Michael J. Stuart, Mayo Clinic, 200 First St, SW, Rochester, MN 55905, USA.
Am J Sports Med. 2010 Nov;38(11):2248-54. doi: 10.1177/0363546510376230. Epub 2010 Aug 17.
The medial patellofemoral ligament (MPFL) is the primary restraint to extreme lateral displacement and is typically disrupted with an acute lateral patellar dislocation. Patients who fail a comprehensive nonoperative program and experience recurrent lateral patellar instability episodes are candidates for surgical treatment. Current surgical procedures include a variety of proximal realignment techniques, including repair or reconstruction of the MPFL along with distal realignment of the tibial tubercle when indicated.
The objective of this study was to review the clinical, functional, and radiographic outcomes of isolated MPFL repair for recurrent lateral patellar dislocation.
Case series; Level of evidence, 4.
The records of all patients undergoing MPFL repair for recurrent patellar dislocation at the Mayo Clinic from 2001 to 2006 were retrospectively reviewed. Twenty-seven patients (29 knees) with an average age of 19 years (range, 11-32 years) were included in this study. Clinical, functional, and radiographic outcomes were assessed at an average of 4 years after surgery (range, 2-7 years), using recurrent instability as the primary end point.
The success rate of MPFL repair for preventing recurrent dislocations was 72% (21 of 29 knees). Eight patients (28%) experienced a recurrent lateral patellar dislocation. Five of these patients required a reoperation, including two MPFL reconstructions, 1 tibial tubercle osteotomy with MPFL reconstruction, 1 tibial tubercle osteotomy with revision MPFL repair, and 1 revision MPFL repair. At final follow-up, the mean Lysholm and Kujala scores were 86 (range, 42-100) and 92 (range, 57-105), respectively. Postoperative radiographs revealed a mean patellofemoral congruence angle improvement of 27° (range, 5°-44°). The only statistically significant risk factor for failure was nonanatomical MPFL repair at the medial femoral condyle (P = .004).
Isolated repair of the MPFL for recurrent patellar instability is associated with a relatively high failure rate, but remains a viable surgical option if surgical technique principles are followed. The clinical success of this operation depends on restoration of the anatomical origin of the MPFL and careful patient selection.
内侧髌股韧带（MPFL）是限制髌骨极度外移的主要结构，通常在急性外侧髌骨脱位时会被撕裂。如果经过全面的非手术治疗方案后仍复发髌骨外侧不稳定，或者患者经历了多次外侧髌骨脱位反复发作，这些患者则适合进行手术治疗。目前的手术方法包括多种近端矫正技术，包括如果需要的话，可以修复或重建 MPFL，以及矫正胫骨结节的远端。
本研究旨在回顾分析单纯 MPFL 修复治疗复发性髌骨外侧脱位的临床、功能和影像学结果。
病例系列；证据等级，4 级。
回顾性分析 2001 年至 2006 年在梅奥诊所接受 MPFL 修复治疗复发性髌骨脱位的所有患者的病历。本研究纳入了 27 例患者（29 个膝关节），平均年龄 19 岁（范围，11-32 岁）。平均在术后 4 年（范围，2-7 年）评估临床、功能和影像学结果，以复发性髌骨不稳定为主要终点。
MPFL 修复术预防复发性髌骨脱位的成功率为 72%（29 个膝关节中的 21 个）。8 例患者（28%）出现了复发性髌骨外侧脱位。其中 5 例患者需要再次手术，包括 2 例 MPFL 重建、1 例胫骨结节截骨术联合 MPFL 重建、1 例胫骨结节截骨术联合修正 MPFL 修复、1 例修正 MPFL 修复。末次随访时，平均 Lysholm 评分和 Kujala 评分分别为 86（范围，42-100）和 92（范围，57-105）。术后 X 线片显示髌骨股骨匹配角平均改善 27°（范围，5°-44°）。唯一具有统计学意义的失败风险因素是非解剖学的股骨内侧髁 MPFL 修复（P =.004）。
复发性髌骨不稳定的单纯 MPFL 修复与较高的失败率相关，但如果遵循手术技术原则，仍不失为一种可行的手术选择。该手术的临床成功取决于 MPFL 解剖学起源的恢复和患者的仔细选择。
