Parikh Shital N, Rajdev Neil
Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA.
University of Cincinnati, Cincinnati, OH, USA.
Knee Surg Sports Traumatol Arthrosc. 2023 Dec;31(12):5299-5305. doi: 10.1007/s00167-023-07569-8. Epub 2023 Sep 21.
Bilateral involvement is common in patients with patellar instability. The management of bilateral patellar instability is associated with increased complication rate. The higher complication rate in this cohort may be related to the presence of underlying anatomic risk factors. The purpose of the study was to evaluate the presence and side-to-side differences in risk factors between knees in bilateral patellar instability.
In a retrospective study (2008-2017), demographic information, characteristics of patellar dislocation and anatomic risk factors on MRI (trochlear dysplasia, patellar height, tibial tubercle lateralization, patellar tilt, sulcus angle, bump height) were evaluated in both knees of all patients (n = 32, 15 males and 17 females) with bilateral patellar instability. The risk factors were analyzed based on established cut off values and were compared between gender, laterality and more symptomatic (index) knee. Knee symmetry and absolute differences between risk factors for both knees were analyzed.
The mean age of 32 patients was 14.6 ± 2.3 years. Of the 4 major anatomic risk factors, the most common were trochlear dysplasia in 59/64 (92.1%) knees and patella alta in 51/64 (79.7%) knees. Tibial tubercle lateralization was the least common risk factor being present in 8/64 (12.5%) knees. Of 64 knees, 55 (85.9%) had 2 or more risk factors and 30 (46.8%) had 3 or all 4 risk factors present. There were no significant differences in risk factors based on gender, laterality or index knee. There was symmetry between paired knees for 31/32 (96.8%) patients for trochlear depth, 29/32 (90.6%) for patellar tilt, 27/32 (84.3%) for TT-TG distance and 25/32 (78.1%) for patellar height. There were no significant differences in absolute measurements between knees for any of the risk factors.
Patients with bilateral instability had multiple risk factors, with trochlear dysplasia being the most common and increased TT-TG distance being the least common. Majority of patients had 2 or more risk factors and about half had 3 or 4 risk factors in each knee. There was symmetry between paired knees for each risk factor without any significant differences between the index knee compared to the contralateral knee.
Level III.
髌股关节不稳定患者双侧受累较为常见。双侧髌股关节不稳定的治疗与并发症发生率增加相关。该队列中较高的并发症发生率可能与潜在的解剖学危险因素有关。本研究的目的是评估双侧髌股关节不稳定患者双膝之间危险因素的存在情况及双侧差异。
在一项回顾性研究（2008 - 2017年）中，对所有双侧髌股关节不稳定患者（n = 32，男15例，女17例）的双膝进行人口统计学信息、髌股关节脱位特征及MRI上的解剖学危险因素（滑车发育不良、髌骨高度、胫骨结节外移、髌骨倾斜、沟角、隆起高度）评估。根据既定的临界值分析危险因素，并在性别、左右侧及症状更明显（索引）膝关节之间进行比较。分析双膝危险因素的对称性及绝对差异。
32例患者的平均年龄为14.6±2.3岁。在4种主要解剖学危险因素中，最常见的是滑车发育不良，共59/64（92.1%）膝受累，其次是高位髌骨，共51/64（79.7%）膝受累。胫骨结节外移是最不常见的危险因素，仅8/64（12.5%）膝受累。64膝中，55（85.9%）膝有2种或更多危险因素，30（46.8%）膝有3种或全部4种危险因素。基于性别、左右侧或索引膝关节的危险因素无显著差异。31/32（96.8%）患者的滑车深度、29/32（90.6%）患者的髌骨倾斜、27/32（84.3%）患者的TT - TG距离及25/32（78.1%）患者的髌骨高度在配对双膝之间具有对称性。任何危险因素在双膝之间的绝对测量值均无显著差异。
双侧不稳定患者存在多种危险因素，其中滑车发育不良最常见，而TT - TG距离增加最不常见。大多数患者每侧膝关节有2种或更多危险因素，约一半患者每侧膝关节有3种或4种危险因素。各危险因素在配对双膝之间具有对称性，索引膝关节与对侧膝关节之间无显著差异。
III级。
