Elias John J, Smith Bradley W, Daney Blake T
Departments of *Research †Orthopaedic Surgery, Cleveland Clinic Akron General, Akron, OH.
Sports Med Arthrosc Rev. 2017 Jun;25(2):58-63. doi: 10.1097/JSA.0000000000000152.
Biomechanical studies are commonly performed to evaluate the influence of medial patellofemoral ligament (MPFL) reconstruction and tibial tuberosity medialization on patellar tracking and patellofemoral contact pressures. The most common method is in vitro simulation of knee function, but computational simulation of knee function and computational reconstruction of in vivo motion can also be utilized. The current review of the biomechanical literature indicates that MPFL reconstruction and tibial tuberosity medialization reduce lateral patellar tracking. Decreased lateral patellofemoral contact pressures have also been noted. For MPFL reconstruction, the most commonly noted biomechanical concerns are graft overtensioning and nonanatomic attachment on the femur leading to overconstraint of the patella and elevated medial contact pressures. For tuberosity medialization, the influence of altered tibiofemoral kinematics on postoperative function is unknown. Future biomechanical studies should emphasize inclusion of anatomic features and tracking patterns related to patellar instability, with comparison between the surgical approaches for continued development of treatment guidelines.
生物力学研究通常用于评估内侧髌股韧带（MPFL）重建和胫骨结节内移对髌骨轨迹和髌股接触压力的影响。最常用的方法是膝关节功能的体外模拟，但膝关节功能的计算模拟和体内运动的计算重建也可被采用。当前对生物力学文献的综述表明，MPFL重建和胫骨结节内移可减少髌骨的外侧轨迹。外侧髌股接触压力的降低也已被注意到。对于MPFL重建，最常提到的生物力学问题是移植物过度张紧以及在股骨上的非解剖学附着，这会导致髌骨过度受限和内侧接触压力升高。对于胫骨结节内移，胫股运动学改变对术后功能的影响尚不清楚。未来的生物力学研究应强调纳入与髌骨不稳定相关的解剖特征和轨迹模式，并对手术方法进行比较，以持续制定治疗指南。
