Pengas Ioannis, Nash William, Assiotis Angelos, To Kendrick, Khan Wasim, McNicholas Michael
Department of Trauma and Orthopaedics, Royal Cornwall Hospital, Truro, TR1 3LQ, UK.
Department of Trauma and Orthopaedics, Guy's Hospital, London, SE1 9RT, UK.
Eur J Orthop Surg Traumatol. 2019 Dec;29(8):1705-1708. doi: 10.1007/s00590-019-02480-w. Epub 2019 Jul 10.
Most knee osteoarthritis and meniscectomy studies focus on osteoarthritis in the tibiofemoral joint and ignore the patellofemoral joint. This study aims to assess the long-term effects of total meniscectomy on the patellofemoral joint. To our knowledge, this is the only study of osteoarthritis in the patellofemoral joint following meniscectomy that extends to a 40-year follow-up period. Twenty-two patients with osteoarthritis were evaluated at a mean of 40 years post-meniscectomy using standardised weight-bearing radiographs of the operated and non-operated knees. Patellofemoral joint osteoarthritis was diagnosed by the presence of osteophytes and joint space narrowing to less than 5 mm. Kellgren and Lawrence scores were calculated from the radiographs. Patellofemoral joint osteoarthritis and tibiofemoral joint osteoarthritis were correlated with International Knee Documentation Committee scores and range of movement measurements. A significant difference was observed between the operated and non-operated knees in terms of patellofemoral joint osteophyte formation. There was a significant difference in tibiofemoral joint Kellgren and Lawrence scores, International Knee Documentation Committee scores and range of movement measurements between knees with lateral facet patellofemoral joint space of < 5 mm and > 5 mm. This study shows an association between open total meniscectomy and patellofemoral joint osteoarthritis at 40 years following surgery. There was also an association between patellofemoral joint space narrowing in the lateral facet and tibiofemoral joint osteoarthritis. Possible causes include altered biomechanical loading patterns following meniscectomy as well as global processes within the knee.
大多数膝关节骨关节炎和半月板切除术的研究都集中在胫股关节的骨关节炎，而忽略了髌股关节。本研究旨在评估全半月板切除术对髌股关节的长期影响。据我们所知，这是唯一一项对半月板切除术后髌股关节骨关节炎进行长达40年随访的研究。对22例骨关节炎患者在半月板切除术后平均40年时进行评估，使用手术侧和非手术侧膝关节的标准化负重X线片。通过骨赘的存在和关节间隙狭窄至小于5毫米来诊断髌股关节骨关节炎。根据X线片计算Kellgren和Lawrence评分。髌股关节骨关节炎和胫股关节骨关节炎与国际膝关节文献委员会评分及活动范围测量结果相关。在手术侧和非手术侧膝关节之间，髌股关节骨赘形成方面存在显著差异。在外侧髌股关节间隙<5毫米和>5毫米的膝关节之间，胫股关节Kellgren和Lawrence评分、国际膝关节文献委员会评分及活动范围测量结果存在显著差异。本研究表明，开放性全半月板切除术后40年与髌股关节骨关节炎之间存在关联。外侧小面髌股关节间隙变窄与胫股关节骨关节炎之间也存在关联。可能的原因包括半月板切除术后生物力学负荷模式的改变以及膝关节内的整体过程。
