Schorn Dominik, Yang-Strathoff Sera, Gosheger Georg, Vogler Tim, Klingebiel Sebastian, Rickert Carolin, Andreou Dimosthenis, Liem Dennis
Department of General Orthopedics and Tumor Orthopedics, Münster University Hospital, Albert-Schweitzer-Campus 1, 48149, Münster, Germany.
BMC Musculoskelet Disord. 2017 Jun 24;18(1):277. doi: 10.1186/s12891-017-1636-8.
There is currently no consensus regarding the optimal surgical treatment method for patients with recurrent patella instability. Our goal was to evaluate the long-term results of combined arthroscopic medial reefing and lateral release, to identify possible risk factors for recurrent dislocations and residual complaints after surgical treatment and to assess functional outcome.
We performed a retrospective study of 38 patients (43 knees) treated with all-inside technique between 2001 and 2010. The functional outcome was evaluated with the Kujala score, while pain intensity was scored on a visual analogue scale (VAS). Contingency tables were analysed with Fisher's exact test. Non-parametric analyses were carried out with the Mann-Whitney U and the Wilcoxon signed-rank test. Survival curves were calculated with the Kaplan-Meier method and compared with the log-rank test.
The median age at surgery was 16 years (range, 9-44 years) and the median follow-up amounted to 9.7 years (range, 4.7-14.7 years). Residual complaints were present in 34 cases (79%). Patients with residual complaints had a trend for a higher body mass index (BMI) at surgery (25.7 vs. 21.6, P = .086). Twenty-two cases had recurrent dislocation after a median interval of 30 months. The probability of recurrent dislocations amounted to 16% after 1 year and 52% after 10 years. There were no significant differences in the presence of residual complaints (P = .721) and median VAS score (P = .313) between patients with or without recurrent dislocation. Patients with recurrent dislocations had a trend towards younger age at surgery (15 vs. 18 years, P = .076). The median Kujala score of the affected knee was 81. Patients with recurrent dislocations had a significantly lower score compared to patients without recurrent dislocations (67 vs. 91, P < .001).
The combined arthroscopic lateral release with medial reefing does not appear to be an adequate treatment for patients with chronic patellar instability in long-term follow-up. Younger patients might be at a higher risk for recurrent dislocations, while a higher BMI at surgery might be associated with residual complaints.
目前对于复发性髌骨不稳定患者的最佳手术治疗方法尚无共识。我们的目标是评估关节镜下内侧紧缩术联合外侧松解术的长期效果，确定手术治疗后复发性脱位和残留症状的可能危险因素，并评估功能结局。
我们对2001年至2010年间采用全关节镜技术治疗的38例患者（43膝）进行了回顾性研究。功能结局采用Kujala评分评估，疼痛强度采用视觉模拟量表（VAS）评分。列联表采用Fisher精确检验进行分析。非参数分析采用Mann-Whitney U检验和Wilcoxon符号秩检验。生存曲线采用Kaplan-Meier方法计算，并与对数秩检验进行比较。
手术时的中位年龄为16岁（范围9-44岁），中位随访时间为9.7年（范围4.7-14.7年）。34例（79%）存在残留症状。有残留症状的患者手术时体重指数（BMI）有升高趋势（25.7 vs. 21.6，P = 0.086）。22例在中位间隔30个月后出现复发性脱位。1年后复发性脱位的概率为16%，10年后为52%。有或无复发性脱位的患者在残留症状的存在（P = 0.721）和中位VAS评分（P = 0.313）方面无显著差异。复发性脱位的患者手术时年龄有偏小趋势（15 vs. 18岁，P = 0.076）。患膝的中位Kujala评分为81分。与无复发性脱位的患者相比，复发性脱位的患者评分显著更低（67 vs. 91，P < 0.001）。
在长期随访中，关节镜下外侧松解联合内侧紧缩术似乎不是慢性髌骨不稳定患者的充分治疗方法。年轻患者复发性脱位的风险可能更高，而手术时较高的BMI可能与残留症状有关。
