Department of Orthopaedic Surgery, National University Health System (NUHS), Singapore, Singapore.
J Knee Surg. 2023 Oct;36(12):1297-1301. doi: 10.1055/s-0042-1755356. Epub 2022 Sep 1.
The study aimed to compare the midterm outcomes of medialization and anteromedialization tibial tubercle osteotomies when used in the management of recurrent patellofemoral instability. The hypothesis is that both techniques would result in significant improvement for patellofemoral instability, but anteromedialization would result in a lower incidence of early osteoarthritis. In the cohort study, all skeletally mature patients aged 18 years old or younger who underwent tibial tubercle osteotomy for recurrent patellofemoral instability within a 10-year period in a single institution were included. All patients underwent either medialization or anteromedialization tibial tubercle osteotomy. The preoperative and postoperative outcomes of the tibial tubercle osteotomies were compared. All patients included in the study had a minimum of 5-year follow-up duration before the conclusion of the study. There was no statistically significant difference in the rates of preoperative and postoperative patellofemoral dislocation when either technique was employed ( = 0.999). Additionally, both the preoperative and postoperative Kujala scores were similar ( = 0.166 and = 0.554, respectively). The knees did not have a statistically significant difference in their patellar tilt angles and tibial tubercle-trochlear groove distances preoperatively or postoperatively when either technique was used ( = 0.165 and 0.149, respectively). There was also no incidence of osteoarthritis identified in either of the groups ( = 0.999). Both anteriorization and anteromedialization tibial tubercle osteotomies were effective surgical management for patellofemoral instability when combined with medial patellofemoral ligament reconstruction. There were no significant differences in clinical, functional, and radiological outcomes when either medialization or anteromedialization tibial tubercle osteotomy was performed.
本研究旨在比较内侧化和前内侧化胫骨结节截骨术在复发性髌股关节不稳定治疗中的中期结果。假设这两种技术都将显著改善髌股关节不稳定，但前内侧化将导致早期骨关节炎的发生率降低。在这项队列研究中，所有在单一机构接受胫骨结节截骨术治疗复发性髌股关节不稳定的骨骼成熟患者，年龄均在 18 岁或以下，且随访时间至少为 5 年。所有患者均接受内侧化或前内侧化胫骨结节截骨术。比较胫骨结节截骨术的术前和术后结果。在研究结束时，所有纳入研究的患者均有至少 5 年的随访时间。当使用这两种技术时，术前和术后髌股关节脱位的发生率没有统计学差异（=0.999）。此外，术前和术后的 Kujala 评分也相似（=0.166 和=0.554）。当使用这两种技术时，术前和术后膝关节的髌骨倾斜角和胫骨结节滑车沟距离均无统计学差异（=0.165 和 0.149）。两组均未发现骨关节炎的发病率（=0.999）。当结合内侧髌股韧带重建时，前外侧化和前内侧化胫骨结节截骨术都是治疗髌股关节不稳定的有效手术方法。当进行内侧化或前内侧化胫骨结节截骨术时，临床、功能和影像学结果没有显著差异。
