Department of Orthopaedic Surgery, Service de Chirurgie orthopédique, Centre Hospitalo Universitaire de Saint-Étienne, University Hospital of Saint Etienne, Hôpital Nord, 42055, Saint-Étienne Cedex 2, France.
EA 7424, Inter-University Laboratory of Human Movement Science, University Lyon, University Jean Monnet Saint Etienne, Saint-Étienne, France.
Knee Surg Sports Traumatol Arthrosc. 2019 Mar;27(3):805-813. doi: 10.1007/s00167-018-5102-4. Epub 2018 Aug 28.
The hypotheses were that medial patellofemoral ligament reconstruction (MPFLr) would improve the long-term symptoms of patellofemoral Instability (PFI) and control patellar tilt, based on computed tomography (CT), and that the addition of a TT transfer, when it is necessary, would not deteriorate the outcome. The purpose of this study was to evaluate the long-term clinical and radiographic outcomes of a large series of MPFLr, either isolated or associated with a TT transfer.
From 133 MPFLr with a minimum of 4 years postoperatively, three groups were defined: isolated MPFLr, MPFLr with tibial tubercle (TT) medialisation or MPFLr with TT medialisation and distalisation. IKDC and Kujala scores were evaluated. Patellar tilt was evaluated on the patient's preoperative and the last available radiograph, and on CT scan measurements performed preoperatively and at 6-month postoperatively.
The mean follow-up was 6.3 ± 1.7 years [4.1-10.3] and four patients reported recurrent patellar dislocation. Between pre and postoperative at last follow-up a significant improvement in IKDC and Kujala functional scores was observed (P < 0.01), with no difference between the three groups. Regarding patellar tilt, there were significant decreases in Laurin and Merchant angles and an improvement of the Maldague stage (P < 0.01). The CT analysis of patellar tilt also demonstrates a significant improvement of the patella tilt (P < 0.01). The control of the patella tilt was correlated with a good functional result (P < 0.01).
The MPFLr, whether isolated or associated with a TT transfer, provides good long-term clinical and radiological outcomes with a low rate of recurrence. The addition of a TT transfer, when necessary, results in the same good outcomes. This article provides a guide for surgeons evaluating PFI to choose the most appropriate procedure.
IV.
假设内侧髌股韧带重建（MPFLr）将通过计算机断层扫描（CT）改善髌股不稳定（PFI）的长期症状并控制髌骨倾斜，并且当需要时，添加 TT 转移不会恶化结果。本研究的目的是评估大量孤立的 MPFLr 或与 TT 转移相关的 MPFLr 的长期临床和放射学结果。
从 133 例 MPFLr 中，至少有 4 年的术后随访，定义了三组：孤立的 MPFLr、MPFLr 联合胫骨结节（TT）内移或 MPFLr 联合 TT 内移和下移。评估 IKDC 和 Kujala 评分。髌骨倾斜在术前和最后一次可获得的 X 线片上进行评估，并在术前和术后 6 个月进行 CT 扫描测量。
平均随访时间为 6.3±1.7 年[4.1-10.3]，4 例患者报告复发性髌骨脱位。与术前相比，末次随访时 IKDC 和 Kujala 功能评分均显著提高（P<0.01），三组间无差异。关于髌骨倾斜，Laurin 和 Merchant 角显著减小，Maldague 分期改善（P<0.01）。髌骨倾斜的 CT 分析也表明髌骨倾斜有显著改善（P<0.01）。髌骨倾斜的控制与良好的功能结果相关（P<0.01）。
孤立的 MPFLr 或联合 TT 转移均可提供良好的长期临床和放射学结果，且复发率低。当需要时，添加 TT 转移会产生相同的良好效果。本文为评估 PFI 的外科医生提供了选择最合适手术的指南。
IV。
