Zhang Lei, Li Zhiyao, Liu Jinsong, Sun Jin, Ma Jia
Department of Arthroscopy and Sports Medicine, Institute of Orthopedics and Traumatology, China Academy of Chinese Medical Sciences, Beijing, 100700, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2010 Jan;24(1):100-3.
To investigate the clinical therapeutic results of allograft tendon for anatomical reconstruction of medial patellofemoral ligament (MPFL) in patellar dislocations.
From September 2005 to June 2008, 20 patients with patellar dislocation underwent MPFL reconstructions. There were 4 males and 16 females, aged 13 to 31 years (19 years on average). Patellar dislocations occurred in 7 left and 13 right knees, including 6 cases of acute dislocation and 14 cases of recurrent dislocation. The disease course was 1 day to 2 years. The frequency of dislocation was 1-6 (4 on average). Affected knee joint showed pain, swelling and patellar instability; the range of action for patella obviously increased. The X-ray films showed patellar dislocation or medial margin avulsion fracture. The preoperative Q angle was (15 +/- 3) degrees, the congruence angle was (10 +/- 11) degrees. Reconstruction was performed via allograft tendon. Allograft tendon was anchored to the superomedial pole of the patella by two bone anchors, and the other end was fixed at the natural MPFL insertion site near the medial femoral condyle with an interference screw in a bone tunnel. All patients were evaluated postoperatively; Kujala patellofemoral scores, objective knee function, complications, and reoperations were assessed.
Primary healing was achieved in 18 cases and secondary healing in 2 cases. No infection or necrosis and absorption of grafts was observed. All patients were followed up for an average of 25.6 months (range, 6-34 months) postoperatively. At last follow-up, other patients had no pain, swelling and patellar instability except 1 case; neither patella redislocation nor fracture occurred. The X-ray films showed good position of anchors and tunnel 6 months after operation, and the congruence angle was (3 +/- 8) degrees, showed statistically significant difference when compared with preoperation (P < 0.05). The postoperative Q angle was (15 +/- 2) degrees, the Kujala knee function score improved significantly from 60.8 +/- 7.2 to 83.4 +/- 8.0 at last follow-up, showing statistically significant difference (P < 0.05). According to Insall et al. for function, the results were excellent in 12 cases, good in 6 cases, and fair in 2 cases, the excellent and good rate was 90%.
MPFL reconstruction improves clinical symptoms. Anatomical MPFL reconstruction is effective for patellar dislocation, and it offer good recovery of the pre-morbid patella mechanics. There would be little bone loss when tendon is fixed by anchors, and there would be less patellar fracture than bone tunnel technique. The bone anchors also provide firm fixation. Allograft can avoid the graft harvest site morbidity, but it increases the cost of the surgery.
探讨同种异体肌腱解剖重建髌股内侧韧带（MPFL）治疗髌骨脱位的临床疗效。
2005年9月至2008年6月，对20例髌骨脱位患者行MPFL重建术。其中男性4例，女性16例，年龄13～31岁（平均19岁）。左膝脱位7例，右膝脱位13例，其中急性脱位6例，复发性脱位14例。病程1天至2年。脱位次数为1～6次（平均4次）。患膝关节疼痛、肿胀，髌骨不稳定；髌骨活动范围明显增大。X线片显示髌骨脱位或内侧缘撕脱骨折。术前Q角为（15±3）°，适合角为（10±11）°。采用同种异体肌腱进行重建。同种异体肌腱通过两枚骨锚固定于髌骨上极内侧，另一端用挤压螺钉固定于股骨内侧髁附近的MPFL自然附着点处的骨隧道内。所有患者术后均进行评估；评估Kujala髌股评分、客观膝关节功能、并发症及再次手术情况。
18例一期愈合，2例二期愈合。未观察到感染或移植物坏死吸收。所有患者术后平均随访25.6个月（6～34个月）。末次随访时，除1例患者外，其他患者无疼痛、肿胀及髌骨不稳定；未发生髌骨再脱位及骨折。术后6个月X线片显示锚钉及隧道位置良好，适合角为（3±8）°，与术前比较差异有统计学意义（P<0.05）。术后Q角为（15±2）°，末次随访时Kujala膝关节功能评分由术前的60.8±7.2显著提高至83.4±8.0，差异有统计学意义（P<0.05）。根据Insall等的功能评定标准，优12例，良6例，可2例，优良率为90%。
MPFL重建可改善临床症状。解剖重建MPFL治疗髌骨脱位有效，可使髌骨力学恢复至病前状态。采用骨锚固定肌腱时骨量丢失少，与骨隧道技术相比，髌骨骨折发生率低。骨锚固定牢固。同种异体肌腱可避免取腱部位的并发症，但增加了手术费用。
