Magnussen Robert A, Feller Julian A, Sillanpää Petri, Kuroda Ryosuke, Tompkins Marc A, Vial Raimundo, Agel Julie, Arendt Elizabeth A
The Ohio State University, Columbus, OH, USA.
OrthoSport Victoria, Epworth Healthcare, Richmond VIC, Australia.
J ISAKOS. 2025 Jun;12:100862. doi: 10.1016/j.jisako.2025.100862. Epub 2025 Apr 9.
Recurrent patellar instability is often managed with medial patellofemoral ligament (MPFL) reconstruction. Recent work has demonstrated poorer outcomes of MPFL reconstruction in patients with articular cartilage damage. We quantified prevalence and location of articular cartilage injuries in patients treated for patellar instability with MPFL reconstruction and identified factors associated with cartilage damage.
One hundred ninety-nine patients undergoing isolated MPFL reconstruction at 6 centers on 5 continents between 2016 and 2020 were prospectively enrolled. All procedures were performed for recurrent patellar instability. All patients underwent a diagnostic arthroscopy. Patellofemoral articular cartilage damage location and severity were recorded according to the International Cartilage Restoration Society (ICRS) system, with damage of ICRS grade 2 or greater defined as substantial cartilage damage. Patient and injury factors were compared based on the presence or absence of substantial cartilage damage. Multiple logistic regression models were created to identify factors associated with cartilage damage.
One hundred eleven patients (56 %) were noted to have substantial patellofemoral articular cartilage injury (72 grade 2, 27 grade 3, 12 grade 4). Most patients (106) had patellar cartilage damage, with trochlear damage less common (19). Sixty-nine of the 106 patients (65 %) with patellar cartilage damage had medial patellar damage. The cartilage damage group demonstrated significantly increased age at surgery (p = 0.022) and trends toward higher body mass index (BMI) (p = 0.059), and lower Beighton score (0.059). Increased age at surgery (odds ratio = 1.079, p = 0.010) was the only significant predictor of substantial cartilage injury. Increased age at surgery, increased BMI, and increased tibial tubercle-trochlear groove (TT-TG) distance were associated with distal and lateral patellar chondral damage, while presence of knee hyperextension greater than 10° was associated with a decreased risk of medial chondral damage.
Substantial cartilage damage was present in 56 % of patients who underwent isolated MPFL reconstruction for recurrent patellar instability, with medial patellar lesions being the most common. Increased age at surgery was associated with increased risk of substantial patellofemoral cartilage damage. Increased age at surgery, increased BMI, and increased TT-TG distance were associated with distal and lateral patellar chondral damage.
Level 3-case control study.
复发性髌骨不稳通常采用髌股内侧韧带（MPFL）重建术进行治疗。最近的研究表明，在患有关节软骨损伤的患者中，MPFL重建的效果较差。我们对接受MPFL重建治疗髌骨不稳的患者关节软骨损伤的患病率和位置进行了量化，并确定了与软骨损伤相关的因素。
前瞻性纳入了2016年至2020年间在5个大洲6个中心接受单纯MPFL重建的199例患者。所有手术均针对复发性髌骨不稳进行。所有患者均接受了诊断性关节镜检查。根据国际软骨修复协会（ICRS）系统记录髌股关节软骨损伤的位置和严重程度，将ICRS 2级或更高等级的损伤定义为严重软骨损伤。根据是否存在严重软骨损伤比较患者和损伤因素。建立多因素逻辑回归模型以确定与软骨损伤相关的因素。
111例患者（56%）被发现存在严重的髌股关节软骨损伤（72例2级，27例×3级，12例4级）。大多数患者（106例）有髌骨软骨损伤，滑车损伤较少见（19例）。106例有髌骨软骨损伤的患者中，69例（65%）有髌骨内侧损伤。软骨损伤组手术时年龄显著增加（p = 0.022），体重指数（BMI）有升高趋势（p = 0.059），Beighton评分较低（p = 0.059）。手术时年龄增加（比值比 = 1.079，p = 0.010）是严重软骨损伤的唯一显著预测因素。手术时年龄增加、BMI增加和胫骨结节 - 滑车沟（TT - TG）距离增加与髌骨远端和外侧软骨损伤相关，而膝关节过伸大于10°与内侧软骨损伤风险降低相关。
在因复发性髌骨不稳接受单纯MPFL重建的患者中，56%存在严重软骨损伤，其中髌骨内侧损伤最为常见。手术时年龄增加与严重髌股软骨损伤风险增加相关。手术时年龄增加、BMI增加和TT - TG距离增加与髌骨远端和外侧软骨损伤相关。
3级——病例对照研究。
