外侧髌骨不稳患者基线体力活动与形态学因素的相关性
简介
该研究回顾性分析了111例因外侧髌骨不稳行MPFL重建患者的基线体力活动水平与髌股关节形态学参数的关系，按运动参与度分为竞技、休闲及非运动三组。结果显示竞技组滑车深度显著大于其他组，但双侧手术率仍较高，非运动组亦呈较高双侧手术率，可能反映更严重的滑车发育不良。提示年轻髌骨不稳患者的手术适应证制定需同时考虑基线活动水平与滑车形态。
英文摘要
BACKGROUND: Lateral patellar instability is more common in adolescents and young adults, and morphologic factors contribute to patellar dislocation. However, the relationship between baseline physical activity and morphologic risk factors in this population remains unclear. PURPOSE: To investigate the association between baseline physical activity and morphologic factors in patients with lateral patellar instability. STUDY DESIGN: Cohort study; Level of evidence 3. METHODS: A total of 111 knees of 75 patients (mean ± SD age, 20.4 ± 10.0 years) undergoing medial patellofemoral ligament reconstruction for lateral patellar instability were retrospectively analyzed. Patients were stratified into the competitive sports (n = 34), recreational sports (n = 18), and nonsports (n = 23) groups based on presymptom activity. Imaging parameters included trochlear depth (TD), Dejour classification and patellar height (Insall-Salvati ratio [ISR]) on preoperative lateral radiographs; congruence angle (CA), sulcus angle (SA), and tilt angle (TA) on Merchant view; and tibial tuberosity-trochlear groove (TT-TG) distance on preoperative computed tomography. To compare morphological parameters among the 3 groups, generalized estimating equations were used to account for within-patient clustering. RESULTS: The nonsports group had a significantly higher mean age (P < .01). Bilateral knee surgeries were more frequent in competitive and nonsports groups (P = .04). Mean TD was 1.9 mm (95% CI, 1.4-2.3 mm) in the competitive group, 1.0 mm (0.3-1.6 mm) in the recreational group, and 1.1 mm (0.6-1.6 mm) in the nonsports group; TD was significantly higher in the competitive group than in the other groups (P = .02). Mean CA was 8.4° (7.3°-9.5°), 9.1° (7.8°-10.4°), and 6.8° (5.5°-8.0°), respectively, with a significant difference between the recreational and nonsports groups (P = .03). No group differences were observed for ISR, SA, TA, TT-TG, and Dejour classification. CONCLUSION: Many competitive athletes demonstrated greater TD but nonetheless frequently underwent bilateral surgical procedures. Similarly, nonsports participants also showed a high rate of bilateral procedures, which may reflect more severe trochlear dysplasia rather than activity-related demand alone. These findings highlight the importance of considering both baseline activity level and trochlear morphology when determining surgical indications in young patients with lateral patellar instability.