 1990 and 2010. A retrospective review was conducted to gather information about the injury, subsequent dislocations (ipsilateral or contralateral), and structural characteristics including trochlear dysplasia, patella alta, and tibial tubercle to trochlear groove (TT-TG) distance. Risk factors were assessed to delineate associations with subsequent dislocations and time to recurrence.
At a mean follow-up of 12.4 years, 173 patients had ipsilateral recurrence, and 25 patients had a subsequent contralateral dislocation. At 20 years, the cumulative incidence of ipsilateral recurrence was 36.0%, while the cumulative incidence of contralateral dislocations was 5.4%. Trochlear dysplasia (odds ratio [OR], 18.1), patella alta (OR, 10.4), age <18 years at the time of the first dislocation (OR, 2.4), elevated TT-TG distance (OR, 2.1), and female sex (OR, 1.5) were associated with recurrent ipsilateral dislocations. Time to recurrence was significantly decreased in patients with trochlear dysplasia (23.0 months earlier time to recurrence; P < .001), elevated TT-TG distance (18.5 months; P < .001), patella alta (16.4 months; P = .001), and age <18 years at the time of the first dislocation (15.4 months; P < .001). Risk factors for subsequent contralateral dislocations included patella alta and trochlear dysplasia.
At 20 years after a first-time lateral patellar dislocation, the cumulative incidence of recurrent ipsilateral patellar dislocations was 36.0%, compared with 5.4% for contralateral dislocations. Trochlear dysplasia, elevated TT-TG distance, patella alta, age <18 years at the time of the first dislocation, and female sex were associated with ipsilateral recurrence. Trochlear dysplasia, elevated TT-TG distance, patella alta, and age <18 years at the time of the first dislocation were predictive of a statistically significant decrease in time to recurrence.
既往研究报道复发性外侧髌股关节不稳定的发生率各不相同，主要原因是队列规模有限。此外，目前缺乏关于对侧髌股关节不稳定的信息。
评估首次外侧髌股关节脱位后同侧复发性髌骨脱位和对侧髌骨脱位的发生率。此外，研究与复发性脱位（同侧或对侧）相关的危险因素以及复发时间。
队列研究；证据等级，3级。
这项基于人群的研究纳入了1990年至2010年间首次发生外侧髌股关节脱位的584例患者。进行回顾性分析以收集有关损伤、后续脱位（同侧或对侧）以及结构特征的信息，包括滑车发育不良、高位髌骨和胫骨结节至滑车沟（TT-TG）距离。评估危险因素以确定与后续脱位和复发时间的关联。
平均随访12.4年时，173例患者出现同侧复发，25例患者随后发生对侧脱位。20年时，同侧复发的累积发生率为36.0%，而对侧脱位的累积发生率为5.4%。滑车发育不良（优势比[OR]，18.1）、高位髌骨（OR，10.4）、首次脱位时年龄<18岁（OR，2.4）、TT-TG距离增大（OR，2.1）以及女性（OR，1.5）与同侧复发性脱位相关。滑车发育不良（复发时间提前23.0个月；P <.001）、TT-TG距离增大（18.5个月；P <.001）、高位髌骨（16.4个月；P =.001）以及首次脱位时年龄<18岁（15.4个月；P <.001）的患者复发时间显著缩短。后续对侧脱位的危险因素包括高位髌骨和滑车发育不良。
首次外侧髌股关节脱位20年后，同侧复发性髌骨脱位的累积发生率为36.0%，对侧脱位为5.4%。滑车发育不良、TT-TG距离增大、高位髌骨、首次脱位时年龄<18岁以及女性与同侧复发相关。滑车发育不良、TT-TG距离增大、高位髌骨以及首次脱位时年龄<18岁可预测复发时间在统计学上显著缩短。
