Kita Keisuke, Tanaka Yoshinari, Toritsuka Yukiyoshi, Amano Hiroshi, Uchida Ryohei, Shiozaki Yoshiki, Takao Rikio, Horibe Shuji
Department of Sports Orthopaedics, Osaka Rosai Hospital, Sakai, Japan.
Department of Sports Orthopaedics, Kansai Rosai Hospital, Amagasaki, Japan.
Am J Sports Med. 2017 Jun;45(7):1599-1607. doi: 10.1177/0363546517690348. Epub 2017 Mar 9.
Reconstruction of the medial patellofemoral ligament (MPFL) for recurrent lateral patellar dislocation is gaining popularity. However, the morphological changes in the femoral tunnel after MPFL reconstruction are still not fully documented.
This study used 3-dimensional (3D) computed tomography to evaluate morphological changes in the femoral tunnel after MPFL reconstruction with hamstring tendon graft to investigate factors affecting the phenomenon and to elucidate whether it is associated with clinical outcomes.
Case series; Level of evidence, 4.
Twenty-three patients with recurrent patellar dislocation were prospectively enrolled in this study. The patients included 6 males and 17 females with a mean age of 24 years (range, 14-53). The MPFL was reconstructed by creating 2 patellar bone sockets and 1 femoral bone socket anatomically under X-ray control, and the semitendinosus autograft was fixed with cortical suspension devices. Computed tomography scans obtained 3 weeks and 1 year after surgery were reconstructed into 3D constructs with a volume analyzer. Cross-sectional areas (CSAs) of the aperture and inside the femoral tunnel were compared between the 2 time points. Likewise, the location of tunnel walls and center of the femoral tunnel footprint were evaluated. Relationships were assessed between femoral tunnel morphological changes and potential risk factors-such as age, body mass index, sex, femoral tunnel positioning, patellar height, sulcus angle, congruence angle, lateral tilt angle, degree of trochlear dysplasia, lateral deviation of the tibial tubercle, and Kujala score.
No patient reported recurrence of patellar dislocation during the follow-up period. The CSA of the femoral tunnel aperture enlarged by 41.1% ± 34.7% ( P < .01). The center, anterior border, and proximal border of the femoral tunnel significantly shifted in the anterior direction ( P < .01). The distal border significantly shifted in both anterior and distal directions ( P < .01). Patella alta was associated with distal migration of the tunnel center ( P < .05). Morphological changes were not associated with other risk factors or Kujala score.
The CSA of the femoral tunnel aperture enlarged, and the tunnel aperture migrated anteriorly with time after MPFL reconstruction. Risk factors for patellar dislocation other than patella alta did not influence morphological changes of the femoral tunnel.
重建内侧髌股韧带（MPFL）治疗复发性髌骨外侧脱位正逐渐受到欢迎。然而，MPFL重建后股骨隧道的形态变化仍未得到充分记录。
本研究采用三维（3D）计算机断层扫描来评估采用腘绳肌腱移植重建MPFL后股骨隧道的形态变化，以研究影响该现象的因素，并阐明其是否与临床结果相关。
病例系列；证据等级，4级。
前瞻性纳入23例复发性髌骨脱位患者。患者包括6例男性和17例女性，平均年龄24岁（范围14 - 53岁）。在X线控制下，通过解剖方式创建2个髌骨骨槽和1个股骨骨槽来重建MPFL，并用皮质悬吊装置固定自体半腱肌肌腱。将术后3周和1年获得的计算机断层扫描图像用容积分析仪重建为3D结构。比较两个时间点股骨隧道开口处和隧道内的横截面积（CSA）。同样，评估隧道壁位置和股骨隧道足迹中心。评估股骨隧道形态变化与潜在风险因素之间的关系，这些因素包括年龄、体重指数、性别、股骨隧道定位、髌骨高度、沟角、适合角、外侧倾斜角、滑车发育不良程度、胫骨结节外侧移位以及库贾拉评分。
随访期间无患者报告髌骨脱位复发。股骨隧道开口处的CSA增大了41.1%±34.7%（P <.01）。股骨隧道的中心、前缘和近端边界显著向前移位（P <.01）。远端边界在前后方向均显著移位（P <.01）。高位髌骨与隧道中心的远端移位相关（P <.05）。形态变化与其他风险因素或库贾拉评分无关。
MPFL重建后，股骨隧道开口处的CSA增大，且隧道开口随时间向前移位。除高位髌骨外，髌骨脱位的风险因素不影响股骨隧道的形态变化。
