Watanabe Toshifumi, Muneta Takeshi, Ikeda Hiroo, Tateishi Tomohiko, Sekiya Ichiro
Department of Orthopaedic Surgery, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan.
J Orthop Sci. 2008 Jan;13(1):32-8. doi: 10.1007/s00776-007-1196-0. Epub 2008 Feb 16.
We studied the efficacy of medial patellofemoral ligament (MPFL) reconstruction, with or without tibial tubercle (TT) transfer, for recurrent dislocation of the patella, based on subjective functional assessment using the visual analog scale (VAS).
Forty-two consecutive knees of 40 patients who underwent MPFL reconstruction using a hamstring tendon were followed up for an average of 4.3 years. Twenty-nine knees underwent MPFL reconstruction (MPFL group) and 13 knees underwent MPFL reconstruction combined with medial transfer of TT (TT+MPFL group). Clinical results, including the VAS score at the latest follow-up in both groups, were assessed.
An apparent deficit in the range of motion was observed in two cases from the TT+MPFL group. The ratio of negative apprehension test was significantly improved from 3% preoperatively to 79% postoperatively in the MPFL group and from 8% to 69% in the TT+MPFL group. The Lysholm scores were significantly improved from 70 points preoperatively to 92 points postoperatively in the MPFL group and from 72 points to 90 points in the TT+MPFL group. There was no significant difference between the two groups in the ratios of negative apprehension tests and the Lysholm scores after surgery as well as before surgery. In the VAS assessment, the MPFL group scored significantly higher than the TT+MPFL group in "Japanese full sitting" (average score 92 vs 62). The scores of the two groups were not significantly different in any of the other items, although the total average score was significantly higher in the MPFL group (91 vs 81).
MPFL reconstruction without TT transfer achieved satisfactory results including high scores on subjective functional assessments without disadvantage caused by the TT transfer. Isolated MPFL reconstruction has been suggested to be a useful treatment method for recurrent dislocation of the patella.
我们基于使用视觉模拟量表（VAS）的主观功能评估，研究了内侧髌股韧带（MPFL）重建术（伴或不伴胫骨结节（TT）转移）治疗复发性髌骨脱位的疗效。
对40例接受腘绳肌腱MPFL重建术的患者的42个膝关节进行连续随访，平均随访4.3年。29个膝关节接受了MPFL重建术（MPFL组），13个膝关节接受了MPFL重建术联合TT内侧转移术（TT + MPFL组）。评估了临床结果，包括两组最新随访时的VAS评分。
TT + MPFL组有2例出现明显的活动范围受限。MPFL组的恐惧试验阴性率从术前的3%显著提高到术后的79%，TT + MPFL组从8%提高到69%。MPFL组的Lysholm评分从术前的70分显著提高到术后的92分，TT + MPFL组从72分提高到90分。两组术后和术前的恐惧试验阴性率及Lysholm评分均无显著差异。在VAS评估中，MPFL组在“日本全坐”方面的得分显著高于TT + MPFL组（平均得分92分对62分）。尽管MPFL组的总平均分显著更高（91分对81分），但两组在其他任何项目上的得分均无显著差异。
不进行TT转移的MPFL重建术取得了满意的结果，包括主观功能评估得分较高，且没有因TT转移带来的不利影响。单纯MPFL重建术被认为是治疗复发性髌骨脱位的一种有效治疗方法。
