Kerlan-Jobe Institute, Los Angeles, California, U.S.A..
Kerlan-Jobe Institute, Los Angeles, California, U.S.A.
Arthroscopy. 2018 May;34(5):1603-1607. doi: 10.1016/j.arthro.2017.12.011. Epub 2018 Feb 1.
The purpose of this study was to review our results of arthroscopic release in patients diagnosed with refractory patellofemoral arthrofibrosis (PFA) after having undergone anterior cruciate ligament (ACL) reconstruction.
From 2006 to 2016, all patients who underwent arthroscopic release for refractory PFA after ACL reconstruction were reviewed retrospectively. All patients then completed surveys containing the International Knee Documentation Committee (IKDC) and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and were asked 2 subjective questions. Patients included in the study exhibited at least one finding of PFA and failed conservative treatment for at least 3 months. Included patients also had a minimum of 12 months of postoperative follow-up after PFA release. Patients who underwent any other concomitant surgery in the same operative setting as arthroscopic release for PFA were excluded from the study.
Thirty-two patients were included in the study. The mean age was 32.8 years (range, 19-58 years) with an average follow-up of 43.6 months (range, 16-98 months). There was a statistically significant increase preoperatively to postoperatively in the IKDC score from 49.6 to 69.4 (P < .00001), and 16 of 32 patients (50%) achieved a minimal clinically important difference (MCID). WOMAC scores also significantly increased from 74 to 85.3 (P < .00001), with 15 of 32 patients (47%) achieving MCID. Thirty-one patients (97%) reported that the procedure helped, and 25 patients (78%) said they would have the procedure again.
Arthroscopic release, consisting of an extended lateral release, debridement of the notch/fat pad, and manual manipulation of the patella, results in significant increases in validated outcome measures and is well tolerated by patients.
Level IV, case series.
本研究旨在回顾我们对诊断为复发性髌股关节（PF）关节挛缩（PFA）且既往接受过前交叉韧带（ACL）重建的患者行关节镜下松解术的结果。
回顾性分析 2006 年至 2016 年所有因 ACL 重建后复发性 PFA 而行关节镜下松解术的患者。所有患者均完成国际膝关节文献委员会（IKDC）和西安大略和麦克马斯特大学骨关节炎指数（WOMAC）问卷调查，并回答了 2 个主观问题。入组患者至少有 1 项 PFA 的表现，且至少接受了 3 个月的保守治疗失败。纳入患者在 PFA 松解术后至少有 12 个月的随访。在同一手术环境中因 PFA 行关节镜下松解术且同时行其他联合手术的患者被排除在本研究之外。
本研究共纳入 32 例患者。患者平均年龄为 32.8 岁（1958 岁），平均随访时间为 43.6 个月（1698 个月）。与术前相比，术后 IKDC 评分从 49.6 分提高到 69.4 分，差异有统计学意义（P<0.00001），32 例患者中有 16 例（50%）达到了最小临床重要差异（MCID）。WOMAC 评分也从 74 分显著提高到 85.3 分，32 例患者中有 15 例（47%）达到 MCID。31 例患者（97%）报告该手术有帮助，25 例患者（78%）表示会再次接受该手术。
关节镜下松解术包括广泛的外侧松解、切迹/脂肪垫清理和髌骨手法松动，可显著改善验证性结局指标，且患者耐受性良好。
IV 级，病例系列研究。
