Department of Joint Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China.
Arthroscopy. 2013 May;29(5):891-7. doi: 10.1016/j.arthro.2013.01.030. Epub 2013 Apr 6.
The purpose of this study was to evaluate the clinical results of medial retinaculum plasty (MRP) and medial patellofemoral ligament reconstruction (MPFLR) with concomitant lateral retinacular release with respect to imaging and functional results.
Seventy patients with recurrent patellar instability were randomly divided into 2 groups based on their birth years (even/odd), receiving either MRP or MPFLR. Lateral retinacular release was also performed in all patients. Preoperatively, all patients received magnetic resonance imaging to evaluate the injury to the medial patellofemoral ligament. Computed tomography was performed before surgery and at follow-up. The subjective symptoms and functional outcome were evaluated preoperatively and postoperatively with the Kujala score, the Tegner activity score, and a subjective questionnaire. The physical apprehension test was examined, and redislocation was recorded.
Patients were followed up for a mean period of 40 months (range, 24 to 55 months). The measurement results for the congruence angle, patellar tilt angle, and patellar lateral shift decreased significantly from the pretreatment measurements to the normal range at the latest follow-up, without a statistically significant difference between the 2 groups (P > .05). The median Kujala score had significantly improved after surgery. However, no statistically significant difference was found between the 2 groups at the latest follow-up (P > .05). In 6 cases in the MRP group (19%) and 3 in the MPFLR group (9%), we found patellar lateral shift that exceeded 1.5 cm but was less than 2.0 cm with a firm endpoint for the apprehension test, without a significant difference between the 2 groups.
This prospective randomized study showed that MPFLR for recurrent patellar instability could achieve good clinical results, with a good congruous patellofemoral joint and good knee function. MRP could yield similar results to MPFLR for recurrent patellar instability in adults with medial patellofemoral ligament injuries from the patella or midsubstance portions.
Level II, prospective comparative study.
本研究旨在评估内侧髌股韧带成形术（MRP）和内侧髌股韧带重建（MPFLR）联合外侧支持带松解术的临床效果，重点关注影像学和功能结果。
70 例复发性髌骨不稳定患者按出生年份（偶数/奇数）分为 2 组，分别接受 MRP 或 MPFLR 治疗。所有患者均行外侧支持带松解术。所有患者术前均接受 MRI 评估内侧髌股韧带损伤。术前和随访时均行 CT 检查。采用 Kujala 评分、Tegner 活动评分和主观问卷评估术前和术后的主观症状和功能结果。检查物理触诊试验，并记录再脱位情况。
患者平均随访 40 个月（24-55 个月）。从术前到随访时的最新测量值，髌骨吻合角、髌骨倾斜角和髌骨外侧移位测量值均显著降低，且 2 组间无统计学差异（P＞.05）。术后中位数 Kujala 评分显著提高，但 2 组间在随访时的最新测量值无统计学差异（P＞.05）。MRP 组 6 例（19%）和 MPFLR 组 3 例（9%）出现触诊试验终点有明确抵抗但髌骨外侧移位超过 1.5cm 但不足 2.0cm，2 组间无统计学差异。
这项前瞻性随机研究表明，复发性髌骨不稳定的 MPFLR 可获得良好的临床效果，具有良好的髌股关节吻合度和良好的膝关节功能。对于有髌骨或中部内侧髌股韧带损伤的成年人，MRP 治疗复发性髌骨不稳定可获得与 MPFLR 相似的效果。
II 级，前瞻性对比研究。
