非解剖MPFL重建及未能处理相关病变是髌股关节不稳治疗后出现治疗损伤的常见原因
简介
基于丹麦患者赔偿协会2004-2025年数据，分析405例髌股关节不稳治疗相关索赔。关键发现：治疗损伤最常见原因为手术失误（38%），其中近半数源于MPFL重建时股骨侧移植物位置错误；未充分评估或处理解剖危险因素（如滑车发育不良、高位髌骨、胫骨结节外偏）占20%，常需二次手术；神经损伤（13%）和延迟治疗（8%）也较常见，深静脉血栓（3%）和深部感染（1%）…
英文摘要
PURPOSE: Management of patellofemoral instability (PFI) tailored to the individual patoanatomy can be complex with potential pitfalls. However, reports on complications and suboptimal outcomes remain limited. The aim of this study was to analyse problems related to PFI treatment in Denmark. This knowledge can be used to optimize future treatment of PFI. METHODS: Compensation claims from 2004 to 2025 related to PFI were identified in the Danish Patient Compensation Association. Medical records and imaging were independently reviewed by two observers. Radiographs and magnetic resonance imaging were analysed for anatomical risk factors (trochlear dysplasia, patella alta, lateralized tibial tubercle) and to evaluate postoperative surgery. For each patient, the appropriate surgical management was defined according to an á-la-carte principle, and for each patient it was assessed whether treatment had been appropriate. Information about accepted complications and compensation was registered for each case. RESULTS: There were 405 eligible claims. The most frequent cause of treatment injury was surgical malpractice (38%), particularly incorrect femoral graft placement in medial patellar-femoral ligament reconstruction, which accounted for nearly half of these cases. Failure to adequately evaluate or treat anatomical risk factors (20%) often resulted in additional surgery. Nerve injuries (13%) and delayed treatment (8%) were also significant, while deep vein thrombosis (3%) and deep infection (1%) were rare. The 210 claims (54%) being approved received a total compensation of 34 million DKK. CONCLUSION: Many treatment injuries following PFI surgery were in principle preventable. Standardized imaging protocols and treatment algorithms are suggested as means to reduce complications. LEVEL OF EVIDENCE: Level II.