Abstract：
The likelihood of patellar instability and consequently, risk of patellar dislocations is higher in those with anatomical abnormalities. Fibular hemimelia is a congenital disorder resulting in partial or full absence of the fibula, often with absence of the lateral and cruciate ligaments, although this patient group rarely undergoes ligament reconstruction. There is potential for adverse outcomes, in the longer term, including, possible increased risk of patellar dislocation and pain in the knee and hip. We aim to investigate the potential risk of spontaneous, unprovoked patellar dislocation among patients with fibular hemimelia, through a review of medical records and radiological investigations. All patients with a diagnosis of fibular hemimelia were included (n = 25), regardless of ultimate approach to management. Tibiofemoral angle measurement and Caton-Deschamps indices were calculated where suitable radiology was available, to better establish extent of potential patellar instability. All the patients with normal Caton-Deschamps indices had only partial fibular absence, although this does not detract from absence or hypoplasia of the anterior cruciate ligament, as a risk factor for patellar dislocation by predisposing to anterior tibial translation. Notably, of the three patients with increased Caton-Deschamps indices, two had complete fibular absence and underwent definitive amputation surgery at age 18 months and 3 years, respectively. Ultimately, this was a young patient group and on-going follow-up might yield better understanding of knee stability. Maintaining a well-aligned lower limb throughout growth might be protective even in the presence of anatomical abnormalities. This article mainly aims to raise awareness among prosthetic and orthotic professionals regarding the increased risk of patella dislocations.
摘要：
髌骨不稳定的可能性，解剖异常的患者发生髌骨脱位的风险较高.腓骨半球症是一种先天性疾病，导致腓骨部分或完全缺失，通常没有外侧和交叉韧带，尽管该组患者很少进行韧带重建。有可能出现不良后果，从长远来看，包括,可能增加髌骨脱位和膝关节和髋关节疼痛的风险。我们的目标是调查自发性的潜在风险，腓骨半角症患者无端髌骨脱位，通过对医疗记录和放射调查的审查。纳入所有诊断为腓骨半位症的患者（n=25），无论最终的管理方法如何。在有合适的放射学的情况下，计算了胫骨股角度测量和卡顿-德尚指数，以更好地确定潜在髌骨不稳定的程度。所有卡顿-德尚指数正常的患者只有部分腓骨缺失，虽然这并不影响前交叉韧带的缺失或发育不全，通过诱发胫骨前平移作为髌骨脱位的危险因素。值得注意的是,在卡顿-德尚指数增加的三名患者中，两个人完全腓骨缺失，在18个月和3岁时接受了明确的截肢手术，分别。最终,这是一个年轻的患者组,持续的随访可能会更好地了解膝关节稳定性.即使在存在解剖异常的情况下，在整个生长过程中保持对齐良好的下肢也可能是保护性的。本文主要旨在提高假肢和矫正专业人员对髌骨脱位风险增加的认识。
