Department of Trauma Surgery, Plastic and Reconstructive Surgery, University Medicine, Robert-Koch-Strasse 40, Göttingen, Germany.
Arthroscopy. 2010 Jul;26(7):926-35. doi: 10.1016/j.arthro.2009.11.004. Epub 2010 Mar 3.
The objective of this study was to analyze the injury patterns of the medial patellofemoral ligament (MPFL) in acute lateral patellar dislocations (LPDs) considering the anatomically relevant factors of patellar instability.
Knee magnetic resonance images were collected from 73 patients within 7 weeks after LPD, and the injury patterns of the MPFL were evaluated for trochlear dysplasia, for patellar height, and for the tibial tuberosity-trochlear groove (TT-TG) distance.
Injury to the MPFL was found in 98.6% of the patients (72 of 73) after the acute LPD, with a complete tear in 51.4% (37 of 72), most frequently localized at the femoral attachment site, and a partial tear in 48.6% (35 of 72). Injury to the femoral origin (Fem), to the midsubstance (Mid), and to the patellar insertion (Pat) of the MPFL was found in 50.0% (36 of 72), 13.9% (10 of 72), and 13.9% (10 of 72), respectively. More than 1 site of injury was found in 22.2% (16 of 72), most frequently as a combined injury at the femoral origin and at the patellar insertion sites (Pat+Fem) (13 of 16). The study population, as well as the Pat, Fem, and Pat+Fem subgroups, showed significantly different values of trochlear dysplasia and patellar height when compared with the control group, whereas the data of the Mid group were not significantly different. In addition, injury at the patellar insertion (Pat) was accompanied by a significantly increased TT-TG distance when compared not only with the control group but also with the Fem, Mid, and Pat+Fem groups.
The data from our study indicate that patterns of MPFL injury depend on trochlear dysplasia, patellar height, and TT-TG distance. They show a new aspect in the complex interplay between active, passive, and static stabilizers of the patellofemoral joint.
Level IV, diagnostic case-control study.
本研究旨在分析急性外侧髌骨脱位（LPD）中内侧髌股韧带（MPFL）的损伤模式，同时考虑到髌股关节不稳定的解剖相关因素。
在 LPD 后 7 周内，从 73 例患者中收集膝关节磁共振图像，并评估 MPFL 的损伤模式，包括滑车发育不良、髌骨高度和胫骨结节-滑车沟（TT-TG）距离。
73 例 LPD 患者中，98.6%（72/73）存在 MPFL 损伤，其中完全撕裂占 51.4%（37/72），最常见于股骨附着处，部分撕裂占 48.6%（35/72）。MPFL 的股骨起点（Fem）、中间（Mid）和髌骨止点（Pat）损伤分别为 50.0%（36/72）、13.9%（10/72）和 13.9%（10/72）。22.2%（16/72）的患者存在 1 个以上部位的损伤，最常见的是股骨起点和髌骨止点的联合损伤（Pat+Fem）（13/16）。与对照组相比，研究人群以及 Pat、Fem 和 Pat+Fem 亚组的滑车发育不良和髌骨高度值差异均有统计学意义，而 Mid 亚组的数据无明显差异。此外，与对照组以及 Fem、Mid 和 Pat+Fem 亚组相比，髌骨止点（Pat）损伤时 TT-TG 距离明显增加。
本研究数据表明，MPFL 损伤模式取决于滑车发育不良、髌骨高度和 TT-TG 距离。这为髌股关节主动、被动和静态稳定器之间的复杂相互作用提供了一个新的方面。
IV 级，诊断病例对照研究。
