Section of Sports Medicine, Midwest Orthopaedics at Rush, Chicago, Illinois, USA.
Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, Oregon, USA.
Am J Sports Med. 2018 Mar;46(4):883-889. doi: 10.1177/0363546517745625. Epub 2018 Jan 3.
Medial patellofemoral ligament (MPFL) reconstruction has become one of the most common and widely used procedures to regain stability among patients with recurrent lateral patellar dislocation. While recent studies demonstrated low recurrence rates, improved patient-reported outcome measures, and a high rate of return to sports, limited literature explored its effectiveness as an isolated intervention in the context of trochlear dysplasia.
To determine the efficacy of isolated MPFL reconstruction in treating patellar instability in the setting of trochlear dysplasia.
Case series; Level of evidence, 4.
This was a retrospective review of consecutive patients who underwent uni- or bilateral medial patellofemoral ligament reconstruction for patellofemoral instability with a minimum 2-year follow-up. No osteotomies were included. Pre- and postoperative assessment included ligamentous laxity, patellar crepitus, tilt, translation, apprehension, and radiographic features, including tibial tubercle-trochlear groove (TT-TG) distance, Dejour classification, and Caton-Deschamps index.
A total of 121 MPFL reconstructions were included. Mean age at surgery was 23.8 years, and 4.4 dislocation events occurred before surgery. Mean follow-up was 44 months; 76% of patients were female. Mean preoperative TT-TG ratio was 13.5, and mean Caton-Deschamps ratio was 1.2; 92% of patients had Dejour B, C, or D trochlear dysplasia. Kujala score improved from 55.0 preoperatively to 90.0 ( P < .001). Almost all patients (94.5%) were able to return to sports at 1 year, with 74% returning to the same or higher level of play. Only 3 patients reported a postoperative dislocation or subluxation event.
For patients without significantly elevated TT-TG distances or significant patella alta, isolated MPFL reconstruction provides a safe and effective treatment for patellofemoral instability, despite the presence of trochlear dysplasia. Most patients are able to return to sports by 1 year postoperatively at the same or higher level of play.
内侧髌股韧带（MPFL）重建已成为恢复复发性外侧髌骨脱位患者稳定性的最常用和广泛使用的手术之一。虽然最近的研究表明复发率较低、患者报告的结果测量指标改善以及重返运动的比例较高，但在滑车发育不良的情况下，其作为单一干预措施的有效性的相关文献有限。
确定在滑车发育不良的情况下，孤立性 MPFL 重建治疗髌骨不稳定的效果。
病例系列；证据水平，4 级。
这是一项对接受单侧或双侧内侧髌股韧带重建术治疗髌股不稳定的连续患者进行的回顾性研究，随访时间至少为 2 年。不包括截骨术。术前和术后评估包括韧带松弛度、髌骨弹响、倾斜、平移、不安感以及影像学特征，包括胫骨结节-滑车沟（TT-TG）距离、Dejour 分类和 Caton-Deschamps 指数。
共纳入 121 例 MPFL 重建。手术时的平均年龄为 23.8 岁，术前有 4.4 次脱位事件。平均随访时间为 44 个月，76%的患者为女性。术前 TT-TG 比值平均为 13.5，Caton-Deschamps 比值平均为 1.2；92%的患者存在 Dejour B、C 或 D 型滑车发育不良。Kujala 评分从术前的 55.0 分提高到 90.0 分（P<0.001）。几乎所有患者（94.5%）在 1 年内能够重返运动，74%的患者恢复到相同或更高的运动水平。只有 3 例患者报告术后出现脱位或半脱位事件。
对于 TT-TG 距离无明显升高或髌骨高位不明显的患者，尽管存在滑车发育不良，孤立性 MPFL 重建仍是治疗髌股不稳定的安全有效方法。大多数患者在术后 1 年内能够以相同或更高的运动水平重返运动。
