Balcarek Peter, Walde Tim Alexander
Department of Trauma Surgery, Plastic and Reconstructive Surgery, University Medical Center, Göttingen, Germany ARCUS Sportsclinic, Pforzheim, Germany
Department of Trauma Surgery, Plastic and Reconstructive Surgery, University Medical Center, Göttingen, Germany.
Am J Sports Med. 2015 Sep;43(9):2228-32. doi: 10.1177/0363546515591265. Epub 2015 Jul 21.
Reconstruction of the medial patellofemoral ligament (MPFL) is an established operative procedure for patients with recurrent episodes of lateral patellar instability. However, recent articles have reported remarkable complication rates, with nonanatomic femoral tunnel positioning in up to 64% of patients.
To evaluate the sensitivity of femoral tunnel placement using lateral fluoroscopic guidance to minor degrees of deviation from the true-lateral view using established radiographic landmarks.
Controlled laboratory study.
Six human cadaveric femora were used for this study. A 6-mm radiopaque eyelet was used to mark the native femoral insertion of the MPFL according to previously described radiographic landmarks. Radiographic landmarks were also applied with the femur positioned in 2.5° and 5° of internal and external rotation, respectively, and with the femur in 2.5° and 5° of hip abduction and adduction, respectively. The distance between the center of the 6-mm eyelet to the center of the native femoral MPFL insertion, as established in the true-lateral view, was measured and determined as the degree of shift in each position.
Hip adduction, abduction, and internal and external rotations of 2.5° resulted in a shift from the native femoral MPFL insertion point to a more distal (adduction), proximal (abduction), anterior (internal rotation), and posterior location (external rotation) of 2.7 ± 0.7, 2.0 ± 0.7, 2.7 ± 1.1, and 3.0 ± 1.3 mm, respectively (all P < .05). Malpositioning increased to a distance of 5.0 ± 0.7 mm distally, 3.6 ± 1.0 mm proximally, 5.2 ± 0.8 mm anteriorly, and 6.2 ± 0.6 mm posteriorly to the native insertion point when the attachment was marked with 5° of divergence from the true-lateral view (all P < .05).
The results of this study indicate the high sensitivity of femoral tunnel placement using lateral fluoroscopic guidance to minor degrees of deviation from the true-lateral view.
The study highlights the importance of an exact lateral view when fluoroscopic guidance is used for femoral tunnel positioning in the daily practice of MPFL reconstruction, and a possible explanation for the high incidence of nonanatomic tunnel placement is suggested.
对于复发性髌骨外侧不稳定的患者，重建髌股内侧韧带（MPFL）是一种成熟的手术方法。然而，近期的文章报道了显著的并发症发生率，高达64%的患者存在非解剖学股骨隧道定位情况。
使用外侧荧光透视引导，通过既定的影像学标志，评估股骨隧道放置对于与真正侧位视图存在微小偏差的敏感度。
对照实验室研究。
本研究使用6具人类尸体股骨。根据先前描述的影像学标志，用一个6毫米的不透射线小孔标记MPFL在股骨上的天然附着点。分别将股骨置于2.5°和5°的内旋和外旋位置，以及2.5°和5°的髋关节内收和外展位置时，也应用影像学标志。测量并确定在真正侧位视图中建立的6毫米小孔中心与天然股骨MPFL附着点中心之间的距离，作为每个位置的移位程度。
髋关节内收、外展以及2.5°的内旋和外旋分别导致从天然股骨MPFL附着点向更远端（内收）、近端（外展）、前方（内旋）和后方位置（外旋）的移位，分别为2.7±0.7、2.0±0.7、2.7±1.1和3.0±1.3毫米（所有P<.05）。当附着点标记为与真正侧位视图有5°的偏差时，相对于天然附着点，向远端、近端、前方和后方的错位分别增加到5.0±0.7毫米、3.6±1.0毫米、5.2±0.8毫米和6.2±0.6毫米（所有P<.05）。
本研究结果表明，使用外侧荧光透视引导时，股骨隧道放置对于与真正侧位视图的微小偏差具有高度敏感性。
该研究强调了在MPFL重建的日常实践中，当使用荧光透视引导进行股骨隧道定位时，精确侧位视图的重要性，并提出了非解剖学隧道放置高发生率的一种可能解释。
