述评：髌骨高位究竟多高算高？——理解髌骨高位测量方法的局限性
简介
该篇述评指出，髌骨高位是髌骨不稳的主要危险因素，其精确测量对决定是否行胫骨结节远端截骨术（TTO）至关重要。作者强调，TTO会增加手术风险及恢复时间，且远端截骨使骨不连或延迟愈合风险增加3倍。因此，临床医生在解读先进影像测量结果时需谨慎，应结合患者个体形态学危险因素，以更准确地筛选适合远端TTO的患者。
英文摘要
Patellar height is a primary risk factor for patellar instability, reflecting the increase in knee flexion required before the patella can engage in the osteochondral constraint of the trochlea. From a surgical perspective, measurements of patella alta are factored into the equation of when we should consider performing distalizing tibial tuberosity osteotomy (TTO), which can change the nature of the surgery and recovery for patients. The addition of TTO increases the risk and recovery time when compared with a soft tissue procedure alone, and furthermore, the distalizing component of TTO can increase the rate of nonunion or delayed union by 3-fold when compared with nondistalizing TTO. Therefore, our ability to precisely measure patella alta and indicate distalizing TTO is paramount in safely and adequately addressing the symptoms of patellar instability. Although the search for the optimal imaging measurement technique continues, those who are using advanced imaging measurements to assess patella alta should exercise caution when interpreting such numbers and consider the context of the patient. By understanding the principles and limitations of each measurement and the influence of additional morphologic risk factors, we can better identify which patients would benefit from distalizing TTO in the management of patellar instability.