外侧支持带松解术不建议与 MPFL 重建术联合应用于复发性髌骨脱位。
Lateral retinacular release is not recommended in association to MPFL reconstruction in recurrent patellar dislocation.
机构信息
FIFA Medical Center of Excellence, Orthopaedics Surgery and Sports Medicine Department, Croix Rousse Hospital, Civil Hospices of Lyon, 103 Boulevard de la Croix Rousse, 69004, Lyon, France.
OSU Sports Medicine Research Institute, Department of Orthopaedics, The Ohio State University, Columbus, OH, USA.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2019 Aug;27(8):2659-2664. doi: 10.1007/s00167-018-5294-7. Epub 2018 Nov 27.
PURPOSE
Reconstruction of the medial patellofemoral ligament (MPFL) has become the gold standard for the treatment of the recurrent patellar dislocation (RPD). Lateral retinacular release can be performed in association with MPFL reconstruction, but the effect on outcomes is not clear. To evaluate the effect of lateral release on outcomes following MPFL reconstruction is the aim of this study. It is hypothesized that isolated MPFL reconstruction was not inferior to MPFL reconstruction and lateral retinacular release in terms of IKDC subjective score and patellar tilt (PT).
METHODS
Patients between ages 18 and 45 scheduled to undergo MPFL reconstruction without an associated bony procedure (tibial tubercle osteotomy or trochleoplasty) were randomized to isolated MPFL reconstruction or MPFL reconstruction (no LRR group) and arthroscopic LRR (LRR group). Evaluation criteria were subjective IKDC score as the primary outcome and PT evaluated with a CT-scan. PT was evaluated with the quadriceps relaxed (PTQR) and contracted (PTQC).
RESULTS
Of 43 patients included in the trial, 7 were lost of follow-up, 3 were not able to complete evaluation because of medical reasons, and 33 patients were evaluated with a minimum of 12 months and a median follow-up of 24 (12-60) months. The average subjective IKDC score was at 86 ± 20 (29-94) in the LRR group and 82 ± 15 (39-95) in the no LRR group (p = 0.45). The PTQR was at 22° ± 7° (13-37) in the LRR group and 21 ± 10 (4-37) in the no LRR group (n.s.). The PTQC was at 27° ± 9° (12-40) in the LRR group and 25 ± 12 (5-45) in the no LRR group (n.s.). No complications were noted in either group.
CONCLUSIONS
No significant differences were found in subjective IKDC score or patellar tilt based on the addition of an arthroscopic LRR to an MPFL reconstruction in patients with RPD not undergoing associated bony procedures. There is no indication to a systematic lateral retinacular release in association with MPFL reconstruction in the treatment of RPD.
LEVEL OF EVIDENCE
II.
目的
重建内侧髌股韧带（MPFL）已成为治疗复发性髌骨脱位（RPD）的金标准。外侧支持带松解术可与 MPFL 重建同时进行，但对结果的影响尚不清楚。本研究旨在评估外侧松解术对 MPFL 重建后结果的影响。假设孤立的 MPFL 重建在 IKDC 主观评分和髌骨倾斜（PT）方面不劣于 MPFL 重建和外侧支持带松解。
方法
计划接受无相关骨手术（胫骨结节截骨术或滑车成形术）的 MPFL 重建的 18-45 岁患者被随机分为孤立的 MPFL 重建或 MPFL 重建（无 LRR 组）和关节镜下 LRR（LRR 组）。评估标准为主要结局的主观 IKDC 评分和 CT 扫描评估的 PT。PT 采用股四头肌放松（PTQR）和收缩（PTQC）评估。
结果
43 例患者中，7 例失访，3 例因医疗原因无法完成评估，33 例患者至少随访 12 个月，中位数随访时间为 24（12-60）个月。LRR 组的平均主观 IKDC 评分为 86±20（29-94），无 LRR 组为 82±15（39-95）（p=0.45）。LRR 组的 PTQR 为 22°±7°（13-37），无 LRR 组为 21°±10（4-37）（n.s.）。LRR 组的 PTQC 为 27°±9°（12-40），无 LRR 组为 25°±12（5-45）（n.s.）。两组均无并发症。
结论
在不进行相关骨手术的情况下，RPD 患者接受 MPFL 重建并同时行关节镜下外侧支持带松解术与单独行 MPFL 重建相比，在主观 IKDC 评分或髌骨倾斜方面无显著差异。在 RPD 的治疗中，没有指征进行系统的外侧支持带松解术。
证据水平
II 级。
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