Karlsson J, Bunketorp O, Lansinger O, Romanus B, Swärd L
Arch Orthop Trauma Surg (1978). 1986;105(1):40-5. doi: 10.1007/BF00625659.
From a series of 72 patients treated with anterior advancement of the tibial tubercle for patellofemoral pain syndrome, secondary lowering of the patella was noted in eight. In all eight patients the results were poor following surgery, with severe disabling retro- and peripatellar pain and atrophy of the quadriceps muscle. We describe this complication and illustrate and discuss the biomechanical consequences. The shortening of the patellar ligament and lever arm of the ligament were determined from radiographs of the knee joints before and after surgery. A theoretical analysis was made of the compressive force in the patellofemoral joint in one of these patients. The Insall-Salvati index decreased from 0.88-1.25 (mean 1.07) preoperatively to 0.54-0.78 (mean 0.70) at follow-up, 1.0-2.5 years post-operatively. The lowering of the patella was correlated to a reduction of the lever arm of the patellar ligament in seven patients. The mechanism behind the lowering of the patella is obscure, but the reduced lever arm of the patellar ligament will increase the compressive force in the patellofemoral joint, and this might be one explanation of the poor results. Impaired congruity of the patellofemoral joint, increased tension in the patellar ligament, and increased pressure against the quadriceps tendon are other possible explanations.
在一组72例因髌股疼痛综合征接受胫骨结节前移治疗的患者中，有8例出现了髌骨继发性下移。所有这8例患者术后结果均较差，伴有严重的致残性髌后和髌周疼痛以及股四头肌萎缩。我们描述了这种并发症，并举例说明和讨论了其生物力学后果。通过膝关节术前和术后的X线片确定髌韧带的缩短情况及韧带力臂。对其中1例患者的髌股关节压力进行了理论分析。Insall-Salvati指数从术前的0.88 - 1.25（平均1.07）降至术后1.0 - 2.5年随访时的0.54 - 0.78（平均0.70）。7例患者中髌骨下移与髌韧带力臂减小相关。髌骨下移背后的机制尚不清楚，但髌韧带力臂减小会增加髌股关节的压力，这可能是结果不佳的一个原因。髌股关节协调性受损、髌韧带张力增加以及对股四头肌腱压力增加是其他可能的原因。
