University of Alabama at Birmingham, Birmingham, Alabama, USA.
J Bone Joint Surg Am. 2011 May 18;93(10):954-62. doi: 10.2106/JBJS.H.00103.
The medial patellomeniscal ligament has been determined in vitro to be the only substantial distal-medial restraint to lateral patellar displacement. The purpose of this study of prospectively collected data was to determine if isolated deficiency of the medial patellomeniscal ligament, resulting in excessive lateral patellar translation and associated symptoms, could be identified. We hypothesized that, if symptoms were associated with isolated deficiency of that ligament, the laxity and symptoms should resolve after plication of that ligament alone.
Testing for lateral patellar displacement in the extended knee by exertion of force through the distal patellar attachment of the medial patellomeniscal ligament was performed on 745 patients with patellofemoral syndromes during a twenty-eight-month period. In addition, the ability to recognize pathologically increased lateral patellar translation preoperatively with use of such testing was compared with the ability to recognize increased lateral translation with testing in 439 patients undergoing arthroscopy under anesthesia during that period for any reason. Preoperative symptoms and impairment in knees with isolated deficiency of the medial patellomeniscal ligament were documented and compared with the postoperative results.
Isolated medial patellomeniscal ligament deficiency was identified with testing under anesthesia in twenty-three of the 439 knees undergoing arthroscopy for any reason, and twenty of those twenty-three cases had been detected preoperatively with use of lateral patellar displacement testing. Isolated medial patellomeniscal ligament plication was performed in these twenty-three cases, and follow-up data at a mean of 30.8 months were available for twenty-one of the cases. The mean International Knee Documentation Committee subjective score increased from 38.9 preoperatively to 84.6 postoperatively, and recurrent symptomatic pathological lateral patellar translation was present in only one patient.
Isolated deficiency of the medial patellomeniscal ligament can be detected by physical examination. Restoration of the normal length of the ligament by plication can lead to resolution of detectable patellar subluxation and its associated symptoms.
内侧髌股韧带在体外已被确定为限制外侧髌骨位移的唯一实质性的远端内侧约束。本前瞻性收集数据的研究旨在确定是否可以识别孤立的内侧髌股韧带缺陷，导致过度的外侧髌骨平移和相关症状。我们假设，如果症状与该韧带的孤立性缺陷有关，那么仅单独修复该韧带就应该可以解决松弛和症状。
在 28 个月的时间里，对 745 例髌股关节综合征患者进行了伸展膝关节时通过内侧髌股韧带的远端髌骨附着处施加力以测试外侧髌骨位移。此外，还比较了使用这种测试术前识别病理性外侧髌骨过度平移的能力与在该期间因任何原因接受麻醉下关节镜检查的 439 例患者中使用测试识别外侧平移增加的能力。记录了孤立性内侧髌股韧带缺陷的膝关节的术前症状和功能障碍，并与术后结果进行了比较。
在因任何原因接受关节镜检查的 439 例膝关节中，有 23 例通过麻醉下测试发现了孤立性内侧髌股韧带缺陷，其中 20 例在使用外侧髌骨位移测试术前已被发现。对这 23 例患者进行了孤立性内侧髌股韧带修补术，其中 21 例获得了平均 30.8 个月的随访数据。国际膝关节文献委员会主观评分从术前的 38.9 分增加到术后的 84.6 分，仅 1 例患者出现复发性有症状的病理性外侧髌骨平移。
孤立性内侧髌股韧带缺陷可以通过体格检查来发现。通过修补术恢复韧带的正常长度可以解决可检测的髌骨半脱位及其相关症状。
