Sadigursky David, Garcia Lucas Cortizo, Armede Maurício, Oliveira Lucas Rodrigues de, Carneiro Rogério Jamil Fernandes, Colavolpe Paulo Oliveira
Clínica Ortopédica Traumatológica, Centro de Estudos em Ortopedia e Traumatologia, Salvador, BA, Brazil.
Faculdade de Tecnologia e Ciências (FTC), Departamento de Ortopedia e Traumatologia, Salvador, BA, Brazil.
Rev Bras Ortop. 2017 Jul 5;52(4):417-422. doi: 10.1016/j.rboe.2017.06.011. eCollection 2017 Jun-Jul.
The aim of this study was to evaluate the reconstruction of the medial patellofemoral ligament associated with the medial patellotibial ligament in skeletally immature patients.
This is a case series study in patients with patellar instability with open physis. In total, seven patients were evaluated: four males and three females were operated using the proposed technique. Patients with open physis who had more than two episodes of recurring patellar dislocation were included. No patients underwent additional procedures. The distance from the anterior tibial tuberosity to the trochlea grove (TT-TG) was measured in all patients. On physical examination, the inverted J-sign, the apprehension sign, and the knee range of motion parameters were used in the pre- and post-operative period. In addition, the Kujala and Lysholm scores were applied before and 12 months after surgery. The results were analyzed with the Wilcoxon test.
The mean age of the patients was 11.28 in both genders. Comparing the data of the pre- and post-operative period, the inverted J-sign was present in six patients (85.7%) absent in one (14.3%). The apprehension sign was absent in cases in the postoperative period; the range of motion was 117.85 ± 8.09 148.57 ± 3.77. The Kujala score was 42.57 ± 8.9 88.57 ± 5.09 and the Lysholm scores were classified as excellent or good in 28.6% and 71.4%, respectively.
The combined reconstruction of the medial patellofemoral ligament combined with the medial patellotibial ligament in skeletally immature patients with predisposing factors, presents satisfactory results without episodes of recurrence or residual subluxation; according to these preliminary results, it should be considered as a treatment option.
本研究旨在评估骨骼未成熟患者中与髌内侧胫韧带相关的髌股内侧韧带重建情况。
这是一项针对骨骺未闭的髌骨不稳定患者的病例系列研究。总共评估了7例患者：4例男性和3例女性接受了所提出的技术手术。纳入了骨骺未闭且髌骨反复脱位超过2次的患者。没有患者接受额外手术。对所有患者测量了胫骨结节至滑车沟（TT-TG）的距离。在体格检查中，术前和术后均使用倒J征、恐惧征和膝关节活动范围参数。此外，术前和术后12个月应用了库贾拉（Kujala）和利绍尔姆（Lysholm）评分。结果采用威尔科克森（Wilcoxon）检验进行分析。
患者的平均年龄在两性中均为11.28岁。比较术前和术后的数据，6例患者（85.7%）存在倒J征，1例（14.3%）不存在。术后病例中无恐惧征；活动范围术前为117.85±8.09，术后为148.57±3.77。库贾拉评分术前为42.57±8.9，术后为88.57±5.09，利绍尔姆评分分别有28.6%为优或良，71.4%为优或良。
在有易感因素的骨骼未成熟患者中，髌股内侧韧带与髌内侧胫韧带联合重建，取得了满意的结果，无复发或残余半脱位情况；根据这些初步结果，应将其视为一种治疗选择。
