Dan Michael, Moralidou Maria, Kuder Isabelle, van Arkel Richard J, Dejour David, Amis Andrew A
Lyon Ortho Clinic, Lyon, France.
Mechanical Engineering Department, Biomechanics Group, Imperial College, London, UK.
Knee Surg Sports Traumatol Arthrosc. 2025 Oct;33(10):3499-3509. doi: 10.1002/ksa.12570. Epub 2024 Dec 25.
High-grade femoral trochlear dysplasia is associated with anterior knee pain, patellar maltracking, instability and the development of osteoarthritis. Scientific studies have signified the importance of trochlear resection on the knee extensor mechanism, and dysplasia can be addressed by a groove-deepening trochleoplasty. Alternatively, tibial tubercle anteriorisation has been proposed to reduce patellofemoral joint (PFJ) pressure and alleviate pain from osteoarthritis. However, the relative contributions of articular changes in the sagittal and axial planes remain unknown. This study aimed to better understand the effect of these different osteotomies, that alter the sagittal plane geometry, on PFJ biomechanics.
Seven cadaveric knees were used to measure the following factors: (1) PFJ contact pressure; (2) Knee extension torque (KET); and (3) Patellar kinematics at 60°, 45°, 30°, 15° and 0° of knee flexion among four different osteotomy states: native, anteriorised trochlea, combined anteriorised trochlea and anteriorised tibial tubercle, and anteriorised tibial tubercle. Analysis was made using a two-way repeated-measures analysis of variance.
Anteriorising the trochlea increased mean PFJ contact pressures ×2.9 at 0° (p = 0.024) and ×2.2 (p = 0.029) at 15° flexion compared to the native state. Peak pressures increased ×4.9 at 0° and ×3.3 at 15° (n.s.). Anteriorising the trochlea reduced KET 18% (p = 0.001) at 40° flexion and 19% (p = 0.009) at 50°. The patella was anteriorised 8 mm in the extended knee (p < 0.001) and flexed 8° at 45° knee flexion (p < 0.001) compared to the native state. Elevating the tibial tubercle, alone or combined with an anteriorised trochlea, did not have a significant effect on the respective outcome measurements.
An anteriorised trochlea elevated PFJ contact pressure, reduced KET and altered patellar position during knee flexion/extension movement, while a tibial tubercle anteriorisation had a negligible opposite effect. These findings indicate that symptoms associated with high grade trochlear dysplasia may be addressed better at the trochlea, rather than at the tibial tubercle.
高级别股骨滑车发育不良与膝前疼痛、髌骨轨迹异常、不稳定以及骨关节炎的发展相关。科学研究表明滑车切除术对膝关节伸肌机制的重要性，发育不良可通过加深滑车的滑车成形术来解决。另外，有人提出胫骨结节前移可降低髌股关节（PFJ）压力并减轻骨关节炎引起的疼痛。然而，矢状面和轴面关节变化的相对作用仍不清楚。本研究旨在更好地了解这些改变矢状面几何形状的不同截骨术对PFJ生物力学的影响。
使用七个尸体膝关节测量以下因素：（1）PFJ接触压力；（2）膝关节伸展扭矩（KET）；（3）在四种不同截骨状态下膝关节屈曲60°、45°、30°、15°和0°时的髌骨运动学：原始状态、滑车前移、滑车前移联合胫骨结节前移以及胫骨结节前移。采用双向重复测量方差分析进行分析。
与原始状态相比，滑车前移使0°时平均PFJ接触压力增加2.9倍（p = 0.024），15°屈曲时增加2.2倍（p = 0.029）。峰值压力在0°时增加4.9倍，在15°时增加3.3倍（无统计学意义）。滑车前移使40°屈曲时KET降低18%（p = 0.001），50°屈曲时降低19%（p = 0.009）。与原始状态相比，伸直膝关节时髌骨前移8mm（p < 0.001），膝关节屈曲45°时屈曲8°（p < 0.001）。单独抬高胫骨结节或与滑车前移联合使用，对各自的结果测量均无显著影响。
滑车前移会增加PFJ接触压力，降低KET，并在膝关节屈伸运动过程中改变髌骨位置，而胫骨结节前移的相反作用可忽略不计。这些发现表明，与高级别滑车发育不良相关的症状在滑车处可能比在胫骨结节处能得到更好的解决。
