Sillanpää Petri J, Peltola Erno, Mattila Ville M, Kiuru Martti, Visuri Tuomo, Pihlajamäki Harri
Centre for Military Medicine, Lahti, Finland.
Am J Sports Med. 2009 Aug;37(8):1513-21. doi: 10.1177/0363546509333010. Epub 2009 Apr 17.
The clinical relevance of medial patellofemoral ligament (MPFL) injury location in primary patellar dislocation has not been studied.
Prognosis after primary traumatic patellar dislocation may vary by MPFL injury location.
Cohort study; Level of evidence, 3.
The initial magnetic resonance imaging (MRI) findings in 53 patients with identical nonoperative management were retrospectively analyzed for medial restraint injuries. The MPFL injury sites were classified as follows: femoral, midsubstance, and patellar. Magnetic resonance imaging was used to assess initial and control articular cartilage lesions in the patellofemoral joint. After a mean follow-up of 7 years, 42 patients were evaluated for redislocations, subjective symptoms, and functional limitations.
Based on the initial MRIs, MPFL rupture was classified as femoral in 35 patients, midsubstance in 11, and patellar in 7. At follow-up, 15 patients reported an unstable patella (13 femoral, 1 patellar, 1 midsubstance; P = .01) and 9 reported patellar redislocations (8 femoral, 1 midsubstance; P = .05). The proportion of patients who regained their preinjury activity level was significantly smaller among those with femoral MPFL injury than among those with midsubstance or patellar MPFL injury (P = .05). The median Kujala score was as follows: 90 for femoral, 91 for patellar, and 96 for midsubstance (P = .76). Control MRI showed full-thickness patellofemoral cartilage lesions in 50% of the patients, unrelated to MPFL injury location.
An MPFL avulsion at the femoral attachment in primary traumatic patellar dislocations predicts subsequent patellar instability. The authors suggest that MPFL injury location be taken into account when planning treatment of primary traumatic patellar dislocation.
内侧髌股韧带(MPFL)损伤部位在初次髌骨脱位中的临床相关性尚未得到研究。
初次创伤性髌骨脱位后的预后可能因MPFL损伤部位而异。
队列研究;证据等级,3级。
回顾性分析53例接受相同非手术治疗患者的初始磁共振成像(MRI)结果,以评估内侧稳定结构损伤情况。MPFL损伤部位分为以下几类:股骨附着点、中间段和髌骨附着点。采用MRI评估髌股关节初始和对照时的关节软骨损伤情况。平均随访7年后,对42例患者进行再脱位、主观症状和功能受限情况的评估。
根据初始MRI检查,35例患者的MPFL断裂位于股骨附着点,11例位于中间段,7例位于髌骨附着点。随访时,15例患者报告髌骨不稳定(13例股骨附着点损伤、1例髌骨附着点损伤、1例中间段损伤;P = 0.01),9例报告髌骨再脱位(8例股骨附着点损伤、1例中间段损伤;P = 0.05)。股骨MPFL损伤患者恢复到伤前活动水平的比例显著低于中间段或髌骨MPFL损伤患者(P = 0.05)。Kujala评分中位数如下:股骨附着点损伤为90分,髌骨附着点损伤为91分,中间段损伤为96分(P = 0.76)。对照MRI显示50%的患者存在髌股关节全层软骨损伤,与MPFL损伤部位无关。
初次创伤性髌骨脱位时股骨附着点处的MPFL撕脱预示着随后的髌骨不稳定。作者建议在规划初次创伤性髌骨脱位的治疗时应考虑MPFL损伤部位。