Honkonen Essi E, Sillanpää Petri J, Reito Aleksi, Kiekara Tommi, Mäenpää Heikki, Mattila Prof Ville M
Department of Orthopaedics, Unit of Musculoskeletal Surgery, Tampere University Hospital, Finland.
Faculty of Medicine and Health Technology, Tampere University, Finland.
Orthop J Sports Med. 2024 Dec 17;12(12):23259671241300319. doi: 10.1177/23259671241300319. eCollection 2024 Dec.
After first-time lateral patellar dislocation, 44% to 70% of patients sustain redislocations. Increased femoral anteversion (FA) is considered to result in increased lateralizing forces on the patella, which might predispose one to patellar instability. When recurrent patellar dislocations (RPDs) are bilateral, it is unclear if the FA is even more increased.
Patients with bilateral RPD would have greater FA than patients with unilateral RPD.
Case-control study; Level of evidence, 3.
A total of 52 skeletally mature patients with RPD and a clinical suspicion of rotational malalignment underwent rotational computed tomography or magnetic resonance imaging. The uni- or bilaterality of the RPD was determined. A control group comprising 54 adult patients with trauma underwent computed tomography of both lower extremities as part of a multitrauma protocol. The FA values of both lower extremities were evaluated separately.
In total, 20 of 52 (38.5%) patients in the study group had a history of unilateral RPD and 32 of 52 (61.5%) patients had a bilateral RPD diagnosis. The mean FA of the asymptomatic limb in unilaterally symptomatic patients was 18.0° (SD, 11.2°; range, 0.5°-40.0°; median, 16.5°). In the symptomatic limb, the mean FA was 19.2° (SD, 9.1°; range, 2.0°-33.0°; median, 19.0°) (mean difference, 1.2°; 95% CI -1.3° to 3.8°). In bilaterally symptomatic patients, the mean FA on the right side was 23.2°, and 22.5° on the left. The mean differences between the symptomatic limbs in the unilateral RPD group and the right or left limbs in the bilateral RPD group were 4.0° ( = .263) and 3.3° ( = .326), respectively. In the control group without RPD, the mean FA was 12.5° (SD, 8.5°; range, 0.8°-33.0°; median, 10.9°). The mean difference between right limbs of the patients with bilateral RPD and right limbs of controls was 10.8° ( = .001).
Patients with bilateral RPD have bilaterally greater FA than patients without a history of RPD. Patients with unilateral RPD have greater FA on both sides compared with the control group without a history of lateral patellar dislocation. No statistically significant difference of FA can be seen between patients with bilateral or unilateral RPD.
首次髌骨外侧脱位后，44%至70%的患者会再次脱位。股骨前倾角（FA）增大被认为会导致髌骨上的外倾力增加，这可能使患者易患髌骨不稳定。当复发性髌骨脱位（RPD）为双侧时，尚不清楚FA是否会进一步增大。
双侧RPD患者的FA大于单侧RPD患者。
病例对照研究；证据等级，3级。
共有52例骨骼成熟且患有RPD并临床怀疑有旋转排列不齐的患者接受了旋转计算机断层扫描或磁共振成像检查。确定RPD的单侧或双侧情况。一个由54例成年创伤患者组成的对照组作为多创伤诊疗方案的一部分接受了双下肢计算机断层扫描。分别评估双下肢的FA值。
研究组52例患者中，20例（38.5%）有单侧RPD病史，32例（61.5%）有双侧RPD诊断。单侧有症状患者无症状肢体的平均FA为18.0°（标准差，11.2°；范围，0.5°至40.0°；中位数，16.5°）。在有症状肢体中，平均FA为19.2°（标准差，9.1°；范围，2.0°至33.0°；中位数，19.0°）（平均差值，1.2°；95%置信区间-1.3°至3.8°）。双侧有症状患者中，右侧平均FA为23.2°，左侧为22.5°。单侧RPD组有症状肢体与双侧RPD组右侧或左侧肢体之间的平均差值分别为4.0°（P = 0.263）和3.3°（P = 0.326）。在无RPD的对照组中，平均FA为12.5°（标准差，8.5°；范围，0.8°至33.0°；中位数，10.9°）。双侧RPD患者右侧肢体与对照组右侧肢体之间的平均差值为10.8°（P = 0.001）。
双侧RPD患者双侧的FA均大于无RPD病史的患者。与无髌骨外侧脱位病史的对照组相比，单侧RPD患者双侧的FA均更大。双侧或单侧RPD患者之间FA无统计学显著差异。
