Unterfrauner Ines, Loretz Ruben, Kühne Nathalie, Grubhofer Florian, Fucentese Sandro F
Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
Unit of Clinical and Applied Research, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
J Exp Orthop. 2022 Feb 15;9(1):16. doi: 10.1186/s40634-022-00452-4.
Patella baja after total knee arthroplasty (TKA) is a common problem that is usually treated via proximal transfer of the tibial tubercle. As the long-term outcomes of this procedure are unclarified, this study aimed to investigate the changes in clinical function and radiographic patellar height during five years of follow-up.
Sixty patients with patella baja after TKA who underwent proximalisation of the tibial tubercle were followed up for a mean of 71 months (range 21-153 months). The pre- and postoperative range of motion (ROM) and clinical scores (Knee Society Score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)) were compared. The radiographic patellar height was measured with the Caton-Deschamps index (CDI), Blackburne-Peel ratio (BP), and modified Insall-Salvati index (MIS).
Proximalisation of the tibial tubercle resulted in a significant improvement in the ROM from 80° to 88°. The KSS and WOMAC did not improve or even worsened after the intervention. The radiographic patellar height immediately after tibial tubercle transfer was not better than prior to the intervention (CDI 0.72 vs. 0.63, p = 0.72; BP 0.66 vs. 0.61, p = 0.72; MIS 1.59 vs. 1.55, p = 1.00) and further decreased significantly so that the mean final values were worse than the values in the native joint (CDI 0.59 vs. 0.78, p = 0.001; BP 0.58 vs. 0.74, p = 0.001; MIS 1.39 vs. 1.81, p < 0.001).
Proximalisation of the tibial tubercle in patients with patella baja after TKA does neither lead to significant improvements in the clinical outcome nor in the radiographic patellar height during long-term follow-up.
III.
全膝关节置换术（TKA）后低位髌骨是一个常见问题，通常通过胫骨结节近端转移来治疗。由于该手术的长期效果尚不清楚，本研究旨在调查随访五年期间临床功能和影像学髌骨高度的变化。
对60例TKA后低位髌骨且接受胫骨结节近端移位术的患者进行平均71个月（范围21 - 153个月）的随访。比较术前和术后的活动范围（ROM）及临床评分（膝关节协会评分（KSS）、西安大略和麦克马斯特大学骨关节炎指数（WOMAC））。用卡顿 - 德尚指数（CDI）、布莱克本 - 皮尔比率（BP）和改良英萨尔 - 萨尔瓦蒂指数（MIS）测量影像学髌骨高度。
胫骨结节近端移位使ROM从80°显著改善至88°。干预后KSS和WOMAC并未改善甚至恶化。胫骨结节转移后即刻的影像学髌骨高度并不优于干预前（CDI 0.72对0.63，p = 0.72；BP 0.66对0.61，p = 0.72；MIS 1.59对1.55，p = 1.00），且进一步显著降低，以至于最终平均值比原生关节的值更差（CDI 0.59对0.78，p = 0.001；BP 0.58对0.74，p = 0.001；MIS 1.39对1.81，p < 0.001）。
TKA后低位髌骨患者的胫骨结节近端移位在长期随访中既未导致临床结果的显著改善，也未使影像学髌骨高度得到改善。
III级
