Effects of arthroscopic patelloplasty combined with lateral patellar retinaculum release and circumpatellar denervation in treatment of moderate and severe patellofemoral osteoarthritis / 中华创伤杂志

ABSTRACT

Objective To investigate the clinical effects of arthroscopic patelloplasty combined with lateral patellar retinaculum release and circumpatellar denervation for treatment of moderate and severe patellofemoral osteoarthritis.Methods A retrospective case-control study was done on 80 patients with moderate to severe patellofemoral osteoarthritis who were treated in our hospital between March 2013 and March 2015.According to treatment methods,the patients were divided into two groupsGroup A including 40 cases (22 cases of Outerbridge grade Ⅲ degree and 18 cases of Outerbridge grade Ⅳ) undergone arthroscopic debridement,and Group B including 40 cases (22 cases of Outerbridge grade Ⅲ degree and 18 cases of Outerbridge grade Ⅳ) undergone arthroscopic patelloplasty combined with lateral patellar retinaculum release and circumpatellar denervation.The Kujula scores and Lysholm scores of the patellofemoral joint were compared between the two groups before and after operation.The lateral patellofemoral angle was measured according to patellar axial X-ray performed 3 months after operation to evaluate patellofemoral joint function.Results All patients were followed up for 13-36 months (average 19.8 months).The patellofemoral joint scores of the two groups was increased at different degrees after operation.In moderate patellofemoral osteoarthritis patients,at 3 months after operation and the last follow-up of Group B,Kujula scores [(85.1 ± 6.8)points,(86.8 ± 4.6)points] and Lysholm scores [(88.1 ± 1.8) points,(88.4 ± 2.3) points] were higher than that of Group A [(78.1 ± 5.7) points,(78.3±5.3)points,(82.4 ±2.9)points,and (82.5 ±2.5)points] (P＜0.05).In each group,the Kujula scores and Lysholm scores at 3 months after operation and the last follow-up were improved to be higher than preoperation (P ＜ 0.05),with insignificant statistical difference between the two groups (P ＞ 0.05).According to the Lysholm scores,the excellent rate after operation in Group B (86％) was higher than that of Group A (55％) (P ＜ 0.05).For patients with severe patellofemoral osteoarthritis,Kujula scores [(72.3 ± 5.3) points,(72.7 ± 3.6) points] and Lysholm scores [(75.1 ± 1.9) points,(75.3 ± 2.3) points] at 3 months postoperatively and at the last follow-up in Group B were higher than that of Group A [(70.8 ± 5.2) points,(71.1 ± 4.2) points,(73.4 ± 2.8) points,and (73.6 ± 2.5) points],but the difference was not statistically significant (P ＞ 0.05).Within each group,although the Kujula scores and Lysholm scores at 3 months postoperatively and at the last follow-up were improved compared with before operation,but the difference was not statistically significant (P ＞ 0.05).According to the Lysholm scores,although the excellent rate after operation of Group B (33％) was higher than that of Group A (28％),with insignificant statistical difference (P ＞ 0.05).No matter Outerbridge Ⅲ or Ⅳ patellofemoral osteoarthritis a patient was,the lateral patellofemoral angle of Group A after operation had no significant improvement (P ＞ 0.05),while Group B showed significant improvement after operation (P ＜0.01).Group B had better improvements than that of Group A (P ＜0.01).Conclusions Compared with simple arthroscopic debridement,patelloplasty combined with lateral patellar retinaculum release and circumpatellar denervation can better relieve the symptoms of moderate patellofemoral osteoarthritis and improve knee function.But for patients with severe patellofemoral osteoarthritis,this method is not effective.