Division of Sportstrauma, Department of Orthopedics, Aarhus University Hospital, Aarhus, Denmark.
Division of Sportstrauma, Department of Orthopedics, Aarhus University Hospital, Aarhus, Denmark.
Arthroscopy. 2019 Apr;35(4):1130-1137. doi: 10.1016/j.arthro.2018.11.051. Epub 2019 Mar 11.
The aim of the present randomized controlled trial was to compare 2 different medial patellofemoral ligament reconstruction (MPFL-R) techniques that utilize different femoral fixation principles, which could affect subjective clinical outcomes and surgical morbidity.
Sixty patients were randomly assigned to 2 MPFL-R techniques: bone or soft-tissue fixation of the graft at the femoral condyle. Patients had operations performed between 2010 and 2015 at a single center. Indication for surgery was 2 or more patellar dislocations. When the bone fixation technique was used, the gracilis tendon was fixed with the use of an interference screw. When the soft-tissue fixation technique was used, the gracilis tendon was looped around the adductor magnus tendon. Both techniques used patella-graft fixation with drill holes in the medial patellar edge. Clinical outcomes were evaluated by means of Kujala, knee injury and osteoarthritis outcome, and pain scores before the operation and at 1- and 2-year follow-up examinations. Surgical morbidity was evaluated by pain on palpation along the reconstruction site.
Kujala scores were 88 and 89 for bone and soft-tissue fixation groups, respectively, with no difference between groups (P = .73). No significant differences in knee injury osteoarthritis outcome or pain scores were found. Analysis of surgical morbidity, defined as femoral-based tenderness overlying the fixation site, demonstrated that 13% and 12% of patients had significant tenderness at the reconstruction site after bone and soft-tissue MPFL-R, respectively. No patellar re-dislocations were observed in either group.
MPFL-R with soft-tissue graft fixation at the femoral condyles resulted in findings for subjective clinical outcome, patellar stability, and pain level similar to those associated with MPFL-R with bone fixation. Surgical morbidity was also similar between patients who had soft-tissue and those who had bone fixation MPFL-R. Soft-tissue femoral graft fixation does not result in inferior clinical outcomes compared with screw fixation, and it can be used safely for MPFL-R.
本随机对照试验的目的是比较两种不同的内侧髌股韧带重建（MPFL-R）技术，这两种技术采用不同的股骨固定原理，可能会影响主观临床结果和手术发病率。
60 名患者被随机分配到 2 种 MPFL-R 技术中：在股骨髁处对移植物进行骨或软组织固定。患者于 2010 年至 2015 年在一个中心进行手术。手术指征为 2 次或 2 次以上髌骨脱位。当使用骨固定技术时，使用干涉螺钉固定股薄肌肌腱。当使用软组织固定技术时，股薄肌肌腱绕过收肌腱。两种技术均使用髌骨-移植物固定，在髌骨内侧边缘钻取钻孔。通过 Kujala、膝关节损伤和骨关节炎结果以及术前和 1 年和 2 年随访检查时的疼痛评分评估临床结果。通过在重建部位触诊时的疼痛评估手术发病率。
骨固定组和软组织固定组的 Kujala 评分分别为 88 和 89，两组之间无差异（P=.73）。在膝关节损伤骨关节炎结果或疼痛评分方面没有发现显著差异。分析手术发病率，定义为固定部位上方的股骨基压痛，表明在骨和软组织 MPFL-R 后，分别有 13%和 12%的患者在重建部位有明显压痛。两组均未观察到髌骨再脱位。
在股骨髁处用软组织移植物固定进行 MPFL-R 可获得与骨固定相似的主观临床结果、髌骨稳定性和疼痛水平。软组织和骨固定的 MPFL-R 患者的手术发病率也相似。与螺钉固定相比，软组织股骨移植物固定不会导致较差的临床结果，并且可以安全地用于 MPFL-R。
