术前MRI预测对改善关节镜治疗慢性髌腱末端病变临床疗效的价值

Prognostic value of preoperative MRI in arthroscopic treatment of chronic patellar tendinopathy

摘要:

摘要：目的??探讨术前磁共振成像（MRI）预测关节镜治疗慢性髌腱末端病变（PT）功能结局和运动恢复情况的价值。方法?前瞻性分析28例接受关节镜下髌骨松解术（APR）的PT患者（女4例，男24例）的临床资料。手术时患者平均年龄为28.2岁（18～49岁），平均随访4.2年（2.2～10.4年）。术前MRI表现包括：髌骨下极骨髓水肿（BME）、髌腱增厚、髌下脂肪垫（IFP）水肿和髌下滑囊炎。分析术前MRI诊断各病变的发生率与功能结局的相关性，以确定术前MRI表现的预后价值。结果?所有患者术后均恢复至伤前运动水平。有IFP水肿患者和无IFP水肿患者术后改良Blazina评分[（0.6±0.1）和（0.2±0.1）分]、膝关节功能评分（SANE）[（86.0±8.8）和（94.3±7.5）分]和疼痛视觉模拟评分（VAS）[（1.0±0.2）和（0.3±0.1）分]比较，差异均有统计学意义（P <0.05）。所有患者恢复运动时间（4.0±1.2）个月，IFP水肿患者恢复运动时间（6.5±3.8）个月，明显长于无IFP水肿者（2.8±1.0）个月，差异有统计学意义（P <0.05）。与单纯性BME或IFP水肿患者比较，BME合并IFP患者术后维多利亚运动学院评分（VISA）[（88.1±11.9）和（98.6±4.2）分]、SANE评分[（84.3±10.2）和（93.1±8.3）分]和VAS评分[（1.3±0.4）和（0.3±0.1）分]明显比单纯性BME或IFP水肿患者差，BME合并IFP与预后差相关。结论?术前MRI显示，BME合并IFP水肿与功能预后不良和运动恢复延迟相关。了解这些预测因素可改进危险分层，使治疗和术后康复实现个性化，有助于提高临床疗效。

Abstract:

Abstract: Objective?To investigate whether preoperatively assessed MRI parameters might be of prognostic value for prediction of functional outcome and return to sports in arthroscopic treatment of chronic patellar tendinopathy (PT).?Methods?A prospective cohort study was conducted including 28 cases (4 female and 24 male competitive athletes) underwent arthroscopic patellar release (APR) due to chronic PT. The mean age was 28.2 years old (range, 18 ~ 49 years old) at the time of surgery, and the mean follow-up period was 4.2 years old (range, 2.2 ~ 10.4 years old). Preoperatively assessed MRI parameters included bone marrow edema (BME) of the inferior patellar pole, patellar tendon thickening, infrapatellar fat pad (IFP) edema, and infrapatellar bursitis. Prevalences of preoperative MRI findings were correlated to functional outcome scores in order to determine statistically significant predictors.?Results?All the athletes regained their preinjury sports levels. Athletes featuring postoperative IFP edema showed significantly inferior modified Blazina score (0.6 ± 0.1) vs (0.2 ± 0.1), single assessment numeric evaluation (SANE) (86.0 ± 8.8) vs (94.3 ± 7.5), and visual analogue scale (VAS) (1.0 ± 0.2) vs (0.3 ± 0.1) compared to subjects without IFP edema (P < 0.05). Return to sports required a mean of (4.0 ± 1.2) months. On average, patients with IFP edema needed significantly more time to return to sports than subjects without IFP edema (6.5 vs 2.8 months; P < 0.05). The simultaneous presence of BME and IFP edema was associated with significantly inferior outcomes by means of the Victorian Institute of Sport Assessment questionnaire for patients with patellar tendinopathy (VISA) (88.1 ± 11.9) vs (98.6 ± 4.2), SANE (84.3 ± 10.2) vs (93.1 ± 8.3), and VAS (1.3 ± 0.4) vs (0.3 ± 0.1) compared to an isolated BME or isolated IFP edema.?Conclusion?Preoperative IFP edema alone or simultaneous BME and IFP edema on preoperative MRI were associated with inferior functional outcome and delayed return to sports. Knowledge of these predictive factors might improve risk stratification, individualize treatment and postoperative rehabilitation, and contribute to improve clinical outcome.