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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Does Ligamentous Laxity Protect Against Chondral Injury in Patients with Patellofemoral Instability?
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Does Ligamentous Laxity Protect Against Chondral Injury in Patients with Patellofemoral Instability?

机译：韧带松弛能防止Pat股不稳定患者的软骨损伤吗？

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Objectives: Hypermobility may be a risk factor for musculoskeletal injuries during sports participation. However, we have seen a low incidence of chondral injuries requiring treatment in patients undergoing medial patellofemoral ligament (MPFL) reconstruction for patellofemoral instability. It is unknown if patients with ligamentous laxity, who are at an increased risk for patellofemoral instability, are somewhat protected from chondral injury. We hypothesize in patients undergoing MPFL reconstruction for patellofemoral instability, patients with ligamentous laxity will be less likely to have chondral defects requiring surgical intervention. Methods: 171 patients (32 male, 139 female) average age 22 years (range 11-57) with patellofemoral instability were rated with the Beighton-Horan (BH) scale for constitutional ligamentous laxity (0-9). Preoperative MRIs were evaluated (chondral injury present/absent, size of chondral injury, Outerbridge grade) and intra-operative arthroscopic findings noted (chondral injury present/absent, size of chondral injury, Outerbridge grade, surgical intervention yeso, type of surgical intervention) of 79 non-lax (BH<6) and 92 ligamentously lax patients (BH≥6) (LAX) undergoing MPFL reconstruction. Anatomic measurements were documented for each patient including: tibial tubercle-trochlear groove (TT-TG) distance, Caton-Deschamps (C/D) ratio for patellar height, and the Dejour classification of trochlear dysplasia. Surgical interventions included chondroplasty, microfracture, particulated juvenile cartilage implantation (DeNovo, Zimmer, Warsaw, IN), osteochondral fracture fixation or osteochondral allograft transplantation (OATS). Results: 58/171 (33.9%) required a surgical intervention for a chondral defect: chondroplasty 29/58 (50%), microfracture 16/58 (27.6%), particulated juvenile cartilage implantation 18/58 (31%), osteochondral fracture fixation 2/58 (3.5%), and OATS 2/58 (3.5%). There was no difference in the proportion of additional procedures in LAX vs. non-lax (p=0.475). There was no difference in the proportion of patellar chondral injuries sustained (LAX 29.3% vs. non-lax 45.7%) (p=0.538) but LAX patients had a lower proportion of patellar grade IV chondral injury compared to non-lax (p=0.026). There was no difference in the proportion of femoral chondral injuries sustained (LAX 13.1% vs. non-lax 26.4%) (p=0.073) but LAX patients had a lower proportion of femoral grade IV chondral injury compared to non-lax (p=0.023). There was no association of chondral injury with trochlear morphology (p=0.843), patellar height (p=0.303), TT-TG (p=0.874), number of instability events (p=0.878), age at time of surgery (p=0.482), and contact vs. non-contact mechanism of injury (p=0.772). Conclusion: LAX patients had a lower proportion of severe patellar and femoral cartilage injuries. There was no significant difference in the proportions of injuries, however there were 2x the proportion of femoral chondral injuries and 1.5x the proportion of patellar chondral injuries in non-lax vs. LAX, which is clinically significant.
机译：目的：运动过度可能是运动参与过程中肌肉骨骼受伤的危险因素。然而，我们已经发现，接受media股内侧韧带（MPFL）重建的患者因cho股不稳而需要治疗的软骨损伤发生率较低。韧带松弛的patients骨不稳定风险增加的患者是否受到软骨损伤的保护尚不明确。我们假设在进行MPFL重建的pa股不稳定患者中，韧带松弛患者的软骨缺损可能性较小，需要手术干预。方法：采用Beighton-Horan（BH）量表对韧带松弛度（0-9）评分，对171例（32例男性，139例女性）平均年龄22岁（范围11-57）的tell股不稳定性进行评分。评估术前MRI（有/无软骨损伤，软骨损伤的大小，外桥分级）并记录术中关节镜检查结果（有/无软骨损伤，软骨损伤的大小，外桥分级，手术干预是/否，手术类型干预）79例非松弛（BH <6）和92例韧带松弛（BH≥6）（LAX）接受MPFL重建的患者。记录了每位患者的解剖学测量结果，包括：胫骨结节-滑车槽（TT-TG）距离，Cat骨高度的Caton-Deschamps（C / D）比以及滑车发育不良的Dejour分类。手术干预包括软骨成骨，微骨折，微粒软骨植入（DeNovo，Zimmer，华沙，印第安纳州），骨软骨骨折固定术或同种异体骨软骨移植（OATS）。结果：58/171（33.9％）需要手术治疗软骨缺损：软骨弹性29/58（50％），微骨折16/58（27.6％），微粒软骨植入18/58（31％），软骨软骨骨折固定2/58（3.5％）和OATS 2/58（3.5％）。 LAX与非Lax的附加手术比例没有差异（p = 0.475）。持续pa骨软骨损伤的比例没有差异（LAX 29.3％对非松弛45.7％）（p = 0.538），但是LAX患者的had骨IV级软骨损伤比例比非松弛（P = 0.026）。持续发生的股骨软骨损伤的比例没有差异（LAX 13.1％，非松弛26.4％）（p = 0.073），但与非松弛相比，LAX患者的股骨IV级软骨损伤比例较低（p = 0.023）。软骨损伤与滑车形态（p = 0.843），pa骨高度（p = 0.303），TT-TG（p = 0.874），不稳定事件数（p = 0.878），手术年龄（p）没有关联。 = 0.482），以及接触与非接触伤害机制（p = 0.772）。结论：LAX患者重度pa骨和股骨软骨损伤的比例较低。在非松驰组与LAX组中，损伤比例没有显着差异，但是股骨软骨损伤比例是2倍，pa骨软骨损伤比例是1.5倍，这在临床上具有重要意义。

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