髌骨脱位后急性软骨和骨软骨损伤手术治疗后翻修率相似：一项多中心队列研究
简介
这项多中心回顾性队列研究纳入208例髌骨脱位后软骨或骨软骨损伤的手术患者，发现软骨与骨软骨损伤的翻修率无显著差异（总体11.2%），但同期行稳定手术可显著降低翻修风险。临床提示：处理此类损伤时，应优先考虑联合稳定手术以改善预后。
英文摘要
PURPOSE: Optimal treatment strategies for (osteo-)chondral injuries following patellar dislocation remain unclear. This retrospective multicentre study aimed to compare outcomes between chondral and osteochondral lesions and to explore factors associated with revision surgery. METHODS: Patients who underwent surgical treatment for (osteo-)chondral injuries secondary to patellar dislocation over a 10-year period were included. The primary endpoint was revision surgery; secondary endpoints included patient-reported outcome measures (PROMs) (Banff Patellofemoral Instability Instrument 2.0, EuroQol 5-Dimension [EQ-5D], International Knee Documentation Committee [IKDC-2000] and Marx Activity Rating Scale). Outcomes were compared between chondral and osteochondral lesions using multivariable regression models to adjust for clinically relevant confounders. RESULTS: A total of 208 patients with chondral and/or osteochondral defects were included (chondral: 27.4%; osteochondral: 71.2%; combined chondral and osteochondral: 1.4%). Only patients with purely chondral or osteochondral lesions were further analysed (n = 205). Treatment strategies differed between groups, with fragment refixation more commonly performed in osteochondral lesions (62.8% vs. 19.3%, p < 0.001). Overall, 11.2% of patients underwent revision surgery, with no significant difference between lesion types. Concomitant stabilising procedures were associated with lower odds of revision surgery (adj. p = 0.005). Patients with chondral lesions had higher scores in the Marx Activity Rating Scale (adj. p = 0.017). CONCLUSIONS: No significant difference in revision rates was observed between chondral and osteochondral lesions following patellar dislocation. Concomitant stabilising procedures were associated with lower odds of revision surgery. Given the retrospective design and limited number of events, these findings should be considered exploratory and require confirmation in prospective studies. LEVEL OF EVIDENCE: Level III.