Universidade Federal de São Paulo Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina/UNIFESP, São Paulo, Brazil.
Center for Regenerative Medicine and Center of Cartilage Repair, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Am J Sports Med. 2019 Aug;47(10):2444-2453. doi: 10.1177/0363546519859320. Epub 2019 Jul 9.
Focal cartilage lesions in the patellofemoral (PF) joint are common. Several studies correlated PF risk factors with PF instability, anterior knee pain, and PF arthritis; however, there is a lack of evidence correlating those factors to PF focal cartilage lesions.
To evaluate the influence of the anatomic PF risk factors in patients with isolated focal PF cartilage lesions.
Cross-sectional study; Level of evidence, 3.
Patients with isolated PF focal cartilage lesions were included in the cartilage lesion group, and patients with other pathologies and normal PF cartilage were included in the control group. Multiple PF risk factors were accessed on magnetic resonance imaging scans: patellar morphology (patellar width, patellar thickness, and patellar angle), trochlear morphology (trochlear sulcus angle, lateral condyle index, and trochlear sulcus depth), patellar height (Insall-Salvati ratio and Caton-Deschamps index), axial patellar positioning (patellar tilt, angle of Fulkerson), and quadriceps vector (tibial tuberosity-trochlear groove distance).
A total of 135 patients were included in the cartilage lesion group and 100 in the control group. As compared with the control group, the cartilage lesion group had a higher sulcus angle ( = .0007), lower trochlear sulcus depth ( < .0001), lower angle of Fulkerson ( < .0001), lower patellar width ( = .0003), and higher Insall-Salvati ratio ( < .0001). From the patients in the cartilage lesion group, 36% had trochlear dysplasia; 27.6%, patella alta; and 24.7%, abnormal patellar tilt. These parameters were more frequent in the cartilage lesion group ( < .0001). Trochlear lesions were more frequent in men, presented at an older age, and had fewer associated anatomic risk factors. Patellar lesions, conversely, were more frequent in women, presented at younger age, and were more closely associated with anatomic risk factors.
PF anatomic abnormalities are significantly more common in patients with full-thickness PF cartilage lesions. Trochlear dysplasia, patella alta, and excessive lateral patellar tilt are the most common correlated factors, especially in patellar lesions.
髌股（PF）关节的局灶性软骨损伤很常见。有几项研究将 PF 危险因素与 PF 不稳定、膝关节前痛和 PF 关节炎相关联；然而，缺乏将这些因素与 PF 局灶性软骨损伤相关联的证据。
评估 PF 解剖学危险因素对单纯 PF 局灶性软骨损伤患者的影响。
横断面研究；证据水平，3 级。
将单纯 PF 局灶性软骨损伤患者纳入软骨损伤组，将存在其他病变且 PF 软骨正常的患者纳入对照组。在磁共振成像扫描上评估多种 PF 危险因素：髌骨形态（髌骨宽度、髌骨厚度和髌骨角）、滑车形态（滑车沟角、外侧髁指数和滑车沟深度）、髌骨高度（Insall-Salvati 比和 Caton-Deschamps 指数）、轴向髌骨定位（髌骨倾斜、Fulkerson 角）和股四头肌向量（胫骨结节-滑车沟距离）。
共纳入 135 例软骨损伤患者和 100 例对照组患者。与对照组相比，软骨损伤组的滑车沟角较大（ =.0007），滑车沟深度较低（ <.0001），Fulkerson 角较小（ <.0001），髌骨宽度较宽（ =.0003），Insall-Salvati 比较高（ <.0001）。软骨损伤组中，36%存在滑车发育不良，27.6%存在高位髌骨，24.7%存在髌骨倾斜异常。这些参数在软骨损伤组中更为常见（ <.0001）。男性的滑车病变更为常见，发病年龄更大，且存在较少的相关解剖学危险因素。相反，女性的髌骨病变更为常见，发病年龄更小，且与解剖学危险因素更为密切相关。
PF 解剖学异常在全层 PF 软骨损伤患者中更为常见。滑车发育不良、高位髌骨和外侧髌骨过度倾斜是最常见的相关因素，尤其是在髌骨病变中。
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