Department of Orthopaedics, General Hospital of the People's Liberation Army, Beijing, People's Republic of China.
Department of Orthopaedics, General Hospital of the People's Liberation Army, Beijing, People's Republic of China.
Arthroscopy. 2019 Mar;35(3):845-854.e1. doi: 10.1016/j.arthro.2018.08.050. Epub 2019 Jan 29.
To compare the stability and clinical outcomes of 2 medial patellofemoral ligament reconstruction (MPFLR) techniques for the treatment of recurrent lateral patellar dislocation in adults.
Ninety-one patients with recurrent patellar dislocation were randomly divided into 2 groups, undergoing either the traditional single-bundle transpatellar tunnel technique (group A) or the double-anchor anatomic reconstruction technique (group B). Preoperatively and at follow-up, the patellar position and rotation were evaluated by computed tomography with the congruence angle, lateral patellar angle, patellar tilt angle, and lateral patellar translation; the subjective symptoms and functional outcomes were evaluated with Kujala, Lysholm, Tegner, and International Knee Documentation Committee subjective scores. Clinical examinations were also performed, and redislocations or episodes of instability were recorded.
Patients were followed up for a mean period of 41.11 ± 7.40 months (range, 29-62 months). At the final point, no recurrent patellar dislocations occurred, except in 4 patients with instability symptoms in group A; however, no significant difference between the 2 groups was seen (χ = 2.503, P = .114). The measurement results from computed tomography decreased significantly to the normal range, and no significant difference was found between the 2 groups except for the lesser patellar tilt angle in group B (t = 2.175, P = .030). The clinical examination improved significantly, no patient exhibited a positive apprehension test in either group, and the number of patients with abnormal lateral patellar translation grade and firm end point showed no statistically significant differences between the 2 groups (P > .05). All score systems significantly improved with no significant difference between the 2 groups except for the higher Kujala score (t = -40.635, P = .001) and International Knee Documentation Committee score (t = -33.823, P = .003) in group B.
Both MPFLR techniques achieved good results in the treatment of patellar dislocation. Compared with the single-bundle transpatellar tunnel technique, the double-anchor anatomic MPFLR technique may be more effective with a more congruous patellofemoral joint and better knee function.
Level II, prospective comparative study.
比较两种治疗成人复发性外侧髌骨脱位的内侧髌股韧带重建（MPFLR）技术的稳定性和临床结果。
91 例复发性髌骨脱位患者随机分为 2 组，分别行传统的单束经髌韧带隧道技术（A 组）或双锚定解剖重建技术（B 组）。术前和随访时，通过 CT 评估髌骨位置和旋转，测量吻合角、外侧髌骨角、髌骨倾斜角和外侧髌骨平移；使用 Kujala、Lysholm、Tegner 和国际膝关节文献委员会（IKDC）主观评分评估主观症状和功能结果。还进行了临床检查，并记录了再脱位或不稳定事件。
患者平均随访 41.11±7.40 个月（范围，29-62 个月）。末次随访时，除 A 组 4 例出现不稳定症状外，无复发性髌骨脱位；但两组间无显著差异（χ2=2.503，P=0.114）。CT 测量结果显著降至正常范围，除 B 组较小的髌骨倾斜角外，两组间无显著差异（t=2.175，P=0.030）。临床检查显著改善，两组均无患者出现明显的恐惧试验阳性，外侧髌骨平移分级和终点硬度异常的患者数量在两组间无统计学差异（P＞0.05）。除 B 组的 Kujala 评分（t=-40.635，P=0.001）和 IKDC 评分（t=-33.823，P=0.003）较高外，所有评分系统均显著改善，两组间无显著差异。
两种 MPFLR 技术治疗髌骨脱位均取得良好效果。与单束经髌韧带隧道技术相比，双锚定解剖 MPFLR 技术可能更有效，髌股关节更吻合，膝关节功能更好。
Ⅱ级，前瞻性对照研究。
