Waaler Per Arne Skarstein, Kjellsen Asle Birkeland, Hysing-Dahl Trine, Inderhaug Eivind
Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway.
Sports Traumatology and Arthroscopy Research Group (STAR Group), Department of Clinical Medicine, University of Bergen, Bergen Norway.
Orthop J Sports Med. 2024 Aug 27;12(8):23259671241270352. doi: 10.1177/23259671241270352. eCollection 2024 Aug.
The association between inherent patellar anatomy and postoperative pain after trochleoplasty in patients with patellar instability is poorly understood.
PURPOSE/HYPOTHESIS: The study purpose was to evaluate outcomes after mini-open, thin-flap trochleoplasty. The hypothesis was that more severe patellar dysplasia would be correlated with increased postoperative pain after trochleoplasty.
Case series; Level of evidence 4.
Patients with patellar instability who underwent mini-open, thin-flap trochleoplasty in combination with other individualized procedures between 2013 and 2022 were included. Patellar dysplasia was evaluated by calculating the Wiberg index at the widest and most distal cartilaginous parts of the patella on preoperative magnetic resonance imaging. At the postoperative follow-up, participants completed the visual analog scale for usual pain (VAS-U), Banff Patellofemoral Instability Instrument 2.0 (BPII), global rating of change scale, and an evaluation of their current symptom state. Redislocations and complications were recorded. The correlation between the Wiberg index and the VAS-U was calculated with the Spearman rho. Between-group analyses based on demographic and pathoanatomic features were conducted using the Mann-Whitney test, independent-samples test, and chi-square test.
Included were 75 knees in 63 patients (median age at surgery, 19.1 years; IQR, 16-22 years) with a median follow-up of 44 months (IQR, 23.8-83.2 months). The median BPII score was 78.2 (IQR, 54.8-92.5), with 88% reporting an improvement in knee function relative to before surgery, but 21.1% remained dissatisfied with their current knee symptom state. New episodes of patellar dislocation were seen in 3 knees (4%), and 14 knees (18.7%) underwent reoperation with either revision surgery (n = 7; 9.3%) or arthroscopic synovectomy (n = 7; 9.3%). A weak positive, nonsignificant correlation was found between increased postoperative pain and a higher Wiberg index, both at the widest ( = 0.16; = .23) and most distal ( = 0.02; = .89) parts of the patella. Significantly worse VAS-U scores were seen in female versus male patients ( = .013).
Good patient-reported results with a low risk of redislocation were seen in the study cohort, but reoperation rates were high, and 21% of the patients remained dissatisfied with their current symptom state. More pronounced patellar dysplasia (increased Wiberg index) had only a poor association with more severe postoperative pain in the current study.
髌骨不稳定患者的固有髌骨解剖结构与滑车成形术后疼痛之间的关联尚不清楚。
目的/假设：本研究旨在评估微型开放薄皮瓣滑车成形术的疗效。假设是更严重的髌骨发育不良与滑车成形术后疼痛增加相关。
病例系列；证据等级4。
纳入2013年至2022年间接受微型开放薄皮瓣滑车成形术并结合其他个体化手术的髌骨不稳定患者。通过术前磁共振成像计算髌骨最宽和最远端软骨部分的维伯格指数来评估髌骨发育不良。术后随访时，参与者完成了日常疼痛视觉模拟量表（VAS-U）、班夫髌股关节不稳定器械2.0（BPII）、整体变化评分量表以及对其当前症状状态的评估。记录再脱位和并发症情况。采用Spearman秩相关系数计算维伯格指数与VAS-U之间的相关性。基于人口统计学和病理解剖学特征的组间分析采用Mann-Whitney检验、独立样本t检验和卡方检验。
纳入63例患者的75个膝关节（手术时中位年龄19.1岁；四分位间距，16 - 22岁），中位随访时间44个月（四分位间距，23.8 - 83.2个月）。BPII评分中位数为78.2（四分位间距，54.8 - 92.5），88%的患者报告膝关节功能相对于术前有所改善，但21.1%的患者对其当前膝关节症状状态仍不满意。3个膝关节（4%）出现髌骨再脱位新发作，14个膝关节（18.7%）接受了再次手术，包括翻修手术（n = 7；9.3%）或关节镜下滑膜切除术（n = 7；9.3%）。在髌骨最宽处（r = 0.16；P = 0.23）和最远端处（r = 0.02；P = 0.89），术后疼痛增加与较高的维伯格指数之间均存在弱正相关但无统计学意义。女性患者的VAS-U评分显著高于男性患者（P = 0.013）。
本研究队列中患者报告的结果良好，再脱位风险低，但再次手术率高，21%的患者对其当前症状状态仍不满意。在本研究中，更明显的髌骨发育不良（维伯格指数增加）与更严重的术后疼痛仅有较弱的关联。
