Retzky Julia S, Gross Preston W, Doyle Shevaun M, Strickland Sabrina M
Hospital for Special Surgery, New York, NY, USA.
HSS J. 2024 Aug;20(3):351-358. doi: 10.1177/15563316241231805. Epub 2024 Mar 20.
Anterior knee pain is a common reason for referral to a pediatric orthopedic surgeon. Although previous studies have found that adults with anatomic risk factors for patellofemoral instability (patella dislocation) are predisposed to anterior knee pain, no studies have elucidated the relationship between anatomic risk factors for patellofemoral instability and anterior knee pain in children. : We sought to characterize common radiographic findings in adolescent patients with a chief complaint of anterior knee pain and to determine the prevalence of abnormal patellofemoral morphology. : We conducted a retrospective review of patients 13 to 18 years old with anterior knee pain at a single tertiary care metropolitan institution from 2016 to 2021. X-rays and magnetic resonance imaging (MRI) were evaluated in those diagnosed with "chondromalacia patellae," "chondromalacia," "patellofemoral disorders," or "anterior knee pain." Patella alta, tibial tubercle-trochlear groove (TT-TG) distance, tubercle height, Wiberg patella type, patellar tilt, and trochlear dysplasia characterization were recorded. : Of the 293 adolescents with anterior knee pain included, 62 had bilateral anterior knee pain. Of the 172 MRIs, 72 (42%) met criteria for patella alta, Caton-Deschamps Index (CDI) >1.3, 35% had a TT-TG distance >15 mm, and 32% had lateral patellar tilt >15°. Magnetic resonance imaging findings included infrapatellar fat pad signal hyperintensity (41%) and patellofemoral dysplasia (23%). Of all 293 adolescents, 74% had images showing abnormal patellofemoral morphology, of which 30% had a history of 1 or more patellar dislocation. Overall, 40% of the adolescents had surgery, most commonly medial patellofemoral ligament (MPFL) reconstruction (18%). : In this retrospective review, nearly 3/4 of adolescents with anterior knee pain had images showing abnormal patellofemoral morphology, including patella alta, increased TT-TG distance, trochlear dysplasia, or abnormal lateral patellar tilt; only 18% had MPFL surgery. These findings suggest that primary care providers might consider obtaining X-rays and/or MRIs to evaluate for pathology that warrants orthopedic evaluation.
膝前疼痛是转诊至小儿骨科医生处的常见原因。尽管先前的研究发现，具有髌股关节不稳定（髌骨脱位）解剖学危险因素的成年人易患膝前疼痛，但尚无研究阐明儿童髌股关节不稳定的解剖学危险因素与膝前疼痛之间的关系。我们试图描述以膝前疼痛为主诉的青少年患者常见的影像学表现，并确定髌股关节形态异常的患病率。我们对2016年至2021年在一家大型三级医疗中心就诊的13至18岁膝前疼痛患者进行了回顾性研究。对诊断为“髌骨软化症”“软骨软化”“髌股关节疾病”或“膝前疼痛”的患者的X线和磁共振成像（MRI）进行了评估。记录了高位髌骨、胫骨结节-滑车沟（TT-TG）距离、结节高度、维伯格髌骨类型、髌骨倾斜度和滑车发育不良特征。在纳入的293例膝前疼痛青少年中,62例有双侧膝前疼痛。在172例MRI检查中，72例（42%）符合高位髌骨标准，卡顿-德尚指数（CDI）>1.3，35%的TT-TG距离>15mm，32%的髌骨外侧倾斜>15°。磁共振成像表现包括髌下脂肪垫信号增强（41%）和髌股关节发育不良（23%）。在所有293例青少年中，74%的图像显示髌股关节形态异常，其中30%有1次或更多次髌骨脱位史。总体而言，40%的青少年接受了手术，最常见的是内侧髌股韧带（MPFL）重建术（18%）。在这项回顾性研究中，近3/4的膝前疼痛青少年图像显示髌股关节形态异常，包括高位髌骨、TT-TG距离增加、滑车发育不良或髌骨外侧倾斜异常；只有18%接受了MPFL手术。这些发现表明，初级保健提供者可能会考虑进行X线和/或MRI检查，以评估是否存在需要骨科评估的病变。
