Almeida Joana, Senra Ana Rita, Correia Maria Clara, Leite Maria João, Oliveira Paulo, Serdoura Francisco, Torres João
Orthopedics and Traumatology Department, Local Health Unit São João, Porto, Portugal.
Faculty of Medicine, Porto, Portugal.
J Orthop. 2025 May 22;66:239-244. doi: 10.1016/j.jor.2025.05.024. eCollection 2025 Aug.
Patellofemoral instability (PFI) is a multifactorial entity that combines osseous and soft tissue abnormalities. Tibial tubercle osteotomy (TTO) addresses biomechanical malalignment but faces 50 % recurrence rates with TT-TG >20 mm. Long-term outcomes show 62.5 % success at 10-15 years post-TTO, though 16-21 % require reoperations. Current evidence lacks long-term data, underscoring the need for individualized surgical planning. This study evaluates 10-year outcomes via MRI and clinical outcomes to identify predictors of suboptimal results.
A retrospective observational study was designed. Demographic and clinical data, including age, gender, number of dislocations, and revision surgery, were collected. Radiologic measures were patellar height, tilt, displacement, maltracking, and trochlear dysplasia. They were assessed with computed tomography (CT) preoperatively and magnetic resonance imaging (MRI) postoperatively, with further identification of chondral lesions. Functional evaluation was based on the Kujala and Lysholm scores.
Data from 36 knees were included. Recurrent dislocation occurred in 14 % (5 cases), primarily in younger females (median age 16) with residual malalignment. Symptomatic hardware removal (50 %) was the most common complication. Significant improvements were observed in the TT-TG distance (23 IQR 15.05-25.3 V S 15 IQR 10-18 mm, p = 0.002), patellar tilt and displacement with 0° of extension (patellar tilt: 28.5 IQR 17.75-34.25 V S 16.5 IQR 10-24.25°, p < 0.005; patellar displacement: 6.3 IQR 3.07-14.6 V S 2.5 IQR 0-8.25 mm, p = 0.01) and with active contraction only patellar tilt (34 IQR 24-42.5 V S 29 IQR 15-36° p = 0.014). Despite 54.8 % present with advanced chondropathy (Outerbridge III/IV), no correlation was found with age, alignment, or functional scores. The median Kujala score was 89.5 IQR 82.5-97.5, and the median Lysholm was 91 IQR 81.75-95.75.
TTO provides reliable long-term outcomes for patellofemoral instability. The risk of joint degeneration is non-negligible, especially in the setting of malalignment or older age on admission.
III.
髌股关节不稳（PFI）是一种多因素疾病，涉及骨与软组织异常。胫骨结节截骨术（TTO）可解决生物力学排列不齐问题，但当胫骨结节-股骨滑车沟（TT-TG）距离>20 mm时，复发率达50%。长期随访结果显示，TTO术后10 - 15年成功率为62.5%，不过16% - 21%的患者需要再次手术。目前证据缺乏长期数据，强调了个体化手术规划的必要性。本研究通过磁共振成像（MRI）评估10年随访结果及临床结局，以确定预后不佳的预测因素。
设计一项回顾性观察性研究。收集人口统计学和临床数据，包括年龄、性别、脱位次数及翻修手术情况。影像学测量指标包括髌骨高度、倾斜度（tilt）、位移、轨迹不良及滑车发育不良。术前采用计算机断层扫描（CT）评估，术后采用磁共振成像（MRI）评估，并进一步识别软骨损伤。功能评估基于Kujala和Lysholm评分。
纳入36例膝关节数据。14%（5例）出现复发性脱位，主要发生在年轻女性（中位年龄16岁）且存在残余排列不齐者。有症状的内植物取出术（50%）是最常见的并发症。TT-TG距离有显著改善（23四分位间距15.05 - 25.3对15四分位间距10 - 18 mm，p = 0.002），伸直0°时髌骨倾斜度和位移也有显著改善（髌骨倾斜度：28.5四分位间距17.75 - 34.25对16.5四分位间距10 - 24.25°，p < 0.005；髌骨位移：6.3四分位间距3.07 - 14.6对2.5四分位间距0 - 8.25 mm，p = 0.01），仅主动收缩时髌骨倾斜度也有改善（34四分位间距24 - 42.5对29四分位间距15 - 36°，p = 0.！4）。尽管54.8%的患者存在晚期软骨病（Outerbridge III/IV级），但未发现与年龄、排列或功能评分相关。Kujala评分中位数为89.5四分位间距82.5 - 97.5，Lysholm评分中位数为91四分位间距81.75 - 95.75。
TTO为髌股关节不稳提供了可靠的长期疗效。关节退变风险不可忽视，尤其是在存在排列不齐或入院时年龄较大的情况下。
III级
