Department of orthopedic surgery, Osaka medical college, 2-7 Daigakumachi Takatsuki, 569-8686 Osaka, Japan.
Department of orthopedic surgery, Osaka medical college, 2-7 Daigakumachi Takatsuki, 569-8686 Osaka, Japan.
Orthop Traumatol Surg Res. 2018 Apr;104(2):217-221. doi: 10.1016/j.otsr.2018.01.003. Epub 2018 Feb 2.
Although several surgical treatments for patellar instability with patella alta have been reported, the clinical outcomes and optimal surgical procedures for patellar instability with patella alta in middle-aged patients are still controversial. We hypothesized that optimal surgical procedures for patellar instability with patella alta in middle-aged patients may induce good clinical outcomes with better patellofemoral geometry.
Twelve middle-aged patients with a mean age of 44 years (range: 40-55 years), who presented with patellar instability and patella alta, were treated with a combination of several surgeries, such as medial patellofemoral ligament (MPFL) reconstruction, trochleoplasty, lateral release, and three-dimensional transfer of the tibial tuberosity, based on a surgical algorithm. Patellar position and clinical outcomes were evaluated postoperatively. The mean follow-up time was 41.5 months (range: 24-72 months).
Patellar position altered from 1.31 (1.21-1.53) preoperatively to 0.88 (0.69-1.06) postoperatively on the Caton-Deschamps Index (p<0.01). The tibial tuberosity-trochlear groove (TT-TG) distance altered from 21.8mm (20.1-25.8mm) to 10.3mm (5.1-14.7mm), and patellar tilt ranged from 28.1° (21-40°) to 14.6° (5-28°), respectively (p<0.01). Clinical outcomes on the Lysholm and Kujala scales improved from 43.1 and 38.4 to 86.7 and 78.3, respectively, at final follow-up (p<0.01). Surgical treatment that included trochleoplasty resulted in better outcomes than other surgical combinations without trochleoplasty (p<0.05). Sulcus angle and postoperative patellar tilt improved more in those who underwent trochleoplasty than in those who did not (p<0.05).
Surgical treatment for patellar instability with patella alta in middle-aged patients resulted in improved clinical outcomes. In particular, a combination surgery including trochleoplasty resulted in the greatest improvement in case of severe trochlear dysplasia.
IV. Retrospective case series study.
尽管已经报道了多种治疗高位髌骨髌骨不稳定的手术方法，但对于中年患者的高位髌骨髌骨不稳定的临床结果和最佳手术方法仍存在争议。我们假设，对于中年患者的高位髌骨髌骨不稳定的最佳手术方法可能会通过改善髌股关节几何结构带来良好的临床效果。
12 名平均年龄为 44 岁（范围：40-55 岁）的中年髌骨不稳定伴高位髌骨患者，根据手术算法，采用多种手术方法联合治疗，如内侧髌股韧带（MPFL）重建、滑车成形术、外侧松解和胫骨结节三维转移。术后评估髌骨位置和临床结果。平均随访时间为 41.5 个月（范围：24-72 个月）。
Caton-Deschamps 指数（p<0.01）从术前的 1.31（1.21-1.53）变为术后的 0.88（0.69-1.06）。胫骨结节滑车沟（TT-TG）距离从 21.8mm（20.1-25.8mm）变为 10.3mm（5.1-14.7mm），髌骨倾斜度从 28.1°（21-40°）变为 14.6°（5-28°），分别（p<0.01）。Lysholm 和 Kujala 评分的临床结果分别从 43.1 和 38.4 提高到 86.7 和 78.3，在最终随访时（p<0.01）。包括滑车成形术在内的手术治疗比不包括滑车成形术的其他手术组合的结果更好（p<0.05）。接受滑车成形术的患者的滑车沟角和术后髌骨倾斜度改善程度大于未接受滑车成形术的患者（p<0.05）。
对于中年患者的高位髌骨髌骨不稳定的手术治疗可改善临床结果。特别是，对于严重滑车发育不良的患者，包括滑车成形术在内的联合手术可获得最大程度的改善。
IV.回顾性病例系列研究。
