Baton Rouge, Louisiana.
Arthroscopy. 2021 May;37(5):1680-1682. doi: 10.1016/j.arthro.2021.01.018.
Treatment algorithms for recurrent patellofemoral instability have evolved over time. Early treatment techniques focusing specifically on pain have been replaced by evidence-based and anatomically appropriate procedures such as ligament reconstruction, osteotomies, and trochleoplasty. Bony and soft-tissue factors contribute to recurrent patellofemoral instability, but the exact indications for soft-tissue, bony, and combined procedures remain controversial. Personally, I am much more likely to combine tibial tubercle osteotomy with medial patellofemoral ligament reconstruction in a patient with trochlear dysplasia, patella alta, and a large J-sign (in addition to an elevated tibial tubercle to trochlear groove distance). As in cases of anterior cruciate ligament injury, in cases of patellofemoral instability we must consider bony morphologic features in addition to soft-tissue status.
复发性髌股关节不稳定的治疗方案随着时间的推移而不断发展。早期专门针对疼痛的治疗技术已被基于证据和解剖学的适当手术所取代，如韧带重建、截骨术和滑车成形术。骨和软组织因素都与复发性髌股关节不稳定有关，但软组织、骨和联合手术的具体适应证仍存在争议。就个人而言，对于滑车发育不良、髌骨高位和 J 征较大（除了胫骨结节至滑车沟距离升高外）的患者，我更倾向于将胫骨结节截骨术与内侧髌股韧带重建相结合。与前交叉韧带损伤的情况一样，在髌股关节不稳定的情况下，我们除了要考虑软组织状况外，还要考虑骨骼形态特征。
