■下肢排列不良与剥脱性骨软骨炎(OCD)有关。然而,强迫症病变的位置通常与机械腿轴不一致。其他可能修改的对准参数可能会影响股骨髁撞击的倾向。
■评估股骨髁内侧(MFC-OCD)或外侧OCD(LFC-OCD)患者下肢对位(LLA)和相对胫骨位置的差异。
■队列研究;证据水平,3.
在2010年1月至2020年1月期间诊断为单髁强迫症的≤30岁患者符合本研究的条件。包括55名患者(年龄,20.8±4.5年)-46患有MFC-OCD,9患有LFC-OCD。研究了术前站立的长腿X光片,以获得主要结果-包括LLA和机械对准分析-以及次要结果-包括膝关节倾角;旋转角;内侧,中央(c-半脱位),和在冠状平面中胫骨相对于股骨的外侧半脱位(L-半脱位);和胫股关节线中心距离(TFJCD)。
■关于主要结果,LLA在MFC-OCD(1.7°±3.1°内翻)和LFC-OCD(2.7±3.1°外翻)之间存在显着差异(P<0.001),78%(36/46)的MFC-OCD患者存在内翻对准,而78%(7/9)的LFC-OCD患者存在外翻比对(P<0.002)。关于次要结果,MFC-OCD患者的胫骨位置相对于股骨更内侧,旋转角度明显较小(5.6°±2.4°vs9.6°±3.6°;P<.001),较小的C半脱位(7.2±6.6vs14.9±8.8mm;P<.01),较小的L-半脱位(2.3±2.6vs4.4±2.7mm;P<0.05),与LFC-OCD组相比,TFJCD减少(3.5±1.7vs6.6±1.8mm;P<.001)。对于MFC-OCD患者,强迫症的大小与C脱位显着相关(r=0.412;P=.006)。
■LLA根据OCD位置而显着不同。在MFC-OCD患者中,胫骨中间半脱位,通过将胫骨内侧隆突逼近股骨内侧髁,导致关节几何形状发生变化,可能导致过度的压力超负荷和软骨的微创伤。有趣的是,半脱位的程度与强迫症大小相关。
UNASSIGNED: Lower limb malalignment has been associated with osteochondritis dissecans (OCD). However, the location of the OCD lesion often is not concordant with the mechanical leg axis. Other potentially modifiable alignment parameters may influence the propensity for
impingement of the femoral condyles.
UNASSIGNED: To assess differences in lower limb alignment (LLA) and relative tibiofemoral position between patients with medial (MFC-OCD) or lateral OCD (LFC-OCD) of the femoral condyle.
UNASSIGNED: Cohort study; Level of evidence, 3.
UNASSIGNED: Patients ≤30 years old who were diagnosed with unicondylar OCD between January 2010 and January 2020 were eligible for this study. Included were 55 patients (age, 20.8 ± 4.5 years)-46 with MFC-OCD and 9 with LFC-OCD. Preoperative standing long-leg radiographs were studied to obtain primary outcomes-including LLA and mechanical alignment analyses-and secondary outcomes-including knee joint obliquity angle; rotation angle; medial, central (c-subluxation), and lateral subluxation (L-subluxation) of the tibia relative to the femur in the coronal plane; and tibiofemoral joint line center distance (TFJCD).
UNASSIGNED: With regard to primary outcomes, LLA was significantly different between MFC-OCD (1.7°± 3.1° varus) and LFC-OCD (2.7 ± 3.1° valgus) (P < .001), and 78% (36/46) of patients with MFC-OCD had varus alignment, whereas 78% (7/9) of patients with LFC-OCD had valgus alignment (P < 0.002). With regard to secondary outcomes, patients with MFC-OCD had a more medial tibial position in relation to the femur, with a significantly smaller rotation angle (5.6°± 2.4° vs 9.6°± 3.6°; P < .001), a smaller C-subluxation (7.2 ± 6.6 vs 14.9 ± 8.8 mm; P < .01), a smaller L-subluxation (2.3 ± 2.6 vs 4.4 ± 2.7 mm; P < .05), and reduced TFJCD (3.5 ± 1.7 vs 6.6 ± 1.8 mm; P < .001) compared with the LFC-OCD group. For patients with MFC-OCD, the size of the OCD was significantly correlated with C-subluxation (r = 0.412; P = .006).
UNASSIGNED: LLA was significantly different according to OCD location. In patients with MFC-OCD, the tibia was subluxated medially, resulting in a change of joint geometry by approximation of the medial tibial eminence toward the medial femoral condyle, potentially causing excessive pressure overload and microtrauma of the cartilage. Interestingly, the extent of subluxation was correlated with OCD size.