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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >The Role of Abnormal Tibiofemoral Rotation in Pediatric and Adolescent Patellar Instability
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The Role of Abnormal Tibiofemoral Rotation in Pediatric and Adolescent Patellar Instability

机译：胫股骨旋转异常在小儿和青少年Pat骨不稳中的作用

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Objectives: Abnormal patellofemoral tracking has been implicated in patellar instability and can be influenced by the bony anatomy and alignment of the femoral trochlea, patella, and tibial tubercle. Tibiofemoral joint rotation has been recently suggested to play a role in patellofemoral kinematics but there has been little investigation of its contribution to patellar instability, including in pediatric and adolescent patients. Methods: A retrospective case-control design was utilized. 30 patients aged 9-18 with a prior patellar dislocation and an MRI of the involved knee were included. Cases were matched for age and gender with controls without patellar instability. Patients with ACL tears, tibial eminence or tubercle fractures, or prior surgery in the involved extremity were excluded. There was no difference in gender, age, height, but BMI was higher in the case group. MRI images taken with knee in extension were analyzed. Tibial tubercle-trochlear groove (TT-TG), tibial tubercle-posterior cruciate ligament (TT-PCL), and tibiofemoral rotation were measured. All measurements were performed by a single reader with excellent intra and interobserver reliability for tibiofemoral rotation (ICC-intra > .954 and ICC-inter > .905) demonstrated in a subset of patients. Results: The TT-TG was increased in patients with patellar instability at 16.3 mm compared to 10.9 mm in controls (p <.001) as was also the TT-PCL at 19.4 mm cases versus 17.6 mm (p=0.02). Tibiofemoral rotation was increased in patients with patellar instability with a mean 6.9° of tibial external rotation compared to 0.8° of tibial internal rotation in controls (p < .001). Overall, 30/41 (75.6%) of patients with patellar instability had tibiofemoral rotation >5° external rotation versus only 3/41 controls (7.3%). There was a strong correlation between TT-TG and tibiofemoral rotation (PCC = 0.776) and a moderate correlation between TT-TG and TT-PCL (PCC = .661). There was only a weak correlation between tibiofemoral rotation and TT-PCL. Conclusion: Increased tibiofemoral rotation is present in patients with patellar instability and may play a role in the pathophysiology of patellar instability. Increased tibiofemoral rotation can lead to an increased TT-TG even when TT-PCL is normal.
机译：目的：pa股股骨追踪异常与in骨不稳定有关，可能受股骨滑车，骨和胫骨结节的骨解剖结构和排列的影响。最近有人建议胫股关节旋转在pa股运动学中起一定作用，但很少研究其对pa骨不稳定的影响，包括在小儿和青少年患者中。方法：采用回顾性病例对照设计。包括30名9-18岁的患者，这些患者先前有pa骨脱位并累及了膝关节MRI。根据年龄和性别对病例进行匹配，对照组没有controls骨不稳定。排除有ACL眼泪，胫骨隆起或结节骨折或在受累肢体中接受过手术的患者。性别，年龄，身高无差异，但病例组的BMI较高。分析了膝盖伸展时拍摄的MRI图像。测量胫骨结节滑车槽（TT-TG），胫骨结节后交叉韧带（TT-PCL）和胫股旋转。所有测量均由单个阅读器执行，该阅读器在胫骨股骨旋转中具有出色的观察者内和观察者间可靠性（ICC内> .954和ICC内> 0.905），在部分患者中得到了证实。结果：pa骨不稳患者在16.3 mm处的TT-TG升高，而对照组为10.9 mm（p <.001），在19.4 mm情况下的TT-PCL也相对于17.6 mm（p = 0.02）。 controls骨不稳患者的胫骨股骨旋转增加，胫骨外旋转平均为6.9°，而对照组的胫骨内旋转平均为0.8°（p <.001）。总体上，30骨不稳的患者中有30/41（75.6％）的胫骨股骨旋转> 5°外旋，而只有3/41对照（7.3％）。 TT-TG和胫股旋转之间有很强的相关性（PCC = 0.776），TT-TG和TT-PCL之间有中等的相关性（PCC = .661）。胫股旋转和TT-PCL之间只有很弱的相关性。结论：pa骨不稳患者的胫股旋转增加，可能在tell骨不稳的病理生理中起作用。即使TT-PCL正常，增加的胫股旋转也会导致TT-TG增加。

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