术前矢状位胫骨结节-滑车沟距离可预测联合滑车成形术与内侧髌股韧带重建术患者的术后结果
简介
回顾性纳入101例复发性外侧髌骨不稳伴高级别滑车发育不良（Dejour B-D）患者，均行MPFL重建联合加深滑车成形术，测量术前矢状位胫骨结节-滑车沟距离（sTTTG）并分析其与术后患者报告结局的关系。术前sTTTG较高者术后主观功能更优、疼痛更低、BPII 2.0评分更高，校正混杂因素后仍显著。提示sTTTG可辅助预测联合术后疗效，但证据等级IV且模型解…
英文摘要
PURPOSE: To evaluate the association between the preoperative sagittal tibial tubercle-trochlear groove (sTTTG) distance and postoperative patient-reported outcomes after combined patellofemoral ligament reconstruction and deepening trochleoplasty in patients with recurrent lateral patellar instability and high-grade trochlear dysplasia. METHODS: This retrospective study included patients who underwent combined medial patellofemoral ligament reconstruction and deepening trochleoplasty for recurrent lateral patellar instability with high-grade trochlear dysplasia (Dejour grade B-D) between 2016 and 2018. Eligibility required ≥2 documented patellar dislocations or persistent symptoms after ≥6 months of nonoperative treatment, high-grade trochlear dysplasia on magnetic resonance imaging, and a minimum follow-up of 18 months. The sTTTG distance was measured on preoperative axial T2-weighted magnetic resonance imaging sequences as the perpendicular offset between the trochlear cartilage and the tibial tubercle, referenced to the posterior condylar axis. Postoperative outcomes were assessed using the Banff Patellofemoral Instability Instrument 2.0 (BPII 2.0) score, alongside numeric rating scales for pain levels and subjective knee function. Univariable and multivariable linear regression analyses were performed, adjusting for age, body mass index, Caton-Deschamps index, Dejour classification of trochlear dysplasia, and tibial tubercle-trochlear groove distance. RESULTS: A total of 101 patients (29 men, 72 women; mean age 22.7 ± 6.6 years; body mass index 24.3 ± 4.9) were included with a mean follow-up of 32.3 ± 8.7 months (range 19-60). Univariable analysis showed that a higher preoperative sTTTG was significantly associated with improved postoperative subjective function (β = 0.088, P = .014), lower pain levels (β = -0.10, P = .048), and higher BPII 2.0 scores (β = 0.98, P = .019). These associations remained statistically significant after adjusting for confounding variables (function: β = 0.096, P = .011; pain: β = -0.11, P = .044; BPII 2.0: β = 0.91, P = .037). Based on a cohort-specific minimal clinically important difference analysis, 89% of patients achieved clinically meaningful improvement in BPII 2.0, 77% in pain, and 88% in function. The multivariable models exhibited moderate explanatory power, with adjusted R2 values ranging from 0.03 to 0.06. CONCLUSIONS: The preoperative sTTTG distance is significantly associated with postoperative patient-reported outcomes in individuals undergoing deepening trochleoplasty. Higher sTTTG values were associated with better functional recovery, reduced pain, and enhanced patellofemoral quality of life. LEVEL OF EVIDENCE: Level IV, retrospective cohort study.