Dippmann Christian, Lavard Peter, Kourakis Anette Holm, Siersma Volkert, Hansen Philip, Talibi Monica, Krogsgaard Michael Rindom
Section of Sportstraumatology M51, Department of Orthopedic Surgery, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.
Department of Public Health, The Research Unit for General Practice and Section of General Practice, University of Copenhagen, Copenhagen, Denmark.
Knee Surg Sports Traumatol Arthrosc. 2025 Feb;33(2):401-412. doi: 10.1002/ksa.12432. Epub 2024 Aug 22.
Trochlear dysplasia is a major risk factor for recurrent patellar instability, reduced quality of life and osteoarthritis of the patellofemoral joint. Patellar instability in patients with trochlear dysplasia can be treated by trochleoplasty, usually in combination with medial patellofemoral ligament reconstruction (MPFL-R). An à la carte treatment algorithm, which also addresses patella alta, lateralisation of the tibial tuberosity and valgus or torsional malalignment when present has been standard in one clinic for treatment of patellar instability patients since 2009, based on the hypothesis that it results in optimal subjective and clinical outcome, normalisation of the lateral trochlea inclination (LTI) angle and a low rate of patellar redislocation.
This prospective study reports the 5-year results for consecutive patients with high-grade trochlea dysplasia operated according to the algorithm 2010-2017, evaluated preoperatively and 1, 2 and 5 years postoperatively. Clinical information on previous surgery and postoperative patellar stability, range-of-motion (ROM) and subsequent surgery were registered. Subjective outcome was evaluated by four patient-reported outcome measures (PROMs): Kujala, Lysholm, International Knee Documentation Committee and Knee injury and Osteoarthritis Outcome Score. The LTI angle was measured pre- and postoperatively on magnetic resonance imaging scans.
There were 131 patients (87 females) with a median age of 22 years (range: 14-38). All had a trochleoplasty and an MPFL-R. Additional procedures (tibial tuberosity medialisation/distalisation and/or femoral/tibial osteotomy) were performed in 52%. All PROM scores improved from preoperatively to 1-year follow-up with further improvement at 2 and 5 years after surgery (p < 0.05). Three patients (2%) had a traumatic patellar dislocation 9, 12 and 24 months postoperatively and 38% underwent subsequent surgery (hardware removal, arthroscopically assisted brisement force, knee arthroscopy). A normalisation of the LTI angle (≥11°) was achieved in 76%.
Treatment according to the à la carte algorithm for patients with patellar instability and high-grade trochlear dysplasia resulted in significant clinical and subjective improvement in all PROM scores and a very low redislocation rate (2%) 5 years after surgery.
Level II.
滑车发育不良是复发性髌骨不稳定、生活质量下降和髌股关节骨关节炎的主要危险因素。滑车发育不良患者的髌骨不稳定可通过滑车成形术治疗，通常联合内侧髌股韧带重建术（MPFL-R）。自2009年以来，一种定制化治疗算法在一家诊所成为治疗髌骨不稳定患者的标准方法，该算法还处理高位髌骨、胫骨结节外移以及存在的外翻或扭转畸形，其基于这样的假设，即该算法能带来最佳的主观和临床结果、使外侧滑车倾斜（LTI）角正常化以及降低髌骨再脱位率。
这项前瞻性研究报告了2010年至2017年期间根据该算法接受手术的连续高位滑车发育不良患者的5年结果，术前以及术后1年、2年和5年进行评估。记录有关既往手术、术后髌骨稳定性、活动范围（ROM）和后续手术的临床信息。通过四项患者报告的结局指标（PROMs）评估主观结果：库贾拉、莱肖尔姆、国际膝关节文献委员会和膝关节损伤与骨关节炎结局评分。术前和术后在磁共振成像扫描上测量LTI角。
有131例患者（87例女性），中位年龄22岁（范围：14 - 38岁）。所有患者均接受了滑车成形术和MPFL-R。52%的患者进行了额外手术（胫骨结节内移/下移和/或股骨/胫骨截骨术）。所有PROM评分从术前到1年随访均有所改善，术后2年和5年进一步改善（p < 0.05）。3例患者（2%）在术后9个月、12个月和24个月发生创伤性髌骨脱位，38%的患者接受了后续手术（取出内固定、关节镜辅助手法松解、膝关节镜检查）。76%的患者实现了LTI角正常化（≥11°）。
对于髌骨不稳定和高位滑车发育不良患者，根据定制化算法进行治疗在术后5年时所有PROM评分均有显著的临床和主观改善，且再脱位率极低（2%）。
二级。
