Nomura Eiki, Inoue Motoyasu, Kobayashi Shigeru
Department of Orthopaedic Surgery, Saitama Municipal Hospital, 2460, Mimuro, Midori-ku, Saitama 336-8522, Japan.
Am J Sports Med. 2007 Nov;35(11):1851-8. doi: 10.1177/0363546507306161. Epub 2007 Aug 27.
Proximal or distal realignment procedures have long been selected as treatment for recurrent patellar dislocation, but associated knee osteoarthritis has been a substantial problem that leads to poor results. A new approach, medial patellofemoral ligament reconstruction, has recently started, but there have been no reports on the long-term follow-up.
Anatomical medial patellofemoral ligament reconstruction can lead to satisfactory long-term outcome and a low association rate of knee osteoarthritis.
Case series; Level of evidence, 4.
Twenty-four knees from 22 patients who underwent medial patellofemoral ligament reconstruction for recurrent patellar dislocation were reviewed at a mean follow-up of 11.9 years (range, 8.5-17.2 years). A lateral release was done on 14 of 24 knees. The clinical/physical outcome and the association of knee osteoarthritis were investigated. Patellofemoral and femorotibial osteoarthritis on the radiographs was evaluated using the Crosby/Insall and the Kellgren/Lawrence grading systems.
According to the Crosby/Insall criteria, 11 knees (46%) were classified as excellent, 10 (42%) as good, 3 (12%) as fair/poor, and none as worse at follow-up. Further lateral subluxation or dislocation occurred in only 2 knees. The mean Kujala score improved significantly from 63.2 points preoperatively to 94.2 points at follow-up (P < .0001). According to the Crosby/Insall grading system, patellofemoral osteoarthritis was none to mild in 23 of the 24 knees and moderate in 1 knee, pre-operatively. At the final follow-up, 21 knees were none to mild, and 3 knees were moderate. There were only 2 knees that had definite progression from none to mild to a moderate grade.
The association of definite knee osteoarthritis in medial patellofemoral ligament reconstruction with or without lateral release was small in the long-term follow-up. The conclusion is that medial patellofemoral ligament reconstruction not only prevents further patellar dislocation but also shows no or only slight progression of knee osteoarthritis.
长期以来，近端或远端重新排列手术一直被选作复发性髌骨脱位的治疗方法，但相关的膝关节骨关节炎一直是导致疗效不佳的一个重大问题。一种新的方法，即髌股内侧韧带重建术，最近已开始应用，但尚无长期随访报告。
解剖学髌股内侧韧带重建可带来满意的长期疗效，且膝关节骨关节炎的发生率较低。
病例系列；证据等级，4级。
对22例因复发性髌骨脱位接受髌股内侧韧带重建术的患者的24个膝关节进行回顾性研究，平均随访11.9年（范围8.5 - 17.2年）。24个膝关节中的14个进行了外侧松解。对临床/体格检查结果及膝关节骨关节炎的相关性进行了调查。使用克罗斯比/英萨尔（Crosby/Insall）和凯尔格伦/劳伦斯（Kellgren/Lawrence）分级系统评估X线片上的髌股关节和股胫关节骨关节炎情况。
根据克罗斯比/英萨尔标准，随访时11个膝关节（46%）评为优，10个（42%）评为良，3个（12%）评为中/差，无评为差的。仅2个膝关节出现进一步的外侧半脱位或脱位。库贾拉（Kujala）评分均值从术前的63.2分显著提高到随访时的94.2分（P <.0001）。根据克罗斯比/英萨尔分级系统，术前24个膝关节中23个髌股关节骨关节炎为无至轻度，1个为中度。末次随访时，21个膝关节为无至轻度，3个膝关节为中度。仅有2个膝关节从无至轻度明确进展为中度。
在长期随访中，无论是否行外侧松解，髌股内侧韧带重建术中明确的膝关节骨关节炎发生率较低。结论是，髌股内侧韧带重建术不仅可防止髌骨进一步脱位，而且膝关节骨关节炎无进展或仅轻微进展。
