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1.
Patellofemoral osteoarthritis after Insall’s proximal realignment for recurrent patellar dislocation
Karl F. Schüttler Johannes Struewer Philip P. Roessler Markus Gesslein Marga B. Rominger Ewgeni Ziring Turgay Efe 《Knee surgery, sports traumatology, arthroscopy》2014,22(11):2623-2628
Purpose
The aim of the present study was to retrospectively investigate the development of patellofemoral osteoarthritis after the historical Insall’s proximal realignment for patellar stabilisation in patients with recurrent patellar dislocation. Furthermore, risk factors for recurrent patellar dislocation and for patellofemoral osteoarthritis development were evaluated.Methods
Forty-two patients underwent patellofemoral stabilising surgery by the historic Insall’s proximal realignment; they were evaluated with a mean follow-up period of 52 months. Plain radiography was used to document osteoarthritic changes by using the Iwano classification. MRIs obtained at the latest follow-up were evaluated for patellofemoral cartilage lesions. Univariate and multivariate logistic regression analyses were performed to evaluate the influence of trochlear dysplasia, tibial tubercle–trochlear groove distance and patellar height on redislocation. Pearson’s χ 2 and the Spearman’s correlation tests were used to assess a possible correlation between trochlear dysplasia and patellar dislocation, as well as between instability and development of patellofemoral osteoarthritis.Results
At the latest follow-up, plain radiographs showed a significant increase in patellofemoral osteoarthritis (grades II–IV according to the Iwano classification) in 18 patients (43 %) compared with 4 patients (10 %) at the time of surgery (P = 0.001). Patellofemoral cartilage lesions (grades II–IV) were detected in 18 patients (43 %) on MRI. Nine patients (21 %) had at least one incidence of redislocation at follow-up. Estimated redislocation-associated risk factors could not be determined. Trochlear dysplasia had a significant impact on patellofemoral osteoarthritis development (P = 0.001), whereas recurrent patellar instability had none (n.s.).Conclusion
Insall’s proximal realignment technique leads to a significant progression of patellofemoral osteoarthritis. No risk factors for redislocation could be found; however, the presence of trochlear dysplasia did correlate with patellofemoral osteoarthritis.Level of evidence
IV. 相似文献2.
Matthias J. Feucht Matthias Cotic Knut Beitzel Julia F. Baldini Gebhart Meidinger Philip B. Schöttle Andreas B. Imhoff 《Knee surgery, sports traumatology, arthroscopy》2017,25(9):2784-2791
Purpose
To compare clinical and radiographic results after isolated patellofemoral arthroplasty (PFA) using either a second-generation inlay or onlay trochlear design. The hypothesis was that an inlay design will produce better clinical results and less progression of tibiofemoral osteoarthritis (OA) compared to an onlay design.Methods
Fifteen consecutive patients undergoing isolated PFA with an onlay design trochlear component (Journey? PFJ, Smith & Nephew) were matched with 15 patients after isolated PFA with an inlay design trochlear component (HemiCAP® Wave, Arthrosurface). Matching criteria were age, gender, body mass index, and follow-up period. An independent observer evaluated patients prospectively, whereas data were compared retrospectively. Clinical outcome was assessed using WOMAC, Lysholm score, and pain VAS. Kellgren–Lawrence grading was used to assess progression of tibiofemoral OA.Results
Conversion to total knee arthroplasty was necessary in one patient within each group, leaving 14 patients per group for final evaluation. The mean follow-up was 26 months in the inlay group and 25 months in the onlay group (n.s.). Both groups displayed significant improvements of all clinical scores (p < 0.05). No significant differences were found between the two groups with regard to the clinical outcome and reoperation rate. No significant progression of tibiofemoral OA was observed in the inlay group, whereas 53 % of the onlay group showed progression of medial and/or lateral tibiofemoral OA (p = 0.009).Conclusion
Isolated PFA using either a second-generation inlay or onlay trochlear component significantly improves functional outcome scores and pain. The theoretical advantages of an inlay design did not result in better clinical outcome scores; however, progression of tibiofemoral OA was significantly less common in patients with an inlay trochlear component. This implant design may therefore improve long-term results and survival rates after isolated PFA.Level of evidence
III.3.
Pia M. Jungmann Seng-Choe Tham Hans Liebl Michael C. Nevitt Charles E. McCulloch John Lynch Thomas M. Link 《Skeletal radiology》2013,42(10):1383-1392
Objective
To evaluate trochlear morphology as a potential risk factor for patellofemoral osteoarthritis, determined by morphological and quantitative measurements of cartilage degeneration using 3-T magnetic resonance imaging (MRI) of the knee.Materials and methods
MRI of the right knees of 304 randomly selected subjects, aged 45–60 years, from the Osteoarthritis Initiative (OAI) progression cohort were screened for trochlear dysplasia, defined by an abnormal trochlear depth. Out of 304 subjects, n?=?85 demonstrated a shallow trochlea (depth ≤3 mm; 28 %). In these, and also in a random sample of controls with normal trochlear depth (n?=?50), the facet ratio and the sulcus angle were calculated and knee structural abnormalities were assessed by using a modified Whole Organ MR Imaging Score (WORMS). Cartilage segmentation was performed and T2 relaxation times and patellar cartilage volume were determined. ANOVA and multivariate regression models were used for statistical analysis of the association of MRI structural measures and trochlear morphology.Results
Knees with a shallow trochlea showed higher patellofemoral degeneration (WORMS mean ± standard deviation, 11.2?±?0.5 versus 5.7?±?0.6; multivariate regression, P?<?0.001) and lower patellar cartilage volume than controls (900?±?664 mm3 versus 1,671?±?671 mm3; P?<?0.001). Knees with an abnormal medial-to-lateral facet ratio (<0.4) showed increased patellofemoral WORMS scores (12.3?±?0.9 versus 8.3?±?0.5; P?<?0.001). Knees with an abnormal sulcus angle (>170°) also showed increased WORMS scores (12.2?±?1.1 versus 8.6?±?0.6; P?=?0.003). T2 values at the patella were significantly lower in the dysplasia group with a shallow trochlea. However, significance was lost after adjustment for cartilage volume (P?=?0.673).Conclusion
Trochlear dysplasia, defined by a shallow trochlea, was associated with higher WORMS scores and lower cartilage volume, indicating more advanced osteoarthritis at the patellofemoral joint. 相似文献4.
Ingo J. Banke Ludwig M. Kohn Gebhart Meidinger Alexander Otto Daniel Hensler Knut Beitzel Andreas B. Imhoff Philip B. Schöttle 《Knee surgery, sports traumatology, arthroscopy》2014,22(11):2591-2598
Purpose
Excessive trochlear dysplasia may be responsible for recurrent patellofemoral instability (PFI) due to a missing bony guidance for the patella in early flexion. Thus, an isolated medial patellofemoral ligament reconstruction (MPFLR) can be insufficient, since it mainly addresses instability close to extension and additionally can increase patellofemoral pressure leading to pain in flat or convex trochlear dysplasia. Therefore, in combination with a trochleoplasty, an anatomical trochlear groove is created, resulting in patellofemoral stability also in flexion, while patellofemoral pressure is normalized. In this prospective study, we evaluated the outcome of open trochleoplasty in combination with MPFLR with a minimum follow-up of 2 years for treatment of excessive PFI.Methods
In between 2007 and 2009, 18 knees of 17 consecutive patients (mean age of 22.2 ± 4.9 years) with trochlear dysplasia type B, C or D according to Dejour et al. and positive apprehension from 0 to 60° of flexion were included. Tegner, Kujala and IKDC scores, apprehension and pain, trochlear dysplasia, sulcus angle, tibial tuberosity trochlear groove, patellar tilt and shift, Caton–Deschamps index as well as patellofemoral arthrosis according to the classification of Iwano et al. were assessed pre- and postoperatively.Results
At a mean of 30.5 ± 5.9 months, all but one patient were subjectively satisfied with the outcome of the procedure, all showing absence of positive apprehension or redislocation. Significant (p < 0.001) reduction in pain (5.6 to 2.5 ± 2.8 points, VAS) and increase in Tegner (2, range 0–4 points to 6, range 3–8 points), Kujala (51.1 to 87.9 ± 20.0 points) and IKDC (49.5 to 80.2 ± 21.0 %) scores could be achieved. Radiologically significant (p < 0.02) improvement of patellofemoral positional parameters leading to more normal anatomy was recorded, while short-term arthrosis was absent.Conclusions
Combined treatment for trochleoplasty with MPFLR serves as a successful therapy for chronic PFI. This combinatory treatment concept is a reliable option not only as salvage therapy but also as primary procedure regarding treatment for excessive PFI.Level of evidence
Prospective case series, Level IV. 相似文献5.
Britt Elin Øiestad Inger Holm Lars Engebretsen Arne Kristian Aune Ragnhild Gunderson May Arna Risberg 《Knee surgery, sports traumatology, arthroscopy》2013,21(4):942-949
Purpose
To investigate the prevalence of patellofemoral osteoarthritis (OA) and to explore the association between radiographic patellofemoral OA and symptoms and function 12 years after anterior cruciate ligament (ACL) reconstruction.Methods
The study participants (n = 221) were consecutively included at the time of an ACL reconstruction in the period from 1990 to 1997. Knee laxity (KT-1000), isokinetic quadriceps strength, triple jump, stair hop, and the Cincinnati knee score were measured 6 months, 1 year, 2 years, and 12 years after surgery. At the 12-year follow-up, visual analogue scale for pain, the Knee injury and Osteoarthritis Outcome Score, the Tegner activity scale, and radiographic examination (Kellgren and Lawrence score) were added. To analyse the association between patellofemoral OA, symptoms, and function, binary regression analyses presenting odds ratios and 95 % confidence intervals were used. The analyses were adjusted for age, gender, and body mass index.Results
One hundred and eighty-one of the 221 subjects (82 %), including 76 females (42 %) and 105 males (58 %), were evaluated at the 12.3 ± 1.2-year follow-up. Mean age at the follow-up was 39.1 ± 8.7 years. Additional meniscal or chondral injuries at the time of reconstruction or during the follow-up period were detected in 116 subjects (64 %). Radiographic patellofemoral OA was found in 48 subjects (26 %), including 3 subjects with isolated patellofemoral OA (1.5 %). Those with patellofemoral OA were older, had more tibiofemoral OA, and had significantly more symptoms and impaired function compared with those without patellofemoral OA.Conclusions
Patellofemoral OA was found in 26 % 12 years after ACL reconstruction. Patellofemoral OA was associated with increased age, tibiofemoral OA, increased symptoms, and reduced function. It is of clinical importance to include functional and radiographic assessment of the patellofemoral joint in the examination of long-term consequences following an ACL reconstruction.Level of evidence
II. 相似文献6.
Alasdair R. Dempsey Yuanyuan Wang Jonas B. Thorlund Peter M. Mills Tim V. Wrigley Kim L. Bennell Ben R. Metcalf Fahad Hanna Flavia M. Cicuttini David G. Lloyd 《Knee surgery, sports traumatology, arthroscopy》2013,21(5):1097-1103
Purpose
To examine the relationship between tibiofemoral and patellofemoral joint articular cartilage and subchondral bone in the medial and gait biomechanics following partial medial meniscectomy.Methods
For this cross-sectional study, 122 patients aged 30–55 years, without evidence of knee osteoarthritis at arthroscopic partial medial meniscectomy, underwent gait analysis and MRI on the operated knee once for each sub-cohort of 3 months, 2 years, or 4 years post-surgery. Cartilage volume, cartilage defects, and bone size were assessed from the MRI using validated methods. The 1st peak in the knee adduction moment, knee adduction moment impulse, 1st peak in the knee flexion moment, knee extension range of motion, and the heel strike transient from the vertical ground reaction force trace were identified from the gait data.Results
Increased knee stance phase range of motion was associated with decreased patella cartilage volume (B = ?17.9 (95 % CI ?35.4, ?0.4) p = 0.045) while knee adduction moment impulse was associated with increased medial tibial plateau area (B = 7.7 (95 % CI 0.9, 13.3) p = 0.025). A number of other variables approached significance.Conclusions
Knee joint biomechanics exhibited by persons who had undergone arthroscopic partial meniscectomy gait may go some way to explaining the morphological degeneration observed at the patellofemoral and tibiofemoral compartments of the knee as patients progress from surgery.Level of evidence
III. 相似文献7.
Mo Saffarini Panagiotis G. Ntagiopoulos Guillaume Demey Benoit Le Negaret David H. Dejour 《Knee surgery, sports traumatology, arthroscopy》2014,22(10):2574-2581
Purpose
The design of the trochlear compartment is crucial in patellofemoral arthroplasty (PFA), because 78 % of patients with isolated patellofemoral arthritis present concomitant trochlear dysplasia with patellar maltracking and therefore remain predisposed to post-operative patellar subluxation and dislocation. The study investigated whether current PFA implants are designed with anatomic trochlear parameters such as the sulcus angle, lateral facet height and groove orientation.Methods
Five trochlear components of commercially available PFA implants were scanned, and the generated three-dimensional surfaces were measured using engineering design software. The mediolateral trochlear profiles were plotted at various flexion angles (0°, 15°, 30° and 45°) to deduce the following variables: sulcus angle, height of lateral facet and trochlear groove orientation.Results
Four specimens had sulcus angle >144° in the 45° of flexion, and all five specimens had sulcus angle >143° in 30° of flexion. Three specimens had a facet <5 mm high through the entire range of early flexion (0°–30°), and two specimens had a facet <5 mm high beyond early flexion (30°–45°). The trochlear groove was oriented laterally in all specimens (range 1.6°–13.5°).Conclusion
Current PFA trochlear components are not always designed with anatomic parameters, and some models exhibit characteristics of trochlear dysplasia. Surgeons are therefore advised to implant components with a deep sulcus, particularly in patients with history of patellofemoral disorders, and to adapt the surgical technique and extensor mechanism if the component implanted has a shallow sulcus, to ensure normal patellar tracking.Level of evidence
III. 相似文献8.
Hilde Vandenneucker Luc Labey Jan Victor Jos Vander Sloten Kaat Desloovere Johan Bellemans 《Knee surgery, sports traumatology, arthroscopy》2014,22(10):2560-2568
Purpose
Although controversy still remains, isolated patellofemoral arthroplasty recently gained in popularity as a treatment option for patellofemoral osteoarthritis. It has compared to total knee arthroplasty the advantage of preserving the tibiofemoral articulation, which in theory would allow the preservation of natural tibiofemoral kinematics. Today, however, no data exist to support this assumption. This study was therefore performed in order to investigate the effect of isolated patellofemoral arthroplasty on the native three-dimensional tibiofemoral kinematic behaviour and whether a change in patellar thickness would have an influence.Methods
Six fresh-frozen cadavers were fixed on a custom-made mechanical knee rig. Full 3D kinematics was analysed during passive flexion–extension cycles, open chain extension, with and without mechanical resistance, as well as deep knee squats, using infrared motion capture cameras and retroflective markers. Measurements were taken for the native knee and after prosthetic trochlear resurfacing with and without patellar resurfacing in three different patellar thicknesses.Results
Compared to the natural knee, patellofemoral arthroplasty resulted in significant changes in tibiofemoral kinematics, which were most pronounced in the most loaded motor tasks. Increased internal tibial rotation was noted in the mid- and high flexion ranges, reaching at 120° of flexion a mean difference of 4.5° ± 4.3° (p < 0.0001) during squat motion, over the whole flexion range during open chain motion and in deeper flexion beyond 50° (mean at 70°, 1.9° ± 3.7°) during resisted open chain. During squats, also, a more posterior translation of the lateral femoral condyle was observed. The effect was accentuated in case of patella overstuffing, whereas kinematics was closer to normal with patellar thinning.Conclusion
Isolated patellofemoral arthroplasty alters natural tibiofemoral kinematics, and the effects become more pronounced in case of increased patellar thickness. Therefore, it might be recommended to aim for a slight over-resection of patellar bone if sufficient bone stock is available. 相似文献9.
Samantha J. Wright Tim A. E. J. Boymans Bernd Grimm Anthony W. Miles Oliver Kessler 《Knee surgery, sports traumatology, arthroscopy》2014,22(12):2900-2910
Purpose
Previous investigations suggested that the geometry of the proximal femur may be related to osteoarthritis of the tibiofemoral joint and various patellofemoral joint conditions. This study aims to investigate the correlation between proximal and distal femoral geometry. Such a correlation could aid our understanding of patient complications after total knee arthroplasty (TKA) and be of benefit for further development of kinematic approaches in TKA.Methods
CT scans of 60 subjects (30 males, 30 females) were used to identify anatomical landmarks to calculate anatomical parameters of the femur, including the femoral neck anteversion angle, neck–shaft angle (NSA), mediolateral offset (ML-offset), condylar twist angle (CTA), trochlear sulcus angle (TSA) and medial/lateral trochlear inclination angles (MTIA/LTIA). Correlation analyses were carried out to assess the relationship between these parameters, and the effect of gender was investigated.Results
The CTA, TSA and LTIA showed no correlation with any proximal parameter. The MTIA was correlated with all three proximal parameters, mostly with the NSA and ML-offset. Per 5° increase in NSA, the MTIA was 2.1° lower (p < 0.01), and for every 5 mm increase in ML-offset, there was a 2.6° increase in MTIA (p < 0.01). These results were strongest and statistically significant in females and not in males and were independent of length and weight.Conclusions
Proximal femoral geometry is distinctively linked with trochlear morphology. In order to improve knowledge on the physiological kinematics of the knee joint and to improve the concept of kinematic knee replacement, the proximal femur seems to be a factor of clinical importance.Level of evidence
III. 相似文献10.
Ferran Montserrat Eduard Alentorn-Geli Vicente León Alberto Ginés-Cespedosa Pau Rigol 《Knee surgery, sports traumatology, arthroscopy》2014,22(1):88-96
Purpose
The purpose of this study was to report the survival analysis of partial lateral facetectomy and Insall’s procedure in patients with isolated patellofemoral osteoarthritis, and to assess the risk and protective factors for failure of this procedure.Methods
From 1992 to 2004, all subjects with isolated patellofemoral osteoarthritis who met the inclusion criteria and underwent this procedure were enrolled. Risk and protective factors for failure (failure considered as the need for total knee arthroplasty) were assessed by comparing obtained baseline data between failed and non-failed cases. Eighty-seven cases (mean (SD) age 61.8 (7.7) years, mean (SD) follow-up 9.6 (3.2) years) were included.Results
Twenty-three failed cases were found. Mean (SD) survival time was 13.6 (0.5) years. At 13 years (last failure case), the cumulative survival was 59.3 %. Baseline medial tibiofemoral pain, genu flexum, and worst grade of tibiofemoral osteoarthritis were significant risk factors for failure (p < 0.0001, p = 0.02, p < 0.0001, respectively). In contrast, higher anatomical (p = 0.02) and total (p = 0.03) knee society score (KSS) scores, absence of knee effusion (p = 0.03), higher value of the Caton–Deschamps index (p = 0.03), and lateral position of the patella (p = 0.01) were all protective factors against failure.Conclusion
The treatment for isolated patellofemoral osteoarthritis through partial lateral facetectomy and Insall’s procedure demonstrated good long-term survival. The presence of preoperative medial tibiofemoral pain, genu flexum, and incipient tibiofemoral osteoarthritis increased the risk of failure of this procedure. In contrast, higher anatomical and total KSS scores, absence of knee effusion, higher value of the Caton–Deschamps index, and lateral position of the patella were found to protect against failure.Level of evidence
Prospective case series, Level IV. 相似文献11.
Per Swärd T. Fridén T. Boegård I. Kostogiannis P. Neuman H. Roos 《Knee surgery, sports traumatology, arthroscopy》2013,21(9):2040-2047
Purpose
To investigate the association between varus alignment and post-traumatic osteoarthritis (OA) after an anterior cruciate ligament (ACL) injury.Methods
One hundred subjects with an acute complete ACL tear were followed for 15 years. Anterior–posterior radiographs of the tibiofemoral joint were obtained with a knee flexion of 20°, and the patellofemoral joint was examined with skyline view at 50° knee flexion. Joint space narrowing and osteophytes were graded in the tibiofemoral and patellofemoral joints in the injured (ACL) and uninjured knee according to the radiographic atlas of the Osteoarthritis Research Society International. The alignment of the uninjured, contralateral knee was measured at follow-up, using full-limb radiographs of leg with the knee in full extension. Alignment was expressed as the hip-knee-ankle (HKA) angle. Alignment was defined as valgus (HKA ≤178°), neutral (179°–181°) or varus (≥182°).Results
Data from 68 subjects were included in the analysis. Varus alignment of the uninjured knee at follow-up appeared to be associated with OA of the injured knee 15 years after an ACL injury (odds ratio (95 % confidence interval) 3.9 (1.0–15.8, p = 0.052)).Conclusions
Varus alignment of the uninjured knee at follow-up may be associated with OA of the injured knee 15 years after an ACL injury.Level of evidence
II. 相似文献12.
Purpose
Trochlear dysplasia is an important aetiological factor for the development of patellofemoral instability (PFI). The aim of the study was to identify the arthroscopic morphology of trochlear dysplasia that can be helpful when planning operative treatment for PFI.Methods
Magnetic resonance imaging (MRI) scans and strict lateral radiographs of 46 patients treated for PFI were assigned according to Dejour and matched with arthroscopic views from the lateral superior arthroscopic portal. On arthroscopy, signs of trochlear dysplasia were identified and classified into two types. Intra- and inter-observer agreements of the arthroscopic evaluation were assessed.Results
Arthroscopically, 2 major types of trochlear dysplasia could be distinguished. Type I shows a flat trochlear groove with an elevated trochlear floor in relation to the anterior femoral cortex. In type II, the proximal trochlea was convex with a lateral trochlear bump. Arthroscopic evaluation was not consistent with the Dejour’s radiographic and axial MRI classification. Arthroscopic grading showed excellent intra- and inter-observer agreements (81–92 %).Conclusion
Arthroscopic evaluation can give additional information about the severity of trochlear dysplasia. This additional information can be used as an aid in decision making for the treatment of PFI.Level of evidence
II. 相似文献13.
Peter Balcarek Annika Terwey Klaus Jung Tim Alexander Walde Stephan Frosch Jan Philipp Schüttrumpf Martin Michael Wachowski Henning Dathe Klaus Michael Stürmer 《Knee surgery, sports traumatology, arthroscopy》2013,21(9):2155-2163
Purpose
The geometry of the tibial plateau and its influence on the biomechanics of the tibiofemoral joint has gained increased significance. However, no quantitative data are available regarding the inclination of the medial and lateral tibial slope in patients with patellar instability. It was therefore the purpose of this study to evaluate tibial slope characteristics in patients with patellar dislocations and to assess the biomechanical effect of medial-to-lateral tibial slope asymmetry on lateral patellar instability.Methods
Medial and lateral tibial slope was measured on knee magnetic resonance images in 107 patients and in 83 controls. The medial-to-lateral tibial slope asymmetry was assessed as the intra-individual difference between the medial and lateral tibial plateau inclination considering severity of trochlear dysplasia. The effect of tibial slope asymmetry on femoral rotation was calculated by means of radian measure.Results
Severity of trochlear dysplasia was significantly associated with an asymmetric inclination of the tibial plateau. Whereas the medial tibial slope showed identical values between controls and study patients (n.s.), lateral tibial plateau inclination becomes flatter with increasing severity of trochlear dysplasia (p < 0.01). Consequently, the intra-individual tibial slope asymmetry increased steadily (p < 0.01) and increased internal femoral rotation in 20° and 90° of knee flexion angles in patients with severe trochlear dysplasia (p < 0.01). In addition, the extreme values of internal femoral rotation were more pronounced in patients with patellar instability, whereas the extreme values of external femoral rotation were more pronounced in control subjects (p = 0.024).Conclusion
Data of this study indicate an association between tibial plateau configuration and internal femoral rotation in patients with lateral patellar instability and underlying trochlear dysplasia. Thereby, medial-to-lateral tibial slope asymmetry increased internal femoral rotation during knee flexion and therefore might aggravate the effect of femoral antetorsion in patients with patellar instability.Level of evidence
III. 相似文献14.
15.
Ferran Montserrat Eduard Alentorn-Geli Vicens León Alberto Ginés-Cespedosa Pau Rigol 《Knee surgery, sports traumatology, arthroscopy》2013,21(11):2572-2577
Purpose
To assess the long-term results of lateral facetectomy plus Insall’s realignment procedure to treat isolated patellofemoral osteoarthritis.Methods
All consecutive patients undergoing this procedure with a follow-up between 10 and 14 years were included in this study. Subjects were excluded if they had previous patellar dislocation, patellar fracture, tibiofemoral osteoarthritis (except mild cases) or follow-up <10 or >14 years. Failure cases (need for total knee arthroplasty) of this surgical procedure before 10 years of follow-up were considered in the overall failure rate. Clinical, functional and radiographic outcomes were obtained at baseline and compared to postoperative values.Results
Forty-three patients (mean (SD) age 59.7 (8.1) years) had a follow-up between 10 and 14 years and were finally included in this study. The failure rate in the whole series and included patients was 26.4 and 16.3 %, respectively, for a mean (SD) follow-up of 9.2 (3.2) years and 11.7 (1.4) years, respectively. Patellofemoral pain (p < 0.0001), need for NSAIDs (p < 0.0001), longitudinal (p < 0.0001) and transversal (p < 0.0001) patellar glide tests, Zholen’s sign (p = 0.0007) and knee effusion (p = 0.02) significantly improved in the follow-up. Postoperative Knee Society Score (KSS) anatomical (p < 0.0001), functional (p < 0.0001) and total (p < 0.0001) scores and Kujala’s score (p = 0.001) were significantly higher compared to preoperative values. The patellar tilt (p = 0.001) and shift (p = 0.04) significantly improved postoperatively, whereas the patellofemoral osteoarthritis was not modified (n.s.) with respect to preoperative assessment.Conclusions
The lateral facetectomy plus Insall’s realignment procedure was a successful treatment for isolated patellofemoral osteoarthritis from a clinical, functional and radiographic point of view in the long-term follow-up.Level of evidence
Prospective case series, Level IV. 相似文献16.
Daniel Dornacher Heiko Reichel Sabine Lippacher 《Knee surgery, sports traumatology, arthroscopy》2014,22(10):2382-2387
Purpose
Excessive tibial tuberosity–trochlear groove distance (TT–TG) is considered as one of the major risk factors in patellofemoral instability (PFI). TT–TG characterises the lateralisation of the tibial tuberosity and the medialisation of the trochlear groove in the case of trochlear dysplasia. The aim of this study was to assess the inter- and intraobserver reliability of the measurement of TT–TG dependent on the grade of trochlear dysplasia.Methods
Magnetic resonance imaging (MRI) scans of 99 consecutive knee joints were analysed retrospectively. Hereof, 61 knee joints presented with a history of PFI and 38 had no symptoms of PFI. After synopsis of the axial MRI scans with true lateral radiographs of the knee, the 61 knees presenting with PFI were assessed in terms of trochlear dysplasia. The knees were distributed according to the four-type classification system described by Dejour.Results
Regarding interobserver correlation for the measurements of TT–TG in trochlear dysplasia, we found r = 0.89 (type A), r = 0.90 (type B), r = 0.74 (type C) and 0.62 (type D) for Pearson’s correlation coefficient. Regarding intraobserver correlation, we calculated r = 0.89 (type A), r = 0.91 (type B), r = 0.77 (type C) and r = 0.71 (type D), respectively. Pearson’s correlation coefficient for the measurement of TT–TG in normal knees resulted in r = 0.87 for interobserver correlation and r = 0.90 for intraobserver correlation.Conclusion
Decreasing inter- and intraobserver correlation for the measurement of TT–TG with increasing severity of trochlear dysplasia was detected. In our opinion, the measurement of TT–TG is of significance in low-grade trochlear dysplasia. The final decision to perform a distal realignment procedure based on a pathological TT–TG in the presence of high-grade trochlear dysplasia should be reassessed properly.Level of evidence
Retrospective study, Level II. 相似文献17.
Daniel Wagner Florian Pfalzer Swen Hingelbaum Jochen Huth Frieder Mauch Gerhard Bauer 《Knee surgery, sports traumatology, arthroscopy》2013,21(2):318-324
Purpose
Patellofemoral instability is influenced by ligamentous, boney and neuromuscular factors. The most important variables are trochlea geometry, medial patellofemoral ligament (MPFL), patella height, tibial tuberosity–trochlea groove distance (TT–TG) and the extensor muscles. Treatment is complicated by these multifactorial conditions. This prospective study examined the influence of risk factors on clinical results and athletic activities where treatment was confined to ligamentous procedures only.Methods
Fifty patients with chronic patellofemoral instability were treated with MPFL reconstruction using an autologous gracilis tendon. Clinical data, radiographs and magnetic resonance imaging (MRI) were prospectively evaluated pre- and postoperative (minimum follow-up 12 month) to detect existing risk factors for patellofemoral instability and to evaluate clinical and sport ability scores (Kujala, Valderrabano).Results
There was a low rate of redislocation (2 %) and an average Kujala score of 87 ± 13 points postoperative. The MRI showed good integration of the reconstructed MPFL and a positive effect regarding the decrease of patella tilt (16.1° to 11.2°). A negative relationship was found between the degree of trochlear dysplasia and outcomes. 80 % of all patients returned to the same or higher level of physical activity.Conclusions
Addressing only ligamentous factors through MPFL reconstruction leads to satisfying clinical results and low redislocation rates in most patients. In cases with a high degree of trochlear dysplasia and enlarged TT–TG, additional procedures such as trochleaplasty and tibial tuberosity transfer should be considered as well.Level of evidence
IV. 相似文献18.
Sylvia V. Herrlin Peter O. Wange Gunilla Lapidus Maria Hållander Suzanne Werner Lars Weidenhielm 《Knee surgery, sports traumatology, arthroscopy》2013,21(2):358-364
Purpose
The aim of this prospective randomized intervention study was to evaluate the outcome at a 2 and 5 year follow-up whether combined arthroscopic surgery followed by exercise therapy was superior to the same exercise therapy alone when treating non-traumatic, degenerative medial meniscal tears.Methods
Ninety-six middle-aged patients with MRI-verified degenerative medial meniscus tear and radiographic osteoarthritis grade ≤1 (Ahlbäck) participated in the study. Radiographic examination was done before randomization and after 5 years. The patients were randomly assigned to either arthroscopic treatment followed by exercise therapy for 2 months or to the same exercise therapy alone. At the start of the study and at the follow-ups at 24 and 60 months the patients answered three questionnaires KOOS, Lysholm Knee Scoring Scale and Tegner Activity Scale and made pain ratings on the Visual Analogue Scale (VAS).Results
Both groups showed highly significant clinical improvements from baseline to the follow-ups at 24 and 60 months on all subscales of KOOS, Lysholm Knee Scoring Scale and VAS (p < 0.0001). No group differences were found at any of the testing occasions. One third of the patients that were treated with exercise therapy alone did not feel better after the treatment but were improved after arthroscopic surgery. According to radiographic findings two patients from each group had a slight progression of their osteoarthritis after 5 years.Conclusion
The findings indicate that arthroscopic surgery followed by exercise therapy was not superior to the same exercise therapy alone for this type of patients. Consequently, exercise therapy can be recommended as initial treatment. However, one third of the patients from the exercise group still had disabling knee symptoms after exercise therapy but improved to the same level as the rest of the patients after arthroscopic surgery with partial meniscectomy.Level of evidence
I. 相似文献19.
Purpose
Prospectively, a consecutive group of patients troubled by recurrent patella dislocation and trochlear dysplasia has been followed after a combined arthroscopic deepening trochleoplasty and reconstruction of the medial patellofemoral ligament. The purpose of this follow-up study is to report the clinical results.Methods
Indications for combined arthroscopic deepening trochleoplasty and reconstruction of the medial patellofemoral ligament were two or more patellar dislocations with a persistent apprehension sign above 20° of flexion and trochlear dysplasia grade B or more. Prospectively, the Tegner, Kujala and KOOS scores were recorded. Thirty-one consecutive patients (37 knees), 21 women and 10 men, with a median age of 19 (12–39) underwent the procedure.Results
Results were obtained for 29 knees with a minimum of 12-month follow-up (average 29 months; range 12–57). No complications, redislocations or arthrofibrosis have been recorded. Five patients needed further surgery. The median pre- and postoperative scores (range) are as follows: Kujala 64 (12–90) to 95 (47–100); Tegner 4 (1–6) to 6 (4–9); KOOS score pain 86–94; symptoms 82–86; ADL 91–99; sport 40–86; QDL 25–81. No significant correlation was found with respect to the results and recorded parameters. Significant improvement for all of the scores was observed (p < 0.001).Conclusions
The use of arthroscopic deepening trochleoplasty in combination with reconstruction of the medial patellofemoral ligament was found to be a safe and reproducible procedure. Considering the stability achieved, the knee scores and the patient’s level of satisfaction, the results are encouraging.Level of evidence
Prospective consecutive case series, with evaluation of confounding factor. No control group, Level IV. 相似文献20.
Sina Babazadeh Michelle M. Dowsey James D. Stoney Peter F. M. Choong 《Knee surgery, sports traumatology, arthroscopy》2013,21(12):2810-2816