Post-operative joint stiffness after Bereiter trochleoplasty does not affect 2-year improvement in patient-reported outcomes. A prospective cohort study of 374 Bereiter trochleoplasties

IF 5 2区医学 Q1 ORTHOPEDICS Knee Surgery, Sports Traumatology, Arthroscopy Pub Date : 2025-03-07 DOI:10.1002/ksa.12645

Christian Dippmann, Christos Soleas, Anke Simone Rechter, Volkert Siersma, Kristoffer Weisskirchner Barfod, Peter Lavard

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Abstract

Purpose

Bereiter trochleoplasty (TP) is a well-described procedure to address trochlear dysplasia (TD). Post-operative joint stiffness with reduced range of motion (ROM) is a common complication usually requiring arthroscopically assisted manipulation (AAM) with the removal of adhesions and scar tissue. Inferior clinical outcomes after TP have been reported for patients with subsequent surgery. We hypothesised that a 2-year improvement in patient-reported outcomes would be lower in patients treated with AAM.

Methods

This was a retrospective cohort study of prospectively collected data comparing subgroups of patients with and without post-operative joint stiffness from a consecutive cohort of 374 knees with high-grade TD who underwent TP according to the Copenhagen patello-femoral instability (PFI) algorithm. All patients received supervised training exercises led by a physiotherapist. At 3-month follow-up, patients with an extension deficit >10° and/or flexion <120° were diagnosed with post-operative joint stiffness and treated with AAM. Outcomes were mean differences from baseline in Kujala, Knee injury and Osteoarthritis Outcome Score (KOOS) and Lysholm scores 1 and 2 years after surgery.

Results

Forty-nine (38 females, 11 males) of the 374 knees (12%) had post-operative joint stiffness and underwent AAM. Nine patients underwent subsequent AAMs. Full extension and flexion >135° were achieved in 37 out of 49 cases (75%). In 11 cases, flexion remained reduced, while data on ROM could not be retrieved in one case. While both patients with and without AAM showed clinically relevant improvements in the Kujala, KOOS and Lysholm scores, no statistically significant between-group differences were seen in these improvements.

Conclusions

Post-operative joint stiffness was a common complication after Bereiter TP following the Copenhagen PFI algorithm. Twenty-five per cent of the AAM patients, or 3% of the study population, did not regain full ROM. We did not find that post-operative joint stiffness was associated with inferior improvements in patient-reported outcomes 1 and 2 years after surgery.

Level of Evidence

Level IV, a retrospective cohort study.

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Bereiter滑车成形术后的术后关节僵硬不影响患者报告的2年预后改善。一项对374例股骨滑骨成形术患者的前瞻性队列研究。

目的：小滑车成形术（TP）是一种治疗滑车发育不良（TD）的好方法。术后关节僵硬伴活动范围减小（ROM）是常见的并发症，通常需要关节镜辅助操作（AAM）去除粘连和疤痕组织。有报道称，TP术后患者的临床效果较差。我们假设，在AAM治疗的患者中，患者报告的2年预后改善程度较低。方法：这是一项回顾性队列研究，前瞻性收集数据，比较374例根据哥本哈根髌骨-股骨不稳定（PFI）算法接受TP治疗的高级别TD患者中有和没有术后关节僵硬的患者亚组。所有患者都接受了由物理治疗师指导的有监督的训练。在3个月的随访中，374个膝关节中有49个（38个女性，11个男性）（12%）出现术后关节僵硬并接受了AAM。9例患者随后接受了AAMs。49例患者中有37例（75%）达到完全伸展和屈曲bbb135°。在11例中，屈曲仍然减少，而ROM上的数据无法检索1例。虽然患有和不患有AAM的患者在Kujala， kos和Lysholm评分方面均表现出临床相关的改善，但这些改善在组间无统计学差异。结论：关节僵硬是哥本哈根PFI算法下Bereiter TP术后常见的并发症。25%的AAM患者，或3%的研究人群，没有恢复完全的ROM。我们没有发现术后关节僵硬与患者术后1年和2年报告的预后改善差相关。证据等级：四级，回顾性队列研究。

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来源期刊

Knee Surgery, Sports Traumatology, Arthroscopy 医学-外科

CiteScore

8.10

自引率

18.40%

发文量

418

审稿时长

2 months

期刊介绍： Few other areas of orthopedic surgery and traumatology have undergone such a dramatic evolution in the last 10 years as knee surgery, arthroscopy and sports traumatology. Ranked among the top 33% of journals in both Orthopedics and Sports Sciences, the goal of this European journal is to publish papers about innovative knee surgery, sports trauma surgery and arthroscopy. Each issue features a series of peer-reviewed articles that deal with diagnosis and management and with basic research. Each issue also contains at least one review article about an important clinical problem. Case presentations or short notes about technical innovations are also accepted for publication. The articles cover all aspects of knee surgery and all types of sports trauma; in addition, epidemiology, diagnosis, treatment and prevention, and all types of arthroscopy (not only the knee but also the shoulder, elbow, wrist, hip, ankle, etc.) are addressed. Articles on new diagnostic techniques such as MRI and ultrasound and high-quality articles about the biomechanics of joints, muscles and tendons are included. Although this is largely a clinical journal, it is also open to basic research with clinical relevance. Because the journal is supported by a distinguished European Editorial Board, assisted by an international Advisory Board, you can be assured that the journal maintains the highest standards. Official Clinical Journal of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA).