Lobner Stefan, Krauss Christine, Reichwein Frank, Patzer Thilo, Nebelung Wolfgang, Venjakob Arne J
Department of Orthopaedics, Trauma Surgery and Sports Medicine, Johanna-Etienne Hospital Neuss, Neuss, Germany.
Department of Rheumatology and Arthroscopy, Marienkrankenhaus Duesseldorf-Kaiserswerth, Duesseldorf, Germany.
Arch Orthop Trauma Surg. 2017 Aug;137(8):1087-1095. doi: 10.1007/s00402-017-2705-z. Epub 2017 May 16.
The aim of this retrospective study was to analyse clinical and radiological outcome after medial patellofemoral ligament reconstruction (MPFLR) and tibial tuberosity medialisation (TTM) in patients with recurrent patellar instability.
Thirty-five patients were included between 2008 and 2012. According to defined criteria such as tibial tuberosity-trochlear groove (TTTG) distance, hyperpression on the lateral patella facet and lateral retropatellar cartilage damage either MPFLR (group A) or TTM (group B) was performed: 18 patients underwent TTM, the other 17 patients underwent MPFLR. At a mean of 25.4 ± 9.7 (group A) and 35.2 ± 17.6 months (group B) patients were clinically and radiologically reviewed. Validated knee scores such as Kujala, Lysholm and Tegner score were evaluated.
In both groups one patient reported of a non-traumatic patellar redislocation. Patients who underwent MPFLR (group A) had less pain postoperatively during activity according to the Visual Analogue Scale (group A: 2.0 ± 2.1 points, group B: 3.9 ± 2.3 points). Retropatellar cartilage damage increased in group B from grade 1 (range: 1-3) preoperatively to grade 2 (range 1-3) postoperatively (p > 0.05). All other clinically evaluated items, as well as the applied knee scoring systems, indicated no significant difference (p > 0.05) and displayed good to excellent results.
MPFLR and TTM leed to good clinical results despite its own indications. For this reason-in selected cases-TTM may still be a suitable procedure for surgical treatment of patellar instability. However, patients treated by TTM (group B) revealed an increased retropatellar cartilage damage as well as significantly more pain during activity.
本回顾性研究的目的是分析复发性髌骨不稳定患者行内侧髌股韧带重建术（MPFLR）和胫骨结节内移术（TTM）后的临床和影像学结果。
纳入2008年至2012年间的35例患者。根据胫骨结节 - 滑车沟（TTTG）距离、髌骨外侧小面高压和髌后外侧软骨损伤等既定标准，分别进行MPFLR（A组）或TTM（B组）：18例患者接受TTM，另外17例患者接受MPFLR。平均在25.4±9.7个月（A组）和35.2±17.6个月（B组）时对患者进行临床和影像学复查。评估了Kujala、Lysholm和Tegner评分等经过验证的膝关节评分。
两组均有1例患者报告非创伤性髌骨再脱位。根据视觉模拟量表，接受MPFLR的患者（A组）术后活动时疼痛较轻（A组：2.0±2.1分，B组：3.9±2.3分）。B组髌后软骨损伤从术前的1级（范围：1 - 3）增加到术后的2级（范围1 - 3）（p>0.05）。所有其他临床评估项目以及应用的膝关节评分系统均无显著差异（p>0.05），结果显示良好至优秀。
尽管MPFLR和TTM有各自的适应症，但均能取得良好的临床效果。因此，在某些特定情况下，TTM仍可能是治疗髌骨不稳定的合适手术方法。然而，接受TTM治疗的患者（B组）髌后软骨损伤增加，且活动时疼痛明显更多。
