Noh Jung Ho, Kim Nam Yeop, Song Ki Ill
Department of Orthopaedic Surgery, Kangwon National University School of Medicine, 1 Gangwondaehak-gil, Chuncheon-si, Gangwon-do, 24341, South Korea.
Department of Orthopaedic Surgery, Kangwon National University Hospital, Chuncheon-si, South Korea.
Knee Surg Relat Res. 2021 Mar 20;33(1):9. doi: 10.1186/s43019-021-00091-6.
Patellar maltracking after total knee arthroplasty (TKA) can lead to significant patellofemoral complications such as anterior knee pain, increased component wear, and a higher risk of component loosening, patellar fracture, and instability. This study was to investigate the preoperative and operative variables that significantly affect patellar tracking after cruciate-retaining TKA.
We studied 142 knee joints in patients who had undergone TKA: the knees were dichotomized based on postoperative patellar tracking, which was evaluated on patellar skyline, axial-projection radiographs: group 1, normal patellar tracking (lateral tilt ≤ 10° and displacement ≤ 3 mm) and group 2, patellar maltracking (lateral tilt > 10° or displacement > 3 mm). The patients' demographic data and clinical and radiographic measurements obtained before and after surgery were compared between the two groups.
Preoperative lateral patellar displacement was greater (4.1 ± 2.6 mm vs. 6.0 ± 3.5 mm), as was the frequency of medial collateral ligament (MCL) release (3/67 vs. 24/75) in group 2 than in group 1 (p < 0.001 and p < 0.001, respectively). The distal femur was cut in a greater degree of valgus in group 1 than in group 2. (6.3 ± 0.8° vs. 6.0 ± 0.8°) (p = 0.034).
Complete release of the MCL during surgery was associated with patellar maltracking (logistic regression: p = 0.005, odds ratio = 20.592). Surgeons should attend to patellar tracking during surgery in medially tight knees.
Retrospective comparative study, level III.
全膝关节置换术（TKA）后髌骨轨迹异常可导致严重的髌股并发症，如膝关节前侧疼痛、假体磨损增加、假体松动、髌骨骨折及不稳定风险升高。本研究旨在探讨在保留交叉韧带的TKA术后，显著影响髌骨轨迹的术前及手术变量。
我们研究了142例接受TKA的患者的膝关节：根据术后髌骨轨迹将膝关节分为两组，通过髌骨侧位、轴位X线片进行评估：第1组，髌骨轨迹正常（外侧倾斜≤10°且移位≤3 mm）；第2组，髌骨轨迹异常（外侧倾斜>10°或移位>3 mm）。比较两组患者的人口统计学数据以及手术前后获得的临床和影像学测量结果。
第2组术前髌骨外侧移位更大（4.1±2.6 mm对6.0±3.5 mm），内侧副韧带（MCL）松解频率也高于第1组（3/67对24/75）（分别为p<0.001和p<0.001）。第1组股骨远端截骨外翻角度大于第2组（6.3±0.8°对6.0±0.8°）（p = 0.034）。
手术中MCL完全松解与髌骨轨迹异常相关（逻辑回归：p = 0.005，优势比=20.592）。对于内侧紧张的膝关节，外科医生在手术过程中应关注髌骨轨迹。
回顾性比较研究，III级。
