Orthopädie am Rosenberg, St. Gallen, Switzerland.
Arthroscopy. 2012 Jan;28(1):105-9. doi: 10.1016/j.arthro.2011.07.015. Epub 2011 Oct 15.
The aims of this study were to evaluate the anatomic feasibility of medial patellofemoral ligament (MPFL) reconstruction using a part of the adductor magnus tendon and to identify possible risks.
Twenty cadaveric knees were dissected. The distal part of the adductor magnus tendon was evaluated with respect to the anatomic topography and its utility for MPFL reconstruction. To estimate the risk of injuring the neurovascular structures, the distance from the adductor tubercle to the adductor hiatus was evaluated. An MPFL reconstruction was carried out by preserving the distal insertion on the adductor tubercle and redirecting the proximal portion of the tendon to the medial aspect of the patella.
The anatomic investigation showed the following relationships: The mean distance from the adductor tubercle to the adductor hiatus was 99 ± 14 mm (range, 80 to 120 mm). A graft length of 52 ± 5 mm (range, 45 to 63 mm) with the addition of 10 to 20 mm for fixation was found to be necessary for MPFL reconstruction. The difference between the desired graft length and the distance to the adductor hiatus was found to be at least 30 mm in all cases (mean, 46 mm). Leaving the graft attached to the adductor tubercle resulted in a nearly anatomic femoral attachment of the reconstructed MPFL. Complete detachment of the distal adductor magnus attachment was consistently avoidable.
The adductor magnus tendon was found to be a useful graft for MPFL reconstruction. However, anatomic dangers (damage to the neurovascular bundle of the adductor hiatus, the saphenous nerve, or the saphenous branch of the descending genicular artery) during graft harvest must be considered.
Anatomic knowledge is essential during adductor magnus tendon harvest to avoid damage to neurovascular structures. The adductor magnus tendon is an interesting alternative graft option for MPFL reconstruction if anatomic dangers are considered and avoided.
本研究旨在评估使用部分内收肌大肌腱重建内侧髌股韧带（MPFL）的解剖可行性，并确定可能存在的风险。
解剖了 20 个尸体膝关节。评估了内收肌大肌腱的远端部分的解剖学位置及其在 MPFL 重建中的应用。为了评估损伤神经血管结构的风险，评估了从收肌结节到收肌裂孔的距离。通过保留内收肌结节上的远端附着点并将肌腱的近端部分重新引导至髌骨内侧来进行 MPFL 重建。
解剖研究显示以下关系：从收肌结节到收肌裂孔的平均距离为 99±14mm（范围 80 至 120mm）。发现需要 52±5mm（范围 45 至 63mm）的移植物长度，并增加 10 至 20mm 用于固定，以便进行 MPFL 重建。在所有情况下，所需移植物长度与收肌裂孔之间的差异至少为 30mm（平均 46mm）。将移植物保留在内收肌结节上会导致重建的 MPFL 在股骨上的附着几乎呈解剖学位置。始终可以避免完全分离内收肌大肌腱的远端附着。
内收肌大肌腱被发现是 MPFL 重建的有用移植物。然而，在移植物采集过程中必须考虑到解剖学危险（损伤收肌裂孔的神经血管束、隐神经或膝降动脉的隐支）。
在进行内收肌大肌腱采集时，了解解剖学知识对于避免损伤神经血管结构至关重要。如果考虑并避免了解剖学危险，内收肌大肌腱是 MPFL 重建的一种有趣的替代移植物选择。
