关节软骨损伤在髌股内侧韧带重建时经常被注意到，并且与年龄和髌股解剖结构有关

IF 2.7 Q1 ORTHOPEDICS

Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine Pub Date : 2025-04-09 DOI:10.1016/j.jisako.2025.100862

Robert A. Magnussen , Julian A. Feller , Petri Sillanpää , Ryosuke Kuroda , Marc A. Tompkins , Raimundo Vial , Julie Agel , Elizabeth A. Arendt

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引用次数: 0

摘要

复发性髌骨不稳通常采用内侧髌股韧带（MPFL）重建治疗。最近的研究表明，关节软骨损伤患者的MPFL重建效果较差。我们量化了接受MPFL重建治疗的髌骨不稳患者关节软骨损伤的发生率和位置，并确定了与软骨损伤相关的因素。方法前瞻性纳入2016年至2020年在5大洲6个中心接受孤立性外眦赘植皮重建的199例患者。所有手术均用于复发性髌骨不稳。所有患者均行关节镜诊断。髌骨股骨关节软骨损伤位置及严重程度按照国际软骨修复学会（ICRS）系统进行记录，ICRS 2级及以上的损伤定义为严重软骨损伤。根据存在或不存在实质性软骨损伤来比较患者和损伤因素。建立了多个逻辑回归模型来确定与软骨损伤相关的因素。结果111例（56%）患者存在严重的髌股关节软骨损伤（2级72例，3级27例，4级12例），多数患者（106例）存在髌骨软骨损伤，滑车损伤较少（19例）。106例髌骨软骨损伤患者中69例（65%）髌骨内侧损伤。软骨损伤组手术年龄明显增高（p = 0.022），体重指数（BMI）增高（p = 0.059）， Beighton评分降低（0.059）。手术年龄增加（优势比= 1.079,p = 0.010）是软骨损伤的唯一显著预测因素。手术年龄增加、BMI增加和胫骨结节-滑车沟（TT-TG）距离增加与远端和外侧髌骨软骨损伤相关，而膝关节过伸大于10°与内侧软骨损伤风险降低相关。结论：56%的患者因复发性髌骨不稳而行孤立性强韧带重建，存在严重的软骨损伤，其中髌内侧病变最为常见。手术年龄的增加与髌骨股骨软骨损伤的风险增加有关。手术年龄的增加、BMI的增加和TT-TG距离的增加与远端和外侧髌骨软骨损伤有关。证据水平：3级病例对照研究。

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Articular cartilage damage is frequently noted at the time of medial patellofemoral ligament reconstruction and is associated with age and patellofemoral anatomy

Introduction

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.

Methods

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.

Results

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.

Conclusion

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.