Redler Lauren H, Dennis Elizabeth R, Mayer Gabrielle M, Kalbian Irene L, Nguyen Joseph T, Shubin Stein Beth E, Strickland Sabrina M
Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA.
Mt. Sinai Hospital, New York, New York, USA.
Orthop J Sports Med. 2022 Jul 6;10(7):23259671221107609. doi: 10.1177/23259671221107609. eCollection 2022 Jul.
Many patients undergoing medial patellofemoral ligament (MPFL) reconstruction for patellofemoral instability have chondral or osteochondral injuries requiring treatment.
In patients undergoing MPFL reconstruction for patellofemoral instability, those with ligamentous laxity (LAX) would be less likely to have chondral or osteochondral defects requiring surgical intervention compared with those with no laxity (NLX).
Cohort study; Level of evidence, 2.
Included were 171 patients with patellofemoral instability (32 men, 139 women; mean age, 22 years [range, 11-57 years]) who underwent MPFL reconstruction between 2005 and 2015. Patients with a Beighton-Horan score ≥5 were considered LAX (n = 96), while patients with scores <5 were considered NLX (n = 75). Preoperative magnetic resonance images were evaluated to determine the presence, size, and location of chondral or osteochondral injury as well as the grade according to the Outerbridge classification. Documented anatomic measurements included tibial tubercle-trochlear groove (TT-TG) distance, Caton-Deschamps Index (CDI) for patellar height, and the Dejour classification for trochlear dysplasia.
Of the 171 patients, 58 (34%) required a surgical intervention for a chondral or osteochondral defect: chondroplasty (29/58; 50%), particulated juvenile cartilage implantation (18/58; 31%), microfracture (16/58; 28%), osteochondral fracture fixation (2/58; 3.4%), and osteochondral allograft (2/58; 3.4%). While there was no statistical difference in the proportion of patellar chondral or osteochondral injuries between patients with NLX (58%) versus LAX (67%) ( = .271), there was a significantly higher rate of patellar grade 3 or 4 injuries in the NLX (74%) versus LAX (45%) group ( = .004). Similarly, there was no difference in femoral chondral or osteochondral injury rates between groups ( = .132); however, femoral grade 3 or 4 injuries were significantly higher in the NLX (67%) versus the LAX (13%) group ( = .050). After adjusting for age, sex, radiographic parameters (TT-TG distance and CDI), and trochlear morphology, patients with LAX were 75% less likely to have had a grade 3 or 4 patellar cartilage injury compared with patients with NLX ( = .006).
For patients who sustained patellar or femoral chondral or osteochondral injuries, compared with their counterparts with NLX, patients with LAX were less likely to have severe (grade 3 or 4) injuries requiring surgical intervention.
许多因髌股关节不稳而接受内侧髌股韧带（MPFL）重建的患者存在软骨或骨软骨损伤，需要进行治疗。
在因髌股关节不稳而接受MPFL重建的患者中，与无韧带松弛（NLX）的患者相比，韧带松弛（LAX）的患者发生需要手术干预的软骨或骨软骨缺损的可能性较小。
队列研究；证据等级，2级。
纳入2005年至2015年间接受MPFL重建的171例髌股关节不稳患者（32例男性，139例女性；平均年龄22岁[范围11 - 57岁]）。Beighton - Horan评分≥5分的患者被视为LAX（n = 96），评分<5分的患者被视为NLX（n = 75）。术前磁共振成像用于评估软骨或骨软骨损伤的存在、大小和位置，以及根据Outerbridge分类的分级。记录的解剖学测量包括胫骨结节 - 滑车沟（TT - TG）距离、髌股高度的Caton - Deschamps指数（CDI）和滑车发育不良的Dejour分类。
171例患者中，58例（34%）因软骨或骨软骨缺损需要手术干预：软骨成形术（29/58；50%）、颗粒状青少年软骨植入术（18/58；31%）、微骨折术（16/58；28%）、骨软骨骨折固定术（2/58；3.4%）和骨软骨同种异体移植术（2/58；3.4%）。NLX患者（58%）与LAX患者（67%）之间髌软骨或骨软骨损伤的比例无统计学差异（P = 0.271），但NLX组（74%）髌3级或4级损伤的发生率显著高于LAX组（45%）（P = 0.004）。同样，两组之间股骨软骨或骨软骨损伤率无差异（P = 0.132）；然而，NLX组（67%）股骨3级或4级损伤显著高于LAX组（13%）（P = 0.050）。在调整年龄、性别、影像学参数（TT - TG距离和CDI）和滑车形态后，与NLX患者相比，LAX患者发生3级或4级髌软骨损伤的可能性降低了75%（P = 0.006）。
对于发生髌或股骨软骨或骨软骨损伤的患者，与NLX患者相比，LAX患者发生需要手术干预的严重（3级或4级）损伤的可能性较小。
