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Surgical Treatment of Objective Patellar Instability: Long-Term Results

机译：Objective骨客观不稳定性的外科治疗：长期结果

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>Purpose  To evaluate the long-term results of classical “à la carte” surgical treatment of objective patellar instability as proposed by Dejour in 1987. >Methods  A multicentric retrospective study was conducted evaluating patients that underwent surgical procedure with a 10-year minimum follow-up (mean 12.7; range, 10–15). Surgical procedures were medial transfer of the tibial tubercle transfer according to Elmslie and Trillat et al in 38 cases, plasty of the vastus medialis obliquus according to Insall in 15 cases, open lateral retinacular release in 13 cases, capsuloplasty in 3 cases, and trochleoplasty in 1 case. Different combinations of surgical procedures were adopted according to the pathological features. Subjective outcome was assessed with the visual analog scale (VAS), Kujala score, subjective International Knee Documentation Committee (IKDC) score, Tegner score, and Crosby and Insall scale. Radiographic exams were used to assess the patellar tilt by the Laurin's angle and patellofemoral osteoarthritis (OA) according to the Iwano radiological OA scale. >Results  Forty patients were evaluated. Subjectively, 60% of patients achieved a result judged good, 34% sufficient, and 6% poor. There were only two cases of recurrence of instability. Mean score results were Kujala score 73.4 ± 9.9 (range, 55–95), VAS 4.5 ± 1.2 (range, 1–6), IKDC 64.8 ± 7.9 (range, 51–88), and Tegner score 4. Only nine patients returned to sports activities). Ten patients developed a grade I patellofemoral OA, 8 patients a grade II, and 22 patients a grade III. Average patellar tilt was 10° ±  3.9°. >Conclusion  This retrospective study showed that the traditional surgical procedure was successful for the treatment of patellar instability, but it did not prevent symptomatic patellofemoral OA. >Level of Evidence  Level IV, retrospective case series.
机译：>目的为了评估Dejour在1987年提出的经典“点菜式”手术治疗客观pa骨不稳的长期效果。>方法进行了多中心回顾性研究接受至少10年随访的外科手术患者（平均12.7；范围10-15）。手术方法为：根据Elmslie和Trillat等的方法进行胫骨结节内向转移38例，根据Insall进行斜肌内翻成形术15例，开放性视网膜外侧松解术13例，囊膜成形术3例，行滑囊成形术。 1例。根据病理特点采用不同的手术方法组合。主观结果用视觉模拟量表（VAS），Kujala评分，主观国际膝关节文献委员会（IKDC）评分，Tegner评分以及Crosby和Insall量表进行评估。根据Iwano放射学OA量表，使用放射学检查通过Laurin角和pa股骨关节炎（OA）评估pa骨倾斜度。 >结果对40例患者进行了评估。主观上，有60％的患者达到了判断为好，34％足够和6％较差的结果。仅有两次复发的情况。平均评分结果为Kujala评分73.4±9.9（范围55-95），VAS 4.5±1.2（范围1-6），IKDC 64.8±7.9（范围51-88）和Tegner评分4。仅返回9名患者体育活动）。 10例患者发展为I级pa股骨OA，8例患者发展为II级，22例患者发展为III级。 pa骨平均倾斜度为10°±±3.9°。 >结论这项回顾性研究表明，传统的手术方法可成功治疗pa骨不稳，但不能预防有症状的pa股骨OA。 >证据级别：IV级别IV，回顾性案例系列。

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