Enderlein Ditte, Nielsen Torsten, Christiansen Svend Erik, Faunø Peter, Lind Martin
Division of Sports Trauma, Orthopaedic Department, Aarhus University Hospital, Tage Hansens Gade 2, 8000, Aarhus C, Denmark.
Knee Surg Sports Traumatol Arthrosc. 2014 Oct;22(10):2458-64. doi: 10.1007/s00167-014-3164-5. Epub 2014 Jul 10.
We present the clinical results of a large consecutive, prospective, single-clinic series of patients treated with medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability.
The study included 224 patients undergoing MPFL reconstruction in a total of 240 knees between 2008 and 2011. Indication for surgery was two or more patellar dislocations and ADL limitations due to patella instability.
A gracilis tendon autograft was fixed in drill holes in the medial edge of the patella and with screws at the femoral MPFL insertion point. Outcomes were evaluated with the Kujala Anterior Knee Pain Score and pain scores preoperatively and at follow-up (12-60 months). Furthermore, incidences of re-dislocations, subluxations and revision surgery were evaluated.
The Kujala score improved from 62.5 (17) to 80.4 (18) (p<0.001) at the 1-year follow-up. Pain during activity improved from 3.2 (2.6) to 1.3 (2.7) at 1 year (p<0.001). The revision rate was 2.8%. Some degree of pain at the medial femoral condyle was seen in 30% of the patients. The reconstruction was supplemented with a tibial tuberosity osteotomy in 23% of cases. The outcome for these patients did not differ from that of patients with isolated MPFL reconstruction. Female gender BMI>30, age>30 years and grade 3-4 cartilage injury predisposed a poor subjective outcome.
The present study is the largest MPFL reconstruction patient material reported to date. MPFL reconstruction with a gracilis tendon autograft consistently normalised the patella stability and improved knee function. Moderate medial pain was seen. Age above 30, obesity, cartilage injury and female gender are predictors of a poor subjective outcome.
Level IV.
我们展示了一系列连续、前瞻性、单中心的大量患者接受内侧髌股韧带（MPFL）重建治疗复发性髌骨不稳定的临床结果。
该研究纳入了2008年至2011年间共240个膝关节接受MPFL重建的224例患者。手术指征为两次或更多次髌骨脱位以及因髌骨不稳定导致的日常生活活动受限。
将股薄肌腱自体移植物固定于髌骨内侧边缘的钻孔处，并通过螺钉固定于股骨MPFL附着点。采用库亚拉前膝痛评分以及术前和随访时（12 - 60个月）的疼痛评分对结果进行评估。此外，还评估了再脱位、半脱位和翻修手术的发生率。
在1年随访时，库亚拉评分从62.5（17）提高到80.4（18）（p<0.001）。活动时的疼痛在1年时从3.2（2.6）改善至1.3（2.7）（p<0.001）。翻修率为2.8%。30%的患者在股骨内侧髁出现一定程度的疼痛。23%的病例在重建时补充了胫骨结节截骨术。这些患者的结果与单纯MPFL重建患者的结果无差异。女性、BMI>30、年龄>30岁以及3 - 4级软骨损伤易导致主观结果不佳。
本研究是迄今为止报道的最大规模的MPFL重建患者资料。采用股薄肌腱自体移植物进行MPFL重建可使髌骨稳定性持续恢复正常并改善膝关节功能。出现了中度的内侧疼痛。年龄大于30岁、肥胖、软骨损伤和女性是主观结果不佳的预测因素。
四级。
