University of Connecticut School of Medicine, Farmington, Connecticut, U.S.A.
Department of Orthopedic Surgery, University of Connecticut School of Medicine, Farmington, Connecticut, U.S.A..
Arthroscopy. 2021 Dec;37(12):3469-3476. doi: 10.1016/j.arthro.2021.04.054. Epub 2021 May 5.
The primary study objective was to describe the incidence of osteochondral damage (OD) in our cohort of patients with patellar instability (PI). The secondary objective was to assess for associations between patient demographic characteristics, duration of PI, and quantitative radiographic measurements of anatomic risk factors for PI and OD in this cohort.
A retrospective chart review identified patients treated for PI at a tertiary referral center between 2013 and 2018. Patients were evaluated for osteochondral injury with either magnetic resonance imaging if treated nonoperatively or operative reports if treated surgically. The Caton-Deschamps ratio, proximal tibial tubercle-to-trochlear groove (pTT-TG) distance, distal tibial tubercle-to-trochlear groove (dTT-TG) distance, lateral trochlear inclination (LTI) angle, lateral patellar inclination (LPI) angle, and sulcus angle were calculated from magnetic resonance imaging scans. Trochlear dysplasia is an important risk factor for PI that can be reliability quantified by the pTT-TG distance, dTT-TG distance, LTI angle, sulcus angle, and LPI angle. Demographic data including age at first instability event, sex, body mass index, symptom duration, and number of dislocations were documented.
A total of 125 knees in 118 patients (average age, 13.9 ± 3.4 years; 48% female patients) with PI were identified. Within this cohort, 67% were treated surgically and 53% had OD. No association was identified between osteochondral injury and age, sex, body mass index, symptom duration, LTI angle, LPI angle, dTT-TG distance, pTT-TG distance, or number of dislocations. An increased sulcus angle (more dysplasia) showed a statistically significant association with osteochondral pathology (P = .021), and higher sulcus angles were statistically significantly associated with acute osteochondral fracture compared with chondral injury (P = .001).
Using quantitative analysis of trochlear dysplasia, this study identified a significant association between trochlear dysplasia (sulcus angle) and the incidence of OD in our cohort of patients with PI. The frequency of dislocation or subluxation and patient demographic characteristics were not significantly associated with OD.
Level III, retrospective prognostic study.
本研究的主要目的是描述我们不稳定髌骨（PI）患者队列中骨软骨损伤（OD）的发生率。次要目的是评估患者人口统计学特征、PI 持续时间以及 PI 解剖危险因素的定量放射影像学测量值与该队列中 OD 的相关性。
回顾性图表审查确定了 2013 年至 2018 年在三级转诊中心接受 PI 治疗的患者。对有或没有接受手术治疗的患者进行 MRI 检查以评估骨软骨损伤。使用 MRI 扫描计算 Caton-Deschamps 比、胫骨近端结节到滑车沟（pTT-TG）距离、胫骨远端结节到滑车沟（dTT-TG）距离、外侧滑车倾斜角（LTI）、外侧髌骨倾斜角（LPI）和滑车沟角。滑车发育不良是 PI 的一个重要危险因素，可以通过 pTT-TG 距离、dTT-TG 距离、LTI 角度、滑车沟角和 LPI 角度可靠地量化。记录了人口统计学数据，包括首次不稳定事件的年龄、性别、体重指数、症状持续时间和脱位次数。
共确定了 118 名患者的 125 个膝关节（平均年龄 13.9±3.4 岁；48%为女性患者）患有 PI。在该队列中，67%接受了手术治疗，53%有 OD。OD 与年龄、性别、体重指数、症状持续时间、LTI 角度、LPI 角度、dTT-TG 距离、pTT-TG 距离或脱位次数之间无相关性。沟角（更严重的发育不良）增加与骨软骨病理学有统计学显著相关性（P=0.021），与软骨损伤相比，较高的沟角与急性骨软骨骨折有统计学显著相关性（P=0.001）。
本研究使用滑车发育不良的定量分析，确定了我们不稳定髌骨患者队列中滑车发育不良（沟角）与 OD 发生率之间存在显著相关性。脱位或半脱位的频率和患者的人口统计学特征与 OD 无显著相关性。
III 级，回顾性预后研究。
