Department of Orthopedic Surgery, Boston Children's Hospital, Boston, Massachusetts, USA.
Harvard Medical School, Boston, Massachusetts, USA.
Am J Sports Med. 2022 Jul;50(9):2424-2432. doi: 10.1177/03635465221102917. Epub 2022 Jun 28.
Several anatomic risk factors have been identified in the pathogenesis of patellofemoral instability. The literature is sparce regarding how these anatomic risk factors change during skeletal growth and development.
The anatomic risk factors associated with patellar instability change significantly during skeletal growth and maturation with different patterns in male versus female patients.
Cross-sectional study; Level of evidence, 3.
Magnetic resonance imaging data from 240 unique, asymptomatic knees (7-18 years of age; 50% female) were used to measure patellar height (Caton-Deschamps index), lateral patellar tilt angle, trochlear height, trochlear groove depth, trochlear sulcus angle, and tibial tubercle-trochlear groove (TT-TG) distance. Linear regression was used to test the associations between age and anatomic findings. Two-way analysis of variance with Holm-Šídák post hoc test was used to compare anatomic characteristics between sexes in 3 age groups: prepubertal school-aged children (7-10 years old), early adolescents (11-14 years old), and late adolescents (15-18 years old).
Patellar height (female sex), lateral patellar tilt angle (male sex), and trochlear sulcus angle (both sexes) decreased with age ( < .001). Trochlear height, depth, and TT-TG distance increased with age in both male and female participants ( < .02). Male participants had a larger sulcus angle (by 5.3°± 1.6° at age 11-14 years) and greater trochlear height (by >5 mm across medial, central, and lateral regions at age 15-18 years) than age-matched female participants ( < .01). We found no other sex-related differences in quantified anatomic features ( > .1).
The findings partially support our hypothesis indicating significant age-related changes in all quantified features, which were not different between male and female participants except for trochlear sulcus angle in early adolescence and trochlear height in late adolescence. In general, the majority of anatomic risk factors for patellar instability change with maturity in a direction that assists in reducing the risk of patellar instability and/or dislocation. The only outlier is the TT-TG distance, which increased by age, and in our oldest cohort of patients, the mean fell below the normal adult range. The current observations highlight the importance of age in the interpretation of risk for injury as well as the need for further studies to identify intrinsic and extrinsic factors that may result in abnormal development of these anatomic features during skeletal growth and maturation.
在髌股关节不稳定的发病机制中，已经确定了几个解剖学危险因素。关于这些解剖学危险因素在骨骼生长和发育过程中如何变化的文献很少。
与髌股关节不稳定相关的解剖学危险因素在骨骼生长和成熟过程中会发生显著变化，男性和女性患者的变化模式不同。
横断面研究；证据水平，3 级。
使用 240 例独特的无症状膝关节（7-18 岁；50%为女性）的磁共振成像数据来测量髌股高度（Caton-Deschamps 指数）、外侧髌股倾斜角、滑车高度、滑车沟深度、滑车沟角和胫骨结节-滑车沟（TT-TG）距离。线性回归用于测试年龄与解剖发现之间的关系。采用双因素方差分析和 Holm-Šídák 事后检验比较 3 个年龄组（7-10 岁的学龄期儿童、11-14 岁的青春期早期和 15-18 岁的青春期晚期）之间的解剖特征。
髌股高度（女性）、外侧髌股倾斜角（男性）和滑车沟角（两性）随年龄增长而降低（<0.001）。在男性和女性参与者中，滑车高度、深度和 TT-TG 距离均随年龄增长而增加（<0.02）。与年龄匹配的女性参与者相比，男性参与者的滑车沟角更大（11-14 岁时为 5.3°±1.6°），滑车高度更高（15-18 岁时，内侧、中央和外侧区域的高度均增加>5mm）（<0.01）。我们没有发现其他与性别相关的解剖特征差异（>0.1）。
研究结果部分支持我们的假设，即所有量化特征都与年龄相关，除了青春期早期的滑车沟角和青春期晚期的滑车高度外，男女参与者之间没有差异。总的来说，髌股关节不稳定的大多数解剖学危险因素在成熟过程中发生变化，这有助于降低髌股关节不稳定和/或脱位的风险。唯一的异常是 TT-TG 距离随年龄增加而增加，在我们年龄最大的患者队列中，平均值低于正常成人范围。目前的观察结果强调了年龄在解释损伤风险方面的重要性，以及需要进一步研究确定在骨骼生长和成熟过程中导致这些解剖特征异常发育的内在和外在因素。
