Hodax Jonathan D, Leathers Michael P, Ding David Y, Feeley Brian T, Allen Christina R, Ma C Benjamin, Zhang Alan L
University of California, San Francisco, Medical Center, San Francisco, California, USA.
Orthop J Sports Med. 2019 Aug 21;7(8):2325967119865172. doi: 10.1177/2325967119865172. eCollection 2019 Aug.
The treatment of patellar instability in the setting of trochlear dysplasia is challenging.
PURPOSE/HYPOTHESIS: The purpose of this study was to evaluate outcomes for the treatment of recurrent patellar dislocations due to trochlear dysplasia using anteromedialization tibial tubercle osteotomy combined with medial patellofemoral ligament (MPFL) imbrication. We hypothesized that the treatment of patellar instability with tibial tubercle osteotomy and MPFL imbrication would result in improved patient satisfaction and decrease patellar instability events in patients with prior instability and trochlear dysplasia.
Case series; Level of evidence, 4.
We performed a retrospective analysis of patients who underwent MPFL imbrication and concomitant anteromedialization tibial tubercle osteotomy for recurrent patellofemoral instability at a single institution. The minimum follow-up was 1 year. Patient demographic information including age at the time of surgery, sex, body mass index (BMI), tibial tubercle-trochlear groove (TT-TG) distance, and grade of trochlear dysplasia was collected along with relevant operative data. Postoperatively, recurrent dislocation events as well as Knee injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster Universities Osteoarthritis Index, and Kujala scores were collected, and satisfaction was ascertained by asking patients whether they would undergo the procedure again.
A total of 37 knees from 31 patients (23 female) with a mean follow-up of 3.8 years (range, 1-8.9 years) were included. The mean patient age was 28.8 years (range, 14-45 years), the mean BMI was 24 kg/m (range, 20-38 kg/m), and the mean preoperative TT-TG distance was 18.9 mm (range, 8.4-32.4 mm). Two knees were classified as low-grade trochlear dysplasia (Dejour A) and 35 as high-grade trochlear dysplasia (Dejour B-D). At final follow-up, patients reported mean KOOS subscale scores of 86.5 (Pain), 79.8 (Symptoms), 93.9 (Activities of Daily Living), 74.3 (Sports/Recreation), and 61.9 (Quality of Life), as well as a mean Kujala score of 81.3. Mean patient satisfaction was 8.3 of 10. The majority of knees (86.5%; 32/37) remained stable without recurrent instability after this procedure, while 13.5% (5 knees) suffered a recurrent dislocation, with 2 requiring revision surgery. Eight knees (21.6%) underwent subsequent hardware removal.
Anteromedialization tibial tubercle osteotomy with MPFL imbrication can improve recurrent patellofemoral instability and provide significant clinical benefit to patients with trochlear dysplasia.
在滑车发育不良的情况下治疗髌骨不稳定具有挑战性。
目的/假设：本研究的目的是评估采用胫骨结节内移截骨术联合内侧髌股韧带（MPFL）紧缩术治疗因滑车发育不良导致的复发性髌骨脱位的效果。我们假设，对于既往有不稳定和滑车发育不良的患者，采用胫骨结节截骨术和MPFL紧缩术治疗髌骨不稳定将提高患者满意度，并减少髌骨不稳定事件。
病例系列；证据等级，4级。
我们对在单一机构接受MPFL紧缩术及同期胫骨结节内移截骨术治疗复发性髌股不稳定的患者进行了回顾性分析。最小随访时间为1年。收集患者的人口统计学信息，包括手术时的年龄、性别、体重指数（BMI）、胫骨结节-滑车沟（TT-TG）距离和滑车发育不良分级，以及相关手术数据。术后，收集复发性脱位事件以及膝关节损伤和骨关节炎转归评分（KOOS）、西安大略和麦克马斯特大学骨关节炎指数（WOMAC）以及库贾拉评分，并通过询问患者是否愿意再次接受该手术来确定满意度。
共纳入31例患者（23例女性）的37个膝关节，平均随访3.8年（范围1 - 8.9年）。患者平均年龄为28.8岁（范围14 - 45岁），平均BMI为24 kg/m²（范围20 - 38 kg/m²），术前平均TT-TG距离为18.9 mm（范围8.4 - 32.4 mm）。两个膝关节被分类为低度滑车发育不良（德茹尔A），35个为高度滑车发育不良（德茹尔B - D）。在末次随访时，患者报告的KOOS各子量表平均评分为：疼痛86.5分、症状79.8分、日常生活活动93.9分、运动/娱乐74.3分、生活质量61.9分，库贾拉评分平均为81.3分。患者平均满意度为8.3分（满分10分）。在此手术后，大多数膝关节（86.5%；32/37）保持稳定，无复发性不稳定，而13.5%（5个膝关节）发生复发性脱位，其中2个需要翻修手术。8个膝关节（21.6%）随后取出了内固定物。
胫骨结节内移截骨术联合MPFL紧缩术可改善复发性髌股不稳定，并为滑车发育不良的患者带来显著的临床益处。
