Department of Orthopedic Surgery, Sint Maartenskliniek, Hengstdal 3, 6522 JV, Nijmegen, The Netherlands.
Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands.
Knee Surg Sports Traumatol Arthrosc. 2019 Mar;27(3):716-723. doi: 10.1007/s00167-018-5014-3. Epub 2018 Jun 11.
Trochlear dysplasia is a major risk factor predisposing to patellar instability and has been reported to occur in up to 85% of patients with recurrent patellar dislocation. Different operative techniques have been described to correct trochlear dysplasia, including the Bereiter technique, in which subchondral bone is removed and the cartilage can be compressed into a U-shaped groove. The hypothesis was that after a Bereiter-type trochleoplasty combined with medialisation of the tibial tubercle and MPFL reconstruction, patellar pain and instability decreased and anatomic reconstruction can be seen radiographically after 5-year follow-up.
Between 2004 and 2011, a combined procedure including Bereiter-type trochleoplasty was performed on 21 consecutively included patients (22 knees) with objective patellar instability and severe trochlear dysplasia. Instability and pain were assessed preoperatively and 3, 6, 12, 24 and 60 months postoperatively with the visual analogue scale (VAS) for pain and instability, Kujala, International Knee Documentation Committee Subjective Knee Evaluation (IKDC SKE) and Short Form Health Survey (SF-36). Pre- and postoperatively, a true lateral radiograph was made to investigate the presence of the crossing sign and to measure the trochlear bump and trochlear depth, as well as a sunrise patella view to measure the sulcus angle.
VAS pain and instability, Kujala and IKDC SKE improved significantly 5 years after trochleoplasty (p < 0.05). SF-36 showed no significant improvement. None of the patients reported patellar dislocations postoperatively. Sport activities remained limited. Postoperative radiographs showed no crossing sign. There was a significant increase in trochlear depth (p < 0.0001) and also a significant decrease in trochlear bump and sulcus angle (both p < 0.0001).
A combined procedure consisting of Bereiter-type trochleoplasty, medialisation of the tibial tubercle and MPFL reconstruction in patients with objective patellar instability and severe trochlear dysplasia resulted in a clear decrease of pain and instability. Radiological assessment showed anatomical reconstruction. Nevertheless, residual symptoms remain and the possibility of future cartilage damage is uncertain.
IV.
滑车发育不良是导致髌骨不稳定的主要危险因素，据报道，在反复髌骨脱位的患者中，滑车发育不良的发生率高达 85%。已经描述了多种手术技术来矫正滑车发育不良，包括 Bereiter 技术，其中切除软骨下骨，软骨可以被压缩成 U 形槽。假设在 Bereiter 型滑车成形术联合胫骨结节内移和 MPFL 重建后，髌骨疼痛和不稳定减轻，并且在 5 年随访时可以在影像学上看到解剖重建。
在 2004 年至 2011 年期间，对 21 例连续纳入的有客观髌骨不稳定和严重滑车发育不良的患者（22 膝）进行了包括 Bereiter 型滑车成形术在内的联合手术。在术前和术后 3、6、12、24 和 60 个月时，使用疼痛和不稳定的视觉模拟评分（VAS）、Kujala、国际膝关节文献委员会主观膝关节评估（IKDC SKE）和简明健康调查量表（SF-36）评估不稳定和疼痛。术前和术后均拍摄真正的外侧 X 线片，以检查交叉征的存在，并测量滑车凸起和滑车深度，以及拍摄髌骨日升视图以测量滑车沟角。
Bereiter 型滑车成形术后 5 年，VAS 疼痛和不稳定、Kujala 和 IKDC SKE 显著改善（p<0.05）。SF-36 无明显改善。术后无患者报告髌骨脱位。运动活动仍然受限。术后 X 线片未见交叉征。滑车深度显著增加（p<0.0001），滑车凸起和滑车沟角显著减小（均 p<0.0001）。
在有客观髌骨不稳定和严重滑车发育不良的患者中，采用 Bereiter 型滑车成形术、胫骨结节内移和 MPFL 重建的联合手术，可明显减轻疼痛和不稳定。影像学评估显示解剖重建。然而，残留症状仍然存在，未来软骨损伤的可能性尚不确定。
IV。
