Fuchs Andreas, Frodl Andreas, Yilmaz Tayfun, Feucht Matthias J, Hoffmann Reinhard, Dickschas Jörg, Schmal Hagen, Izadpanah Kaywan
Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Freiburg, Hugstetter Str. 55, 79106, Freiburg, Deutschland.
Orthopädische Klinik Paulinenhilfe, Diakonieklinikum Stuttgart, Rosenbergstr. 38, 70176, Stuttgart, Deutschland.
Orthopadie (Heidelb). 2022 Aug;51(8):652-659. doi: 10.1007/s00132-022-04264-3. Epub 2022 May 23.
Patellofemoral instability is one of the most common pathologies of the knee joint. The planning and implementation of patella-stabilizing operations are very variable. With regard to the operative measures, the preoperative planning is of decisive importance, especially with regard to the complexity of underlying pathologies.
The aim of this study was to depict the current healthcare reality in relation to planning and implementation of patella stabilizing operations in Germany. Furthermore, it was to be ascertained whether automated analysis options would facilitate the planning and implementation of surgical procedures (in primary and revision cases).
An online survey with 16 questions was collected by email among all active members of the German Society of Orthopedic and Trauma Surgery. 7974 members were surveyed; 393 responses could then be analyzed.
MPFL-reconstruction (89.8%) is the most frequently performed procedure, followed by tibial tubercle transfers (64.9%), osteotomies (51.2%), and trochleoplasty (19.9%). The choice of surgical approach is mainly based on a combination of clinical and radiological findings (90.3%). MRI imaging (81.2%), standard X‑ray images (77.4%), and full leg images (76.6%) are mainly used for operative treatment decisions. 59.3% of the respondents would appreciate better preoperative planning and 59.0% would implement more radiologically detectable parameters in their individual preoperative planning if these were automatically available.
The findings of this survey among members of the DGOU identify the MPFL-reconstruction as the central operative approach in the treatment of patellofemoral instabilities, whereas MRI imaging is the diagnostic tool of choice. Future establishment of automated software-based analysis methods could allow a large number of surgeons to expand the radiological parameters taken into account when planning patella-stabilizing operations.
髌股关节不稳是膝关节最常见的病变之一。髌骨稳定手术的规划与实施差异很大。就手术措施而言，术前规划至关重要，尤其是考虑到潜在病变的复杂性。
本研究旨在描述德国髌骨稳定手术规划与实施方面的当前医疗现状。此外，还需确定自动分析选项是否有助于手术程序的规划与实施（初次手术和翻修手术病例）。
通过电子邮件向德国骨科与创伤外科学会的所有活跃会员进行了一项包含16个问题的在线调查。共调查了7974名会员；随后对393份回复进行了分析。
内侧髌股韧带重建术（89.8%）是最常施行的手术，其次是胫骨结节移位术（6,4.9%）、截骨术（51.2%）和滑车成形术（19.9%）。手术入路的选择主要基于临床和影像学检查结果的综合判断（90.3%）。MRI成像（81.2%）、标准X线片（77.4%）和全腿图像（76.6%）主要用于手术治疗决策。59.3%的受访者希望有更好的术前规划，59.0%的受访者表示，如果能自动获取更多影像学可检测参数，他们会在个人术前规划中采用。
这项对德国骨科与创伤外科学会会员的调查结果表明，内侧髌股韧带重建术是治疗髌股关节不稳的主要手术方法，而MRI成像是首选的诊断工具。未来基于软件的自动分析方法的建立，可能会使大量外科医生在规划髌骨稳定手术时考虑更多的影像学参数。
