Nakagawa Shuji, Arai Yuji, Kan Hiroyuki, Ueshima Keiichiro, Ikoma Kazuya, Terauchi Ryu, Kubo Toshikazu
Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Arthrosc Tech. 2013 Nov 15;2(4):e491-5. doi: 10.1016/j.eats.2013.07.009. eCollection 2013 Nov.
Recurrent patellar dislocation has recently been treated with anatomic medial patellofemoral ligament (MPFL) reconstruction using a semitendinosus muscle tendon. Although it is necessary to add tension to fix the tendon graft without loading excess stress on the patellofemoral joint, adjustment of the tension can be difficult. To resolve this problem, we developed an MPFL reconstruction procedure using the ToggleLoc Fixation Device (Biomet, Warsaw, IN), in which the semitendinosus muscle tendon is folded and used as a double-bundle tendon graft and 2 bone tunnels and 1 bone tunnel are made on the patellar and femoral sides, respectively. The patellar side of the tendon graft is fixed with an EndoButton (Smith & Nephew, London, England), and the femoral side is fixed with the ToggleLoc. Stepless adjustment of tension of the tendon graft is possible by reducing the size of the loop of the ToggleLoc hung onto the tendon graft. It may be useful to position the patella in the center of the femoral sulcus by confirming the patellofemoral joint fitting. Stability can be confirmed by loading lateral stress on the patella in the extended knee joint. This procedure is less invasive because opening of the lateral side of the femur is not necessary, and it may be useful for MPFL reconstruction.
复发性髌骨脱位近来采用半腱肌肌腱进行解剖学髌股内侧韧带（MPFL）重建治疗。尽管在不给髌股关节施加过大应力的情况下增加张力来固定肌腱移植物很有必要，但张力的调整可能很困难。为解决这一问题，我们开发了一种使用ToggleLoc固定装置（Biomet公司，印第安纳州华沙）的MPFL重建手术方法，其中半腱肌肌腱被折叠并用作双束肌腱移植物，分别在髌骨侧和股骨侧制作2个骨隧道和1个骨隧道。肌腱移植物的髌骨侧用EndoButton（施乐辉公司，英国伦敦）固定，股骨侧用ToggleLoc固定。通过减小挂在肌腱移植物上的ToggleLoc环的尺寸，可以对肌腱移植物的张力进行无级调整。通过确认髌股关节匹配情况将髌骨置于股骨髁间沟中心可能会有帮助。在伸直的膝关节中对髌骨施加外侧应力可以确认稳定性。该手术创伤较小，因为无需打开股骨外侧，可能对MPFL重建有用。
