Huang Wenhan, Ong Tim-Yun, Fu Sai-Chuen, Yung Shu-Hang
Department of Orthopaedics & Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.
J Orthop Translat. 2019 Aug 6;22:14-25. doi: 10.1016/j.jot.2019.07.004. eCollection 2020 May.
The prevalence of patellofemoral joint (PFJ) osteoarthritis (OA) after anterior cruciate ligament (ACL) injury was inconsistently reported in the literature. This review summarises the reported prevalence of PFJ OA and risk factors of PFJ OA after ACL injury.
PubMed, Embase, WoS, and MEDLINE (OVID) were searched up to 1 March 2019. A modified version of the Coleman methodology score was used to assess the methodological quality of the included studies. Prevalence of PFJ OA was pooled depended on different interventions in ACL injured populations.
Thirty-eight studies were included. Five different radiographic classification methods were used: the Kellgren and Lawrence Grade 2, IKDC Grade B, Fairbank Grade 1, joint space narrowing of Grade 2 based on OARSI, and Ahlbäck Grade 1. One included study used MRI Osteoarthritis Knee Score to evaluate PFJ degenerative changes. The overall prevalence of PFJ OA after ACL injury in included studies varied between 4.5% and 80%. The large variation of PFJ OA prevalence is mainly because of different follow-up period and surgical techniques. The pooled data showed that bone-patellar tendon-bone graft, single-bundle ACL reconstruction (ACLR), and delayed ACLR are likely associated with PFJ degenerative changes after ACL injury. ACLR, delayed ACLR, body mass index (BMI), meniscectomy, patellofemoral chondral lesions, age at surgery, and TFJ OA were identified in the literature inducing PFJ OA after ACL injury.
Large variations of PFJ OA after ACL injury are associated with different follow-up period and surgical techniques. ACL reconstructed population with bone-patellar tendon-bone graft, single-bundle reconstruction, and delayed operation time has a high prevalence of PFJ OA.
This review focuses more on the effect of surgical technique factors on the degenerative changes on PFJ. The results reveal that BPTB, single-bundle reconstruction, and delayed ACLR are more likely associated with PFJ degenerative changes after ACL injury. These findings imply that awareness of PFJ problems after surgical intervention will remind of surgeons taking PFJ into consideration in operations, which is likely to reduce the incidences of anterior knee pain, patellar maltracking, and over-constrained patella in the early stage after surgery.
前交叉韧带（ACL）损伤后髌股关节（PFJ）骨关节炎（OA）的患病率在文献中的报道并不一致。本综述总结了已报道的PFJ OA患病率以及ACL损伤后PFJ OA的危险因素。
检索截至2019年3月1日的PubMed、Embase、WoS和MEDLINE（OVID）数据库。采用改良版的科尔曼方法学评分来评估纳入研究的方法学质量。根据ACL损伤人群的不同干预措施汇总PFJ OA的患病率。
纳入38项研究。使用了五种不同的影像学分类方法：凯尔格伦和劳伦斯2级、国际膝关节文献委员会（IKDC）B级、费尔班克1级、基于骨关节炎研究学会国际联盟（OARSI）的2级关节间隙变窄以及阿尔贝克1级。一项纳入研究使用MRI膝关节骨关节炎评分来评估PFJ的退变改变。纳入研究中ACL损伤后PFJ OA的总体患病率在4.5%至80%之间。PFJ OA患病率的较大差异主要归因于不同的随访期和手术技术。汇总数据显示，骨 - 髌腱 - 骨移植、单束ACL重建（ACLR）以及延迟ACLR可能与ACL损伤后PFJ的退变改变相关。文献中确定ACLR、延迟ACLR、体重指数（BMI）、半月板切除术、髌股软骨损伤、手术时年龄以及胫股关节OA会导致ACL损伤后PFJ OA。
ACL损伤后PFJ OA的较大差异与不同的随访期和手术技术有关。采用骨 - 髌腱 - 骨移植、单束重建以及延迟手术时间的ACL重建人群中PFJ OA的患病率较高。
本综述更多地关注手术技术因素对PFJ退变改变的影响。结果显示，BPTB、单束重建以及延迟ACLR更有可能与ACL损伤后PFJ的退变改变相关。这些发现意味着，对手术干预后PFJ问题的认识将提醒外科医生在手术中考虑PFJ，这可能会降低术后早期前膝痛、髌骨轨迹不良和髌骨过度受限的发生率。
