Steiner Timothy M, Torga-Spak Roger, Teitge Robert A
Wayne State University, Department of Orthopedic Surgery, UHC-7C, 4201 St Antoine, Detroit, MI 48201, USA.
Am J Sports Med. 2006 Aug;34(8):1254-61. doi: 10.1177/0363546505285584. Epub 2006 Mar 27.
Reconstruction of the medial patellofemoral ligament has been proven to restore stability in patients with lateral patellar instability. No study to date has examined the results in a patient population with the predisposing factor of femoral trochlear dysplasia.
Reconstruction of the medial patellofemoral ligament restores stability and provides pain relief in patients who have lateral patellar instability in association with trochlear dysplasia.
Case series; Level of evidence, 4.
Thirty-four patients with chronic patellar instability and trochlear dysplasia were treated with medial patellofemoral ligament reconstruction using an adductor tendon autograft, bone-quadriceps tendon autograft, or bone-patellar tendon allograft. All patients were evaluated preoperatively and postoperatively with Kujala, Lysholm, and Tegner scores at a minimum of 24 months.
Thirty-four patients were followed for a mean of 66.5 months (range, 24-130 months) after surgery. Kujala scores improved from 53.3 to 90.7, Lysholm scores improved from 52.4 to 92.1, and Tegner activity scores improved from 3.1 to 5.1. All improvements were highly statistically significant (P < .001). No statistical difference was found between the postoperative Lysholm, Kujala, and Tegner scores and the degree of dysplasia, graft type, or degree of symptoms. There were 85.3% and 91.1% good and excellent results based on Kujala and Lysholm scores, respectively. No recurrent dislocations have occurred.
Medial patellofemoral ligament reconstruction provides excellent long-term pain relief and functional return in patients with patellar instability and femoral trochlear dysplasia. In addition, reconstruction prevents recurrent dislocation, despite the diminished bony constraint of a dysplastic trochlea.
内侧髌股韧带重建已被证明可恢复外侧髌股不稳定患者的稳定性。迄今为止，尚无研究对存在股骨滑车发育不良这一易感因素的患者群体的治疗结果进行评估。
内侧髌股韧带重建可恢复伴有滑车发育不良的外侧髌股不稳定患者的稳定性并缓解疼痛。
病例系列；证据等级，4级。
34例患有慢性髌股不稳定和滑车发育不良的患者接受了内侧髌股韧带重建术，采用的自体移植物为内收肌腱、骨 - 股四头肌肌腱，同种异体移植物为骨 - 髌腱。所有患者在术前和术后至少24个月时使用库贾拉（Kujala）、利绍尔姆（Lysholm）和特格纳（Tegner）评分进行评估。
34例患者术后平均随访66.5个月（范围为24 - 130个月）。库贾拉评分从53.3提高到90.7，利绍尔姆评分从52.4提高到92.1，特格纳活动评分从3.1提高到5.1。所有改善均具有高度统计学意义（P < 0.001）。术后利绍尔姆、库贾拉和特格纳评分与发育不良程度、移植物类型或症状程度之间未发现统计学差异。根据库贾拉和利绍尔姆评分，分别有85.3%和91.1%的结果为良好和优秀。未发生复发性脱位。
内侧髌股韧带重建为髌股不稳定和股骨滑车发育不良患者提供了出色的长期疼痛缓解和功能恢复。此外，尽管发育不良的滑车骨约束减弱，但重建可防止复发性脱位。
