PDF(Pubmed)
Abstract：
Patella alta is a clinical condition where the patella is positioned too proximal in relation to the femoral trochlea. Such an abnormality may cause patellar instability and predispose to recurrent patellofemoral dislocations and patellofemoral pain. There are no conclusive guidelines for determining a threshold for too high positioned patella, as several different methods have been described to measure patellar height. As a surgical solution, distalising tibial tubercle osteotomy has been described to correct excessive patellar height. In the early phase of the distalising tibial tubercle osteotomy postoperative protocol, weightbearing and knee flexion are limited with a brace commonly for 4-8 weeks to avoid potential implant failure leading to displacement of the osteotomy or non-union. The potential risks for adverse effects associated with the limitation rehabilitation protocol include a delay in regaining knee range of motion, stiffness and muscle weakness. As a result, recovery from surgery is delayed and may lead to additional procedures and long-term morbidity in knee function. This is a prospective, randomised, controlled, single-blinded, single centre trial comparing a novel accelerated rehabilitation protocol with the traditional, motion restricting rehabilitation protocol. All skeletally mature patients aged 35 years and younger, referred to as the distalising tibial tubercle osteotomy procedure group, are eligible for inclusion in the study. Patients will be randomised to either the fast rehabilitation group or the traditional rehabilitation group. Patients with patellar instability will be additionally treated with medial patellofemoral ligament reconstruction. The hypothesis of the trial is that the novel accelerated rehabilitation protocol will lead to faster recovery and improved functional outcome at 6, 12 and 24 weeks compared with the conservative rehabilitation protocol. A secondary hypothesis is that the complication rate will be similar in both groups. The study will document short-term recovery and the planned follow-up will be 3 years. After the 1-year follow-up, the trial results will be disseminated in a major peer-reviewed orthopaedic publication. Protocol version 3.6, date 28/11/2023.
摘要：
髌骨是一种临床疾病，其中髌骨相对于股骨滑车定位得太近。这种异常可能导致髌骨不稳定，并容易导致复发性髌股脱位和髌股疼痛。没有结论性的指导方针来确定髌骨位置过高的阈值，已经描述了几种不同的方法来测量髌骨高度。作为一种手术解决方案，胫骨结节截骨术已被描述为纠正髌骨高度过高。在胫骨结节截骨术术后方案的早期阶段，通常使用支具限制负重和膝关节屈曲4-8周，以避免潜在的植入物失败，导致截骨移位或不愈合。与限制康复方案相关的不良反应的潜在风险包括恢复膝关节运动范围的延迟，僵硬和肌肉无力。因此,手术后的恢复会延迟，并可能导致额外的手术和膝关节功能的长期发病。这是一个潜在的，随机化，控制,单盲,单中心试验将新型加速康复方案与传统的，运动限制康复方案。所有35岁及以下的骨骼成熟患者，称为胫骨结节截骨术组，有资格纳入研究。患者将被随机分配到快速康复组或传统康复组。髌骨不稳定的患者将接受内侧髌股韧带重建治疗。该试验的假设是，与保守的康复方案相比，新的加速康复方案将在6、12和24周导致更快的恢复和改善的功能结果。次要假设是两组的并发症发生率相似。该研究将记录短期恢复情况，计划的随访时间为3年。经过1年的随访，试验结果将在同行评审的主要骨科出版物中传播.议定书3.6版，日期：2023年11月28日。
