Waaler Per Arne Skarstein, Jellestad Truls, Hysing-Dahl Trine, Elvehøy Elise, Inderhaug Eivind
Department of Orthopaedic Surgery, Førde Health Thrust, Førde Central Hospital, Svanehaugvegen 2, 6812, Førde, Norway.
Department of Orthopaedic Surgery, Førde Health Thrust, Lærdal Hospital, Førde, Norway.
J Exp Orthop. 2022 Jul 6;9(1):64. doi: 10.1186/s40634-022-00502-x.
The purpose of this study was to evaluate clinical and radiological results in patients operated for recurrent patellar instability with a surgical approach consisting of Insall proximal realignment with/without tibial tubercle osteotomy (TTO).
Patients that underwent surgery for recurrent patellar instability at one centre with a uniform technique between 2004 and 2020 were included. Eligible patients were assessed by clinical examination and the disease-specific Banff Patellofemoral Instability Instrument 2.0 (BPII 2.0). Pre- and postoperative radiographs were analysed for patellofemoral osteoarthritis (OA) according to Iwano. Preoperative Magnetic Resonance Imaging (MRI) and radiographs were analysed for anatomical risk factors for patellar instability. Student t-test, chi-square test and ANOVA-analyses were used to investigate whether anatomical risk factors and/or patient characteristics could predict an inferior outcome.
Forty-six patients (47 knees) were included at a mean follow-up time of 6.6 years (SD 4.6; range 1-17). Mean BPII 2.0 score was 60.4 (SD 18.4; range 26-98), and 10.6% (n = 5) had suffered a postoperative redislocation. Progression to evident patellofemoral OA was seen in 15% of the patients (p < 0.05). The presence of pathoanatomic risk factors did not correlate with recurrent postoperative instability or inferior BPII 2.0 score at the final evaluation.
Patients treated with the current approach reported acceptable medium- to long-term results, but the risk of patellofemoral OA progression is significant. These findings add to the knowledge of expected outcomes after procedures involving Insall proximal realignment, and can guide clinical decision making for surgeons using similar methods.
Level IV, case series.
本研究旨在评估采用Insall近端重新排列术联合或不联合胫骨结节截骨术（TTO）手术方法治疗复发性髌骨不稳患者的临床和影像学结果。
纳入2004年至2020年期间在一个中心采用统一技术接受复发性髌骨不稳手术的患者。符合条件的患者通过临床检查和疾病特异性的班夫髌股关节不稳仪器2.0（BPII 2.0）进行评估。根据岩野标准对术前和术后的X线片进行髌股关节骨关节炎（OA）分析。对术前磁共振成像（MRI）和X线片进行髌骨不稳的解剖学危险因素分析。采用学生t检验、卡方检验和方差分析来研究解剖学危险因素和/或患者特征是否能预测较差的结果。
纳入46例患者（47膝），平均随访时间为6.6年（标准差4.6；范围1 - 17年）。BPII 2.0平均评分为60.4（标准差18.4；范围26 - 98），10.6%（n = 5）的患者术后发生再脱位。15%的患者出现明显的髌股关节OA进展（p < 0.05）。在最终评估中，病理解剖学危险因素的存在与术后复发性不稳或BPII 2.0评分较低无关。
采用当前方法治疗的患者报告了可接受的中长期结果，但髌股关节OA进展的风险显著。这些发现增加了对Insall近端重新排列术相关预期结果的认识，并可为使用类似方法的外科医生提供临床决策指导。
IV级，病例系列。
