Zheng Lei, Shi Hao, Feng Yan, Sun Bai-Sheng, Ding Hong-Yu, Zhang Guang-Ying
Department of Radiology, Shandong Provincial Corps Hospital of Chinese People's Armed Police Force, Jinan 250014, Shandong, China.
Department of Radiology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan 250014, Shandong, China.
Injury. 2015;46(6):1137-44. doi: 10.1016/j.injury.2015.02.001. Epub 2015 Feb 13.
The purpose of this study was to investigate the injury characteristics of medial patellofemoral ligament (MPFL), and to analyse the correlations between the injury patterns of MPFL and articular cartilage lesions of the lateral femoral condyle in children and adolescents with acute lateral patellar dislocation (LPD).
Magnetic resonance (MR) images were prospectively obtained in 127 consecutive children and adolescents with acute LPD. Images were acquired using standardised protocols and these were independently evaluated by two radiologists.
Fifty-four cases of partial MPFL tear and 69 cases of complete MPFL tear were identified. Injuries occurred at an isolated patellar insertion (PAT) in 47 cases, an isolated femoral attachment (FEM) in 41 cases and an isolated mid-substance (MID) in four cases. More than one site of injury to the MPFL (COM) was identified in 31 cases. The prevalence rate of chondral and osteochondral lesions of the lateral femoral condyle were 23.4% (11/47) and 29.8% (14/47) in the PAT subgroup, 7.3% (3/41) and 9.8% (4/41) in the FEM subgroup and 25.8% (8/31) and 32.3% (10/31) in the COM subgroup, respectively. The PAT and COM subgroups showed significantly higher prevalence rate of chondral and osteochondral lesions in the lateral femoral condyle when compared with the FEM subgroup. The prevalence rate of chondral and osteochondral lesions of the lateral femoral condyle were 17.4% (12/69) and 30.4% (21/69) in the complete MPFL tear subgroup and 20.4% (11/54) and 13% (7/54) in the partial MPFL tear subgroup, respectively. The subgroup of the complete MPFL tear showed significantly higher prevalence rate of osteochondral lesions in the lateral femoral condyle when compared with the subgroup of the partial MPFL tear.
Firstly, the MPFL is most easily injured at the PAT, and secondly at the FEM in children and adolescents after acute LPD. The complete MPFL tear is more often concomitant with osteochondral lesions of the lateral femoral condyle than the partial MPFL tear. The isolated patellar-sided MPFL tear and the combined MPFL tear are more easily concomitant with chondral lesions and osteochondral lesions of the lateral femoral condyle than the isolated femoral-sided MPFL tear.
本研究旨在探讨儿童和青少年急性髌骨外侧脱位（LPD）时内侧髌股韧带（MPFL）的损伤特征，并分析MPFL损伤模式与股骨外侧髁关节软骨损伤之间的相关性。
前瞻性地收集了127例连续的急性LPD儿童和青少年的磁共振（MR）图像。使用标准化方案采集图像，并由两名放射科医生独立评估。
共识别出54例MPFL部分撕裂和69例MPFL完全撕裂。损伤发生在孤立的髌骨附着点（PAT）47例，孤立的股骨附着点（FEM）41例，孤立的韧带中部（MID）4例。31例患者的MPFL损伤超过一个部位（COM）。PAT亚组中股骨外侧髁软骨和骨软骨损伤的患病率分别为23.4%（11/47）和29.8%（14/47），FEM亚组中分别为7.3%（3/41）和9.8%（4/41），COM亚组中分别为25.8%（8/31）和32.3%（10/31）。与FEM亚组相比，PAT和COM亚组中股骨外侧髁软骨和骨软骨损伤的患病率显著更高。MPFL完全撕裂亚组中股骨外侧髁软骨和骨软骨损伤的患病率分别为17.4%（12/69）和30.4%（21/69），MPFL部分撕裂亚组中分别为20.4%（11/54）和13%（7/54）。与MPFL部分撕裂亚组相比，MPFL完全撕裂亚组中股骨外侧髁骨软骨损伤的患病率显著更高。
首先，儿童和青少年急性LPD后MPFL最易在PAT处损伤，其次是FEM处。MPFL完全撕裂比MPFL部分撕裂更常伴有股骨外侧髁骨软骨损伤。与孤立的股骨侧MPFL撕裂相比，孤立的髌骨侧MPFL撕裂和合并的MPFL撕裂更容易伴有股骨外侧髁软骨损伤和骨软骨损伤。
