Surgery for unilateral and bilateral patellar tendinopathy: a seven year comparative study

Purpose

Open surgery for patellar tendinopathy allows patients with unilateral and bilateral tendinopathy to return to high levels of physical activity.

Materials

Two groups of 23 athletes each underwent open surgical exploration for management of patellar tendinopathy. One group suffered from unilateral patellar tendinopathy (unilateral group), and the other group had bilateral (bilateral group) patellar tendinopathy. Maximum voluntary isometric contraction and anthropometric measures were assessed pre-operatively and at an average follow-up of seven years. The Victorian Institute of Sport Assessment (VISA)-P scoring system was also administered; functional outcomes were classified from excellent to poor according to a modification of Kelly’s criteria.

Results

At the final follow-up, in both groups, VISA-P scores were significantly improved compared with preoperative values, with no intergroup differences. Clinical results were excellent or good in 21 patients in the unilateral and 19 in the bilateral group. Twenty of 23 patients in the unilateral group and 17 of 23 in the bilateral group were still active in sports (p = 0.2). In the unilateral group, at the last follow-up, thigh volume and strength were significantly improved compared with baseline, with significant difference between operated and nonoperated limbs. In the bilateral group, there were no significant differences in thigh volume and strength between the dominant and nondominant limbs both before and after the index procedure.

Conclusions

This procedure is not technically demanding and provides a high rate of good and excellent outcomes in the long term.     

髌腱外偏角的测量及在复发性髌骨脱位诊断中的应用

目的:比较髌腱外偏角和胫骨结节-滑车沟距离(tibia tubercle-trochlea groove,TT-TG)的CT测量结果,以及在复发性髌骨脱位中的诊断能力和病理阈值。方法:自2015年1月至2020年3月对46例复发性髌骨脱位患者和112例非髌骨脱位患者的病例资料进行回顾性分析。46例复发性髌骨脱位患者根据TT-TG值分为2组:TT-TG ≥ 20 mm髌骨脱位(A组)11例,男7例,女4例;年龄16~27(21.00±3.98)岁;TT-TG<20 mm髌骨脱位(B组)35例,男14例,女21例;年龄16~37(22.83±6.09)岁;非髌骨脱位(C组)112例,男63例,女49例;年龄16~36(22.87±5.69)岁。比较3组患者的髌腱外偏角和TT-TG值的测量数据,并采用Spearman分析其相关性。采用同类相关系数(intraclass correlation coefficient,ICC)确定组内的可重复性。利用受试者工作特征(receiver operating characteristic,ROC)曲线下面积评价参数的诊断能力,并计算出髌腱外偏角截骨参数,以及髌腱外偏角和TT-TG值在诊断复发性髌骨脱位的诊断参数。结果:A、B、C组的髌腱外偏角分别为(22.04±3.19)°、(17.20±4.43)°、(10.22±3.45)°,TT-TG值分别为(21.15±0.71)、(15.97±2.69)、(11.12±3.77) mm,3组比较差异有统计学意义(P<0.01),且A组与B组比较差异有统计学意义(P<0.01)。髌腱外偏角与TT-TG值对比,存在强正相关(r=0.735,P<0.000 1)。髌腱外偏角在A、B组中的组内ICC值(0.980、0.982)比TT-TG值(0.594、0.775)测量的可重复性更好,C组中髌腱外偏角(0.956)和TT-TG值(0.906)可重复性均很好。在复发性髌骨脱位诊断中,髌腱外偏角的ROC曲线下面积(0.916)大于TT-TG值(0.886),其诊断参数分别为13.84°和14.69 mm;在胫骨截骨术中,髌腱外偏角的ROC曲线下面积为0.821,截骨参数为20.15°。结论:CT成像可以可靠地测量髌腱外偏角。髌腱外偏角与TT-TG值存在强正相关,可通过其测量明确复发性髌脱位病理状态,并且髌腱外偏角在复发性髌骨脱位的诊断能力优于TT-TG值。髌腱外偏角同样可用于指导复发性髌骨脱位的胫骨截骨手术方案的制定。     

Clinical and histological study of patellar chondropathy in adolescents

An arthroscopic and histological investigation of patellar chondropathy in adolescents was performed in 98 knees of 83 patients who were classified into three clinical types of patellofemoral disorder. These were the anterior knee pain syndrome, idiopathic chondropathy, and unstable patella. Histological findings suggested little evidence of progression to high-grade chondropathy in the patients with anterior knee pain syndrome, and this may account for the resolution of clinical symptoms in this group. Even in patients with high-grade lesions in the idiopathic chondropathy and unstable patella groups, histological observations indicated that these lesions could heal either by intrinsic (fibrous metaplasia of chondrocytes and regeneration of matrix) or extrinsic repair. Chondropathy in adolescents may be similar to the early changes of osteoarthritis of the knee. However, chondropathy shows far more potential for repair by the synovium and/or the cartilage itself than does osteoarthritis.     

Factors affecting the outcomes of modified tension band wiring techniques in transverse patellar fractures

IntroductionModified tension band wiring has been widely used to treat transverse patellar fractures. However, few studies have evaluated the clinical outcomes using different methods of Kirschner wire bending, location of the tension band, and depths of Kirschner wires. Thus, we tried to clarify these factors according to our clinical outcomes.Patients and methodsThis retrospective cohort study recruited consecutive patients underwent surgical fixation for patellar fractures using modified tension band technique between January 2010 and December 2015. Different factors in this procedure, including the bending manner of the Kirschner wires, their depth, and location of the tension band with respect to the superior and inferior border of the patella were recorded and analysed. The primary outcome was early loss of fixation. The secondary outcomes were minor loss of reduction, implant breakage, deep infection, and the need for implant removal.ResultsThis study included 170 patients with patellar fractures. Regarding the bending method, similar results were obtained with bilaterally or proximally bent Kirschner wires. Regarding length, the tension band was placed closely (within 25% of the patella length) in 124 patients and distantly in 46 patients. The rates of loss of reduction and implant breakage were significantly higher in the distantly placed tension bands. Regarding depth, 37 patellar fractures were fixed with the Kirschner wires at the superficial one third of the patellae while the K- wires at the middle layer of patella were used in the remaining 133 patellar fractures. A significantly higher rate of minor loss of reduction was obtained using the superficial Kirschner wires.ConclusionThe modified tension band technique for transverse patella fractures provides favourable clinical outcomes, with low failure (5%) and infection (2%) rates. Implant irritation is the major complication, and almost half of cases require implant removal. The location of the tension band with respect to the superior and inferior border of the patella plays an important role in clinical outcomes. Placing the wire close to the patella may prevent major loss of reduction and implant breakage. Superficially placed Kirschner wires also affect clinical outcomes by increasing the rate of minor loss of reduction.     

Groin pain in athletes

Groin pain in athletes is not infrequently a cause of frustration and aggravation to both doctor and patient. Complaints in the groin region can prove difficult to diagnose, particularly when they are of a chronic nature. These injuries are seen more commonly in sports that require specific use (or overuse) of the proximal musculature of the thigh and lower abdominal muscles. Some of the more common sports would be soccer, skiing, hurdling, and hockey. The differential diagnosis can cover a rather broad area of possibilities. Most common groin injuries are soft-tissue injuries, such as muscular strains, tendinitis, or contusions. More difficult areas to pinpoint are such entities as osteitis pubis, nerve entrapment, the so-called "sports hernia," or avulsion fractures, to name but a few. The evaluation of such patients includes a familiarity with the sport and possible mechanism of injury (i.e., taking a careful history), meticulous physical examination of the groin, abdomen, hips, spine, and lower extremities. Diagnostic examinations may or may not prove helpful in formulating a final diagnosis. Some patients may be required to undergo procedures, such as laparoscopic evaluation of the region to obtain adequate information that allows a proper diagnosis and treatment plan. This article describes many of the possible causes of groin pain in athletes. The list is quite lengthy, and only the more common problems will be discussed in detail. Presented, in part, at the American Hernia Society annual meeting in the Riverside Hilton, New Orleans, LA, USA in May 2001.     

Treatment of chronic patellar dislocation with a modified Elmslie-Trillat procedure

Background This paper describes a modification of the Elmslie-Trillat procedure that is usually performed in severe cases of habitual or recurrent patellar instability. Methods Eighteen knees (7 men and 8 women) treated for recurrent or habitual patellar dislocation were evaluated clinically and radiographically at a mean follow-up of 5 years (range 24 months to 9 years). The mean age at follow-up was 26.3 years (range 17–44 years). The IKDC and Kujala and Tegner scores were used for the clinical evaluation. Anteroposterior, lateral and Merchant views were done for radiographic monitoring. When the patella was still unstable during dynamic evaluation after execution of the Elmslie-Trillat procedure, the medial third of the patellar tendon was isolated and harvested with a corresponding 1 cm long and 0.5 cm wide bone plug, maintaining its insertion to the inferior medial side of the patella. This ligament was medialized and put under tension, trying to find a medial insertion that guaranteed patellar stability throughout the full range of motion. Results IKDC classified 11 knees as A (normal), 4 knees as B (almost normal), 2 knees as C (abnormal) and 1 knee as D (severely abnormal). The Kujala score showed excellent results in 16 knees, 1 fair and 1 poor knee. The mean Tegner score rose from 2 preoperatively to 5 at follow-up. The poor knee presented an over-correction of the congruence angle on radiography. On follow-up radiographs, the parameters were almost completely corrected. Statistical analysis showed a significant correction of radiograph parameters, and significantly worse results in patients who underwent trochleoplasty. Conclusion The technique described tries to achieve a dynamic stability of the patella throughout the full range of motion in severe patellar instability where the Elmslie-Trillat procedure is insufficient. No recurrence of patellar instability has been observed. The stability must be obtained with dynamic control in the initial degrees of flexion, trying to avoid an excessive patellar medialization.     

Quadriceps and patellar tendon rupture

Ruptures of the patellar and/or quadriceps tendon are rare injuries that require immediate repair to re-establish knee extensor continuity and to allow early motion. We evaluated 36 consecutive patients with quadriceps or patellar tendon rupture between 1993 and 2000. There were 37 primary ruptures, 3 reruptures, 21 quadriceps and 19 patellar tendon ruptures. Follow up examination (>24 months postoperatively) included the patient's history, assessment of risk factors, clinical examination of both knees, isometric muscle strength measurements and three specific knee scores, Hospital for Special Surgery Score, Knee Society Score and Turba Score, and a short form SF-36. We evaluated 29 patients (26 men) with 33 ruptures (16 patellar tendon, 17 quadriceps tendon). Seven patients were lost to follow up. We found no difference between the range of motion and muscle strength when the injured leg was compared to the non-injured leg. Risk factors did not influence the four scores, patient satisfaction, pain, muscle strength or range of motion. Multiple injured patients had a significant reduction in muscle strength and circumference, however patient satisfaction did not differ to the non-multiple injured patient group.     

Implantless patellar fixation in medial patellofemoral ligament reconstruction

Purpose: The medial patellofemoral ligament (MPFL) acts as primary restraint to lateral patellar dislo cation and its rupture has been reported in almost all cases of acute patellar dislocation. Various surgical techniques have been described for MPFL reconstruction, using many femoral and patellar fixation techniques and different grafts. This article details our technique for MPFL reconstruction using sem itendinosus graft which avoids the use of implant at patellar end. Methods: Twenty patients (8 males and 12 females) with complaints regarding acute and chronic lateral patellar instability were evaluated and treated by MPFL reconstruction procedure. The mean age of patients was 21 years (range 17e34 years). MPFL reconstruction was performed using semitendinosus graft passing through two parallel, obliquely directed tunnels created in patella. Fixation of graft was done with an interference screw only at the femoral end. Mean follow-up period after intervention was 26.4 months (range 23-30 months). Results were evaluated using Kujala score. Results: All patients gained adequate patellar stability and full arc of motion. No incidence of patella fracture was noted. There were no postoperative complications related to the procedure. There was no recurrence of instability in patella at final follow-up. Conclusion: Passing the graft through the tunnels in patella without use of any implant has given excellent functional outcome and moreover has the advantages of less implant-related complications and cost-effectiveness.     

Acute and chronic Achilles tendon ruptures in athletes

The Achilles tendon is the most injured tendon of athletes in the lower extremities and is the most common tendon to rupture spontaneously. Operative repair provides earlier return to sporting activities and lesser rate of rerupture. The general goal is to attempt anastomosis of the acute ruptured ends; however, delayed ruptures may require more extensive procedures. New surgical approaches, including percutaneous and mini-open techniques, are being introduced to potentially diminish perioperative complications. Advent of early protective range of motion and rehabilitation has shown a potential for earlier return to sporting activities for Achilles ruptures.     

骨性和软组织性髌骨脱位模型中滑车发育的实验研究

目的通过股骨截骨术增大股骨前倾角和髌骨内外侧软组织失平衡手术制作髌骨脱位模型,观察股骨滑车局部形态和骨小梁结构的变化。方法取40只3个月龄的新西兰幼兔,分别对其右膝进行两种手术方式(每组20只):①截骨组,接受股骨旋转截骨术,股骨远端内旋来增大股骨前倾角;②软组织组,行髌骨内侧支持带松解和外侧支持带紧缩缝合术。所有左膝作为正常对照组。术后观察4个月至骨骼成熟,将股骨远端进行Micro-CT扫描,测量滑车形态:外侧髁、滑车沟和内侧髁的高度,滑车沟角,滑车的外侧和内侧关节面倾斜角等,并对骨小梁进行分析:骨体积分数、骨小梁厚度、骨小梁数量、骨小梁分离度和骨密度等。相关指标的结果进行组间比较。结果截骨组中1例发生髋关节脱位,而髌骨未发生脱位;3例在屈膝状态下出现完全性的髌骨脱位;16膝在膝关节被动伸直时,髌骨发生脱位。软组织组中15膝在屈膝状态下出现完全性的髌骨脱位,5膝未发生髌骨脱位。截骨组的股骨滑车在滑车入口处伴有局部的突起形成,称为"骨突",而滑车关节面比较光滑,未出现明显的软骨破裂等,而软组织组的股骨滑车未见"骨突"形成,滑车关节面出现软骨破裂、缺损等关节炎表现。与对照组相比,截骨组和软组织组的滑车均变浅和变宽,滑车沟高度和滑车沟角变大,但两组比较没有统计学差异。与对照组相比,截骨组骨小梁发生汇聚,内侧髁和外侧髁的骨小梁厚度增大,内侧髁骨小梁数量减少,而软组织组表现为骨质疏松,内侧髁和外侧髁的骨体积分数、骨小梁厚度、骨小梁数量和骨密度都减少,骨小梁分离度增大。与软组织组相比,截骨组内侧髁和外侧髁的骨体积分数、骨小梁厚度、骨小梁数量和骨密度都较大,骨小梁分离度较小,差异有统计学意义。结论通过股骨截骨术增大股骨前倾角和髌骨内外侧软组织失平衡手术可成功构建髌骨脱位的骨性和软组织型模型,并继发形成不同的滑车形态学改变和骨小梁结构变化。     

胫骨结节内移抬高术联合关节镜下髌骨支持带调整术治疗复发性髌骨脱位的疗效研究

目的探讨胫骨结节内移抬高术联合关节镜下髌骨支持带调整术治疗复发性髌骨脱位的疗效。方法自2008年至2012年对12例复发性髌骨脱位行关节镜下髌骨外侧支持带松解、内侧支持带紧缩联合胫骨结节内移抬高术。术后6周、3个月、6个月、12个月、2年、5年进行门诊随访,物理检查包括髌骨内移度检查,髌骨外推恐惧试验,复查轴位X线片了解截骨块愈合情况、髌股关节适合角、髌骨指数,Lysholm膝关节功能评价表、IKDC评分和Kujala评分表进行评估。结果所有患者均获随访,随访时间1~5年,平均2.0年。术后3~6个月复查X线片见截骨块以达到骨性愈合,在负重行走并行膝关节屈伸功能锻炼,膝关节功能恢复良好。术后髌骨内移度均介于1°~2°之间,术后各时间点髌骨外推恐惧试验阳性率、髌骨适合角、髌骨指数与术前比较,差异均有统计学意义（P〈0.05）;术后各时间点间比较,差异均无统计学意义（P〉0.05）。术后6、12个月,IKDC、Lysholm、Kujala评分均较术前显著提高,差异均有统计学意义（P〈0.05）。术后6、12个月IKDC、Lysholm评分比较,差异无统计学意义（P〉0.05）。术后12个月Kujala评分较术后6个月显著提高,差异有统计学意义。结论关节镜下髌骨外侧支持带松解、内侧支持带紧缩联合胫骨结节内移抬高术能够有效治疗复发性髌骨脱位。     

Neglected locked vertical patellar dislocation

Patellar dislocations occurring about the vertical and horizontal axis are rare and irreducible. The neglected patellar dislocation is still rarer. We describe the clinical presentation and management of a case of neglected vertical patellar dislocation in a 6 year-old boy who sustained an external rotational strain with a laterally directed force to his knee. Initially the diagnosis was missed and 2 months later open reduction was done. The increased tension generated by the rotation of the lateral extensor retinaculum kept the patella locked in the lateral gutter even with the knee in full extension. Traumatic patellar dislocation with rotation around a vertical axis has been described earlier, but no such neglected case has been reported to the best of our knowledge.     

Management of comminuted patellar fracture with non-absorbable suture cerclage and Nitinol patellar concentrator

PurposeTo evaluate the effectiveness and safety of a fixation technique for comminuted patellar fracture using non-absorbable suture cerclage and nickel-titanium patellar concentrator (Ni-Ti PC).MethodsTwenty-nine consecutive patients with displaced comminuted patellar fractures accepted internal fixation procedure using Ni-Ti PC augmented with different types of non-absorbable suture cerclage. During follow-up, the clinical grading scales of Böstman, including range of movement, pain, work, atrophy, assistance in walking, effusion, giving way, and stair-climbing, were used to evaluate the clinical results. Complications including implant loosening, fragment displacement, bone nonunion, infection, breakage of the implants, painful hardware, and post-traumatic osteoarthritis were also assessed.ResultsPatients were followed up for a mean period of 27 months. The bone union radiographically occurred approximately 2.5 months without implant loosening and fragment displacement. According to Böstman method, satisfactory results were obtained, and the mean score at final follow-up was 28 (range 20–30) points. Twenty-two patients with excellent results had mean score of 29.8 ± 0.5 (range 28–30) and seven patients with good results had mean score of 22.7 ± 3.14 (range 20–27). No postoperative complications, such as infection, dislocation, breakage of the implants, painful hardware, and post-traumatic osteoarthritis, were observed.ConclusionNi-Ti PC fixation with non-absorbable suture cerclage is a feasible approach for comminuted patellar fractures. Firm fixation with this technique resulted in satisfactory outcomes without obvious complications.     

Factors predisposing to bacterial invasion and infection

BACKGROUND: Bacterial infections remain important causes of morbidity and mortality in surgical patients. Our understanding of the effects of bacteria on the host, and also the defense mechanisms available to the host, is improving all the time. Modern tools in biochemistry, immunology, and molecular biology have provided powerful methods to further our understanding of the complex interactions that contribute to our host defense response. This review reflects current thinking regarding the factors that contribute to bacterial infection and host defense response. DATA SOURCES: This review was compiled after an extensive review of the current and historical literature, and highlights a number of areas involved in the pathogenesis of bacterial infection. CONCLUSIONS: Bacteria can have a wide-ranging and deleterious effect on the host. Many different therapeutic approaches have been attempted to modulate the host response and limit the deleterious effects of bacteria. As our understanding of the underlying processes improves, these therapies should improve accordingly.     

Factors predisposing to skiing injuries in Britons

A prospective study of 2273 British recreational skiers found an injury rate of 0.8 per cent. Weather, snow conditions, age, alcohol, time of day, stage of holiday and difficulty of run did not seem important factors in injury. British skiers had similar rates of injury to other nationalities. The most important preventable factor was overtightening of bindings. A case can be made for holiday insurance to cover medical treatment on return to the UK.     

Indication for, technic and results of reconstruction of the extensor apparatus in the treatment of patellar instability and patellar chondropathy

Patella dislocation or subluxation is a common cause of internal derangement of the knee. Frequently they lead to lesions of the articular cartilage of the patella. More than one-hundred operative methods have been described for surgical correction of this condition and for treatment of the chondral damage, suggesting that none has been consistently successful. Long-term results of extensor mechanism reconstruction have been published by Turba et al. (26) advocating a numerical rating system with subjective and objective criteria for the follow-up control. We present our operative technique and results with extensor mechanism reconstruction in 54 cases by applying the above mentioned rating system. With a follow-up period from more than one year 39 patients were available for control. The results of proximal reconstruction (24 cases) were good and excellent in 20 cases by subjective and in 23 cases by objective evaluation. The proximal and distal reconstructions (15 cases) showed subjective 13 and objective 14 patients with good and excellent results.     

复发性髌骨脱位的治疗现状

复发性髌骨脱位的主要表现是膝关节周围广泛的疼痛、肿胀和反复的髌骨向外侧脱位。其发病的主因是患者存在膝关节解剖结构异常,如Q角增加、髌骨高位、股骨外髁发育不良、髌骨形态异常、股直肌内侧头萎缩或股直肌外侧头肥大等。本文综述45篇文献,总结了其手术治疗方法。目前复发性髌骨脱位的治疗方法有很多种,大致包括五类:外侧松解、伸膝装置近端重排、伸膝装置远端重排、伸膝装置远、近端联合手术及髌骨切除和股四头肌成形修补术。其中远端重排手术效果最佳,目前尚无一种方法能成功地用于矫正复发性髌骨脱位。     

Quantitative computed tomography for measuring bone mineral density in athletes

We studied the effect of different training patterns on vertebral trabecular and cortical bone mineral density (BMD) in male athletes using quantitative computed tomography. Vertebral trabecular (t) and cortical (c) BMDs of the first three lumbar vertebrae were measured using single energy quantitative computed tomography in 51 athletes including 10 weight lifters (mean age 20 years), 13 soccer players (mean age 27 years), 28 wrestlers (mean age 17 years), and 45 age-matched volunteers (mean age 21 years). Measured BMDs were correlated with age, body height and weight, training hours per week, sports years, and type of physical activity. Vertebral tBMDs were found to be 44%, 23%, and 24% higher in the weight lifters, soccer players, and wrestlers, respectively, compared with the volunteers. The corresponding cBMDs were 18%, 6%, and 11% higher than that of volunteers. There was significant correlation between the trabecular and cBMD, and height of the athletes, sports years, training hours per week, and physical activity. The most significant correlation with BMD was the type of physical activity. Both the height of the subjects and physical activity variables showed variations of 47% and 32% in trabecular and cBMD, respectively. According to the multiple analysis of variance (MANOVA) only the physical activity factor was effective, with a significance level ofP<0.01; the other factors and interactions were not effective (P>0.05) on trabecular and cBMD. Different training patterns have a different anabolic effect on both trabecular and cBMDs of the vertebrae, and this effect is more pronounced on the trabecular compartment. Weight lifting showed the highest anabolic effect on both trabecular and cBMDs compared with soccer playing and wrestling. Of the independent variables, physical activity showed the highest anabolic effect on the vertebrae. These results may have implications for devising exercise strategies to reduce the possibility of fracture in old age.     

Irreversible bone loss in former amenorrheic athletes

Small gains in bone mineral density (BMD) have been reported in the first year following resumption of menses in amenorrheic athletes but there have been no long-term outcome studies. The purpose of this study was to determine whether the BMD of former oligomenorrheic or amenorrheic athletes normalizes following several years of normal menses or use of oral contraceptives. Twenty-nine athletes first studied in this laboratory 8.1 years (range 6–10 years) ago were available for follow-up. At recruitment (time 1) 29 athletes, mean age of 30.6 years, were non-smokers, exercised 4 or more days/week for at least 45 min, had not used oral contraceptives, and had no medical conditions affecting bone metabolism. At time 1, 9 women (R/R) had always menstruated regularly, 9 (R/O/A) had experienced intermittent oligo/amenorrhea as well as regular menses, and 11 (O/A) had never menstruated regularly. At follow-up (time 2) mean age of the women was 38.2 years and there were no significant changes in height, weight or activity patterns. BMD (g/cm²) was measured at the lumbar vertebrae (L1–4 and femoral neck by dual-energy X-ray absorptiometry and expressed as a percentage of R/R values. Vertebral BMD was significantly lower in the O/A group compared with the R/R group at both time 1 and time 2 (p<0.05). The R/O/A group had intermediate values and did not differ significantly from R/R or O/A at either time. Differences in technique between machines for determining femoral neck BMD made it difficult to detect the longitudinal effect of menstrual status at that site. Despite several years of normal menses or use of oral contraceptives, the mean vertebral BMD of former oligo-amenorrheic athletes remained low, being 84.4% of the R/R value compared to 84.8% at time 1. Those experiencing menstrual regularity with intermittent oligo/amenorrhea remained at an intermediate position of 94.7% of the R/R mean. Our results suggest early intervention is necessary to prevent irreversible vertebral bone loss in oligo/amenorrheic athletes     

复发性髌骨外侧脱位的手术治疗现状及展望

目前对于复发性髌骨外侧脱位的外科治疗主要包括内侧髌股韧带重建、胫骨结节截骨、股骨滑车成形、外侧支持带松解及旋转截骨术等。临床报道显示:单独应用一种或者联合几种术式治疗复发性髌骨脱位都取得了理想的短中期临床疗效。但目前对个体髌骨脱位的术式选择尚缺乏统一标准、也未达成共识。同时随着内侧髌股韧带重建等术式应用愈加广泛,也有越来越多值得引起关注的手术并发症和失败率。本文旨在对当前各种术式的应用现状做一系统综述,汇总目前取得的疗效、阐述各种术式的应用要点,以期更精准的指导临床个体化治疗。