Moatshe Gilbert, Cram Tyler R, Chahla Jorge, Cinque Mark E, Godin Jonathan A, LaPrade Robert F
Steadman Philippon Research Institute, Vail, Colorado, USA.
Orthopedic Department, Oslo University Hospital, Oslo, Norway.
Orthop J Sports Med. 2017 Apr 19;5(4):2325967117699816. doi: 10.1177/2325967117699816. eCollection 2017 Apr.
Historically, a lateral retinacular release was one of the primary surgical interventions used to treat lateral patellar instability. However, disruption of the lateral structures during this procedure has been associated with medial instability of the patella.
We hypothesize that good to excellent outcomes can be achieved at midterm follow-up after lateral patellotibial ligament reconstruction.
Case series; Level of evidence, 4.
Thirteen patients were treated for medial patellar instability with a lateral patellotibial ligament reconstruction between May 2011 and December 2013 by a single surgeon. All patients had previously undergone a lateral release procedure and had symptomatic medial patellar instability. Patients were evaluated using patient-reported outcome scores at a minimum of 2 years postsurgery.
The mean Lysholm score improved from 45.6 (range, 11-76) to 71.9 (range, 30-91). The median preoperative Tegner activity scale score was 3 (range, 1-7), while the median postoperative score was 4 (range, 1-9). The median Western Ontario and McMaster Universities Arthritis Index (WOMAC) total score improved from 38 (range, 1-57) preoperatively to 6 postoperatively (range, 0-52). The mean patient satisfaction postoperatively was 8.2 (range, 5-10).
Significantly improved outcomes can be achieved at midterm follow-up with a low rate of complications when reconstructing the lateral patellotibial ligament in the setting of iatrogenic medial patellar instability.
从历史上看，外侧支持带松解术是用于治疗髌骨外侧不稳定的主要外科手术干预措施之一。然而，在此手术过程中外侧结构的破坏与髌骨内侧不稳定有关。
我们假设在外侧髌胫韧带重建术后的中期随访中可以取得良好至优异的结果。
病例系列；证据等级，4级。
2011年5月至2013年12月期间，由一名外科医生对13例因髌骨内侧不稳定而接受外侧髌胫韧带重建术的患者进行治疗。所有患者此前均接受过外侧松解手术，且存在有症状的髌骨内侧不稳定。在术后至少2年时使用患者报告的结局评分对患者进行评估。
Lysholm评分的平均值从45.6（范围11 - 76）提高到71.9（范围30 - 91）。术前Tegner活动量表评分的中位数为3（范围1 - 7），而术后评分的中位数为4（范围1 - 9）。西安大略和麦克马斯特大学骨关节炎指数（WOMAC）总分的中位数从术前的38（范围1 - 57）提高到术后的6（范围0 - 52）。术后患者的平均满意度为8.2（范围5 - 10）。
在医源性髌骨内侧不稳定的情况下重建外侧髌胫韧带，中期随访时可取得显著改善的结果，且并发症发生率较低。
