Luhmann Scott J, Smith June C, Schootman Mario, Prasad Nandan
Department of Orthopaedic Surgery, Washington University School of Medicine.
St. Louis Children's Hospital.
J Pediatr Orthop. 2019 Jan;39(1):33-37. doi: 10.1097/BPO.0000000000001017.
The purpose of the study was to quantify the frequency, severity, and location of patellofemoral (PF) articular cartilage changes recurrent patellar instability treated surgically in patients with preoperative clinical patellar crepitation.
A single-surgeon database was queried for all knees with recurrent patellar instability between 3/2000 and 6/2012 (n=214). Only knees which underwent knee arthroscopy during the surgical treatment were included (n=148). PF articular cartilage condition was assessed arthroscopically.
There were 148 knees in 130 patients (mean age, 16 y), which met inclusion criteria. There were 93 females and 37 males. Diagnoses were dislocations [122 (82.4%)] and subluxations (26). Preoperatively 28 knees (18.9%) had PF crepitation. Statistical analysis demonstrated preoperative PF crepitation was correlated with medial patellar facet lesions (P=0.0022) and were 3.6 times more likely to have medial patellar facet lesions. Crepitation was correlated with the higher outerbridge (OB) patellar grades (P<0.0001) and larger patellar lesion size (P=0.0021). At arthroscopy 89 knees (60.5%) had patellar articular cartilage damage with a mean OB grade of 1.3 (0 to 4) and mean size of 93.2 mm (0 to 750). The femoral articular cartilage was identified in 29 knees (19.7%) with a mean OB grade of 0.44 (0 to 4).
PF articular damage was present in 63% of knees, which were surgically treated for patellar instability. The patella was involved in 61% (mean, 129 mm) and femoral trochlea in 20% (mean 166 mm) of knees. Knee with preoperative PF crepitation (20% of cohort) more commonly had medial patellar facet lesions with higher OB grades, and larger patellar lesion size than knees without preoperative crepitation. Because of the high frequency of patellar (83%) and femoral (36%) articular damage documented at the time of surgical reconstruction, visualization of the PF joint is recommended when knees have preoperative PF crepitation.
Level IV.
本研究的目的是量化术前临床存在髌股关节（PF）弹响的复发性髌骨不稳患者手术治疗后PF关节软骨变化的频率、严重程度和位置。
查询一位外科医生的数据库，纳入2000年3月至2012年6月期间所有复发性髌骨不稳的膝关节（n = 214）。仅纳入手术治疗期间接受膝关节镜检查的膝关节（n = 148）。通过关节镜评估PF关节软骨状况。
130例患者（平均年龄16岁）的148个膝关节符合纳入标准。其中女性93例，男性37例。诊断为脱位[122例（82.4%）]和半脱位（26例）。术前28个膝关节（18.9%）存在PF弹响。统计分析表明，术前PF弹响与髌骨内侧小面损伤相关（P = 0.0022），发生髌骨内侧小面损伤的可能性是无弹响膝关节的3.6倍。弹响与更高的Outerbridge（OB）髌骨分级相关（P < 0.0001）以及更大的髌骨损伤面积相关（P = 0.0021）。关节镜检查时，89个膝关节（60.5%）存在髌骨关节软骨损伤，平均OB分级为1.3（0至4级），平均损伤面积为93.2平方毫米（0至750平方毫米）。29个膝关节（19.7%）发现股骨关节软骨损伤，平均OB分级为0.44（0至4级）。
63%接受髌骨不稳手术治疗的膝关节存在PF关节损伤。61%的膝关节髌骨受累（平均面积129平方毫米），20%的膝关节股骨滑车受累（平均面积166平方毫米）。术前存在PF弹响的膝关节（占队列的20%）比术前无弹响的膝关节更常出现髌骨内侧小面损伤、更高的OB分级以及更大的髌骨损伤面积。由于手术重建时记录到较高频率的髌骨（83%）和股骨（36%）关节损伤，对于术前存在PF弹响的膝关节，建议术中观察PF关节。
四级。
