PDF(Pubmed)
Abstract：
Background: Anterior knee pain is a common reason for referral to a pediatric orthopedic surgeon. Although previous studies have found that adults with anatomic risk factors for patellofemoral instability (patella dislocation) are predisposed to anterior knee pain, no studies have elucidated the relationship between anatomic risk factors for patellofemoral instability and anterior knee pain in children. Purpose: We sought to characterize common radiographic findings in adolescent patients with a chief complaint of anterior knee pain and to determine the prevalence of abnormal patellofemoral morphology. Methods: We conducted a retrospective review of patients 13 to 18 years old with anterior knee pain at a single tertiary care metropolitan institution from 2016 to 2021. X-rays and magnetic resonance imaging (MRI) were evaluated in those diagnosed with \"chondromalacia patellae,\" \"chondromalacia,\" \"patellofemoral disorders,\" or \"anterior knee pain.\" Patella alta, tibial tubercle-trochlear groove (TT-TG) distance, tubercle height, Wiberg patella type, patellar tilt, and trochlear dysplasia characterization were recorded. Results: Of the 293 adolescents with anterior knee pain included, 62 had bilateral anterior knee pain. Of the 172 MRIs, 72 (42%) met criteria for patella alta, Caton-Deschamps Index (CDI) >1.3, 35% had a TT-TG distance >15 mm, and 32% had lateral patellar tilt >15°. Magnetic resonance imaging findings included infrapatellar fat pad signal hyperintensity (41%) and patellofemoral dysplasia (23%). Of all 293 adolescents, 74% had images showing abnormal patellofemoral morphology, of which 30% had a history of 1 or more patellar dislocation. Overall, 40% of the adolescents had surgery, most commonly medial patellofemoral ligament (MPFL) reconstruction (18%). Conclusions: In this retrospective review, nearly 3/4 of adolescents with anterior knee pain had images showing abnormal patellofemoral morphology, including patella alta, increased TT-TG distance, trochlear dysplasia, or abnormal lateral patellar tilt; only 18% had MPFL surgery. These findings suggest that primary care providers might consider obtaining X-rays and/or MRIs to evaluate for pathology that warrants orthopedic evaluation.
摘要：
背景：膝前疼痛是转诊给小儿骨科医生的常见原因。尽管先前的研究发现，患有髌股不稳定（髌骨脱位）的解剖危险因素的成年人易患膝前疼痛，尚无研究阐明儿童髌股不稳定的解剖危险因素与膝关节前疼痛之间的关系。目的：我们试图描述以前膝疼痛为主要主诉的青少年患者的常见影像学表现，并确定髌股形态异常的患病率。方法：我们对2016年至2021年在一家三级护理大都市机构治疗的13至18岁的前膝疼痛患者进行了回顾性研究。对诊断为髌骨软化症的患者进行X线和磁共振成像(MRI)评估，\"\"软骨病,髌股疾病,“或”膝前疼痛。\"髌骨阿尔塔，胫骨结节-滑车沟（TT-TG）距离，结节高度,Wiberg髌骨型,髌骨倾斜,记录滑车发育不良的特征。结果：在293名患有膝前疼痛的青少年中，62例出现双侧膝前疼痛。在172个MRI中，72（42%）符合髌骨标准，卡顿-德尚指数（CDI）>1.3，35％的TT-TG距离>15毫米，32%髌骨外侧倾斜>15°。磁共振成像结果包括髌下脂肪垫信号高强度(41%)和髌股发育不良(23%)。在所有293名青少年中，74%的患者有髌股形态异常的影像,其中30％有1个或更多个髌骨脱位的历史。总的来说,40%的青少年接受了手术，最常见的内侧髌股韧带（MPFL）重建（18％）。结论：在这篇回顾性综述中，近3/4的青少年膝前疼痛图像显示髌股形态异常，包括髌骨,TT-TG距离增加，滑车发育不良,或髌骨外侧倾斜异常；只有18%的患者接受了MPFL手术。这些发现表明，初级保健提供者可能会考虑获得X射线和/或MRI来评估值得骨科评估的病理。
