Teküstün Ferit, Tosyalı Hakan Koray, Yercan Hüseyin Serhat
Orthopedics and Traumatology Department, Muğla Training and Research Hospital, No: 48 Marmaris Road, Kötekli Neighborhood, Menteşe, Muğla, 48000, Turkey.
Department of Orthopedics and Traumatology, Manisa Celal Bayar University Faculty of Medicine, Manisa, 45020, Turkey.
BMC Musculoskelet Disord. 2025 Feb 25;26(1):194. doi: 10.1186/s12891-025-08441-1.
Chronic permenant lateral patellar dislocation is a rare, complex condition that affects an adult's entire lower extremity and may cause functional impairment. This study aimed to identify single-stage surgery for functional recovery in patients and to assess the radiological and functional outcomes of our technique, particularly concerning patellofemoral osteoarthrosis, at mid-term follow-up.
The study retrospectively analyzed eight patients with eleven afflicted knees who had our novel surgical method, termed the all-in-one treatment, from 2011 to 2017. The average follow-up duration was 11.3 years, with a range of 6 to 12 years. An analysis was conducted on the files of patients who satisfied the specified criteria. Data, comprising questionnaires, clinical examinations, radiographs, and functional assessments, were recorded. All patients underwent assessments of the lateral patellofemoral angle, compliance angle, Iwano classification, sulcus angle, and Wiberg-Patellar type. We classified all patients according to the Outerbridge chondromalacia classification, and conducted additional clinical assessment using the Kujala et al. patellofemoral impairment score.
All patients experienced functional improvement, with a mean preoperative Kujala score of 40.89 and a mean postoperative Kujala score of 68.3. No instances of bone nonunion, skin necrosis, or periprostatic fractures were identified in our investigation. No significant degenerative alterations were observed on tomography throughout follow-up, except in one patient who had undergone trochleoplasty. During the postoperative period, no patient experienced any instability.
Our study's primary finding is that the functional gain of knees with chronic dislocations, on which we performed our surgical approach, demonstrated a significant long-term improvement. However, further research is needed to compare single-stage and multi-stage treatments and to assess the long-term outcomes of these treatments and the associated risk of patellafemoral osteoarthritis, re-dislocation, and loss of functional gain.
慢性永久性外侧髌骨脱位是一种罕见的复杂病症，会影响成年人的整个下肢，并可能导致功能障碍。本研究旨在确定用于患者功能恢复的一期手术，并在中期随访时评估我们技术的放射学和功能结果，尤其是关于髌股骨关节炎方面。
本研究回顾性分析了2011年至2017年采用我们称为一体化治疗的新型手术方法治疗的8例患者的11个患膝。平均随访时间为11.3年，范围为6至12年。对符合特定标准的患者病历进行分析。记录包括问卷、临床检查、X光片和功能评估在内的数据。所有患者均接受了外侧髌股角、顺应角、岩野分类、沟角和维伯格-髌骨类型的评估。我们根据Outerbridge软骨软化分类对所有患者进行分类，并使用库亚拉等人的髌股损伤评分进行额外的临床评估。
所有患者功能均有改善，术前库亚拉评分平均为40.89，术后库亚拉评分平均为68.3。在我们的调查中未发现骨不连、皮肤坏死或前列腺周围骨折的情况。除1例接受滑车成形术的患者外，随访期间断层扫描未观察到明显的退行性改变。术后期间，没有患者出现任何不稳定情况。
我们研究的主要发现是，采用我们手术方法治疗的慢性脱位膝关节的功能获得在长期显示出显著改善。然而，需要进一步研究来比较一期和多期治疗，并评估这些治疗的长期结果以及髌股骨关节炎、再脱位和功能获得丧失的相关风险。
