Clark Damian, Walmsley Katie, Schranz Peter, Mandalia Vipul
Exeter Knee Reconstruction Unit, Exeter, United Kingdom.
Arthrosc Tech. 2017 May 15;6(3):e591-e597. doi: 10.1016/j.eats.2017.01.003. eCollection 2017 Jun.
The stability of the patellofemoral joint relies on the tenuous interplay of soft tissue and bony factors. Anatomic risk factors for instability include a shallow trochlea, an abnormally lateral tibial tubercle position, patella alta, hypermobility, or a secondary injury to the medial patellofemoral ligament (MPFL). There is an increasing interest in restoring normal anatomy to achieve stability, and at times more than 1 abnormality exists. This article describes the technique for combining a tibial tuberosity transfer and an MPFL reconstruction. The key features include planning of skin incisions to enable both operations to be undertaken, planning of the screw placement before osteotomy is performed and assessment of the joint through a superolateral portal to assess the need for MPFL reconstruction after tuberosity transfer.
髌股关节的稳定性依赖于软组织和骨因素之间脆弱的相互作用。不稳定的解剖学危险因素包括滑车浅、胫骨结节位置异常偏外、高位髌骨、活动度过大或髌股内侧韧带（MPFL）继发性损伤。人们越来越关注恢复正常解剖结构以实现稳定性，而且有时存在不止一种异常情况。本文描述了联合胫骨结节转移和MPFL重建的技术。关键要点包括规划皮肤切口以便能够同时进行这两种手术，在截骨术前规划螺钉置入位置，并通过上外侧入路评估关节，以在结节转移后评估MPFL重建的必要性。
