Aglietti P, Buzzi R, D'Andria S, Zaccherotti G
First Orthopaedic Clinic, University of Florence, Firenze, Italy.
Clin Orthop Relat Res. 1993 Mar(288):195-204.
A series of 226 anterior cruciate ligament (ACL) reconstructions were reviewed to determine the incidence of patellofemoral (PF) problems and the associated prognostic factors. Patients were divided into four groups according to the type of injury (acute or chronic) and operation (through an arthrotomy or arthroscopic assisted). The average follow-up period was 39 months. Overall there was a 5% incidence of PF crepitus with pain and/or swelling, and a further 20% of clear PF crepitus without pain. The change from open surgery and cast to arthroscopic surgery and early motion allowed a decrease of PF problems from 40% to 21% in acute injuries, but the difference was less marked in chronic knees. A deficit greater than 10% at the one-leg hop test was present in 75% of the knees with PF crepitus and pain. The height of the patella was increased in 5% and decreased in 17% of the knees. Patients with rehabilitation difficulties had the largest decrease in patella height, whereas a patella alta was more frequent after patellar tendon reconstruction. A significant correlation was found between PF problems and female gender, positive congruence angle, preoperative PF crepitation, rehabilitation difficulties, flexion loss greater than 10 degrees, extension loss greater than 5 degrees, and variation in the height of the patella. The importance of avoiding immobilization, rehabilitation difficulties, and permanent flexion or extension loss is emphasized.
回顾了226例前交叉韧带（ACL）重建手术，以确定髌股关节（PF）问题的发生率及相关预后因素。根据损伤类型（急性或慢性）和手术方式（切开手术或关节镜辅助手术）将患者分为四组。平均随访期为39个月。总体而言，伴有疼痛和/或肿胀的PF摩擦音发生率为5%，另有20%为无疼痛的明显PF摩擦音。从开放手术加石膏固定改为关节镜手术及早期活动，使急性损伤中PF问题的发生率从40%降至21%，但在慢性膝关节中差异不明显。在伴有PF摩擦音和疼痛的膝关节中，75%的患者单腿跳测试时缺损大于10%。5%的膝关节髌骨高度增加，17%的膝关节髌骨高度降低。康复困难的患者髌骨高度下降幅度最大，而髌腱重建术后高位髌骨更为常见。发现PF问题与女性性别、正适合角、术前PF摩擦音、康复困难、屈曲丧失大于10度、伸展丧失大于5度以及髌骨高度变化之间存在显著相关性。强调了避免固定、康复困难以及永久性屈曲或伸展丧失的重要性。
