Centre Orthopédique Santy, Hopital Privé Jean Mermoz, Groupe Ramsay-Generale de Santé, Lyon, France.
Am J Sports Med. 2019 May;47(6):1323-1330. doi: 10.1177/0363546519838405.
Reconstruction of the medial patellofemoral ligament (MPFL) is widely acknowledged as an integral part of the current therapeutic armamentarium for recurrent patellar instability. The procedure is often performed with concomitant bony procedures, such as distalization of the tibial tuberosity or trochleoplasty in the case of patella alta or high-grade trochlear dysplasia, respectively. At the present time, few studies have evaluated the clinical effectiveness of MPFL reconstruction as an isolated intervention.
To report the clinical outcomes of isolated MPFL reconstruction in cases of patellar instability and to identify predictive factors for failure.
Case series; Level of evidence, 4.
A retrospective analysis of prospectively collected data was performed, including all patients who had undergone isolated MPFL reconstruction between January 2008 and January 2014. Preoperative assessment included the Kujala score, assessment of patellar tracking ("J-sign"), and radiographic features, such as trochlear dysplasia according to Dejour classification, patellar height with the Caton-Deschamps index (CDI), tibial tubercle-trochlear groove distance, and patellar tilt. The Kujala score was assessed postoperatively. Failure was defined by a postoperative patellar dislocation or surgical revision for recurrent patellar instability.
A total of 239 MPFL reconstructions were included; 28 patients (11.7%) were uncontactable and considered lost to follow-up. Thus, 211 reconstructions were analyzed with a mean follow-up of 5.8 years (range, 3-9.3 years). The mean age at surgery was 20.6 years (range, 12-48 years), and 55% of patients were male. Twenty-seven percent of patients had a preoperative positive J-sign, and 93% of patients had trochlear dysplasia (A, 47%; B, 25%; C, 15%; D, 6%). The mean CDI was 1.2 (range, 1.0-1.7); mean tibial tubercle-trochlear groove distance, 15 mm (range, 5-30 mm); and mean patellar tilt, 23° (range, 9°-47°). The mean Kujala score improved from 56.1 preoperatively to 88.8 ( P < .001). Ten failures were reported that required surgical revision for recurrent patellar instability (4.7%). Uni- and multivariate analyses highlighted 2 preoperative risk factors for failure: patella alta (CDI ≥1.3; odds ratio, 4.9; P = .02) and preoperative positive J-sign (odds ratio, 3.9; P = .04).
In cases of recurrent patellar instability, isolated MPFL reconstruction would appear to be a safe and efficient surgical procedure with a low failure rate. Preoperative failure risk factors identified in this study were patella alta with a CDI ≥1.3 and a preoperative positive J-sign.
重建内侧髌股韧带（MPFL）被广泛认为是治疗复发性髌骨不稳定的当前治疗手段的重要组成部分。该手术通常与骨相关手术同时进行，例如胫骨结节远端化或滑车成形术，分别用于高位髌骨或高位滑车发育不良。目前，很少有研究评估 MPFL 重建作为单独干预的临床效果。
报告孤立性 MPFL 重建治疗髌骨不稳定的临床结果，并确定失败的预测因素。
病例系列；证据水平，4 级。
对前瞻性收集的数据进行回顾性分析，包括 2008 年 1 月至 2014 年 1 月期间接受孤立性 MPFL 重建的所有患者。术前评估包括 Kujala 评分、髌骨轨迹评估（“J 征”）以及影像学特征，如根据 Dejour 分类的滑车发育不良、髌骨高度（Caton-Deschamps 指数，CDI）、胫骨结节-滑车沟距离和髌骨倾斜度。术后评估 Kujala 评分。术后出现髌骨脱位或因复发性髌骨不稳定而进行手术翻修为失败。
共纳入 239 例 MPFL 重建；28 例（11.7%）无法联系，被认为随访丢失。因此，对 211 例重建进行了分析，平均随访 5.8 年（范围，3-9.3 年）。手术时的平均年龄为 20.6 岁（范围，12-48 岁），55%的患者为男性。27%的患者术前存在 J 征阳性，93%的患者存在滑车发育不良（A 型，47%；B 型，25%；C 型，15%；D 型，6%）。平均 CDI 为 1.2（范围，1.0-1.7）；平均胫骨结节-滑车沟距离为 15mm（范围，5-30mm）；平均髌骨倾斜度为 23°（范围，9°-47°）。术前 Kujala 评分从 56.1 分提高到 88.8 分（P<0.001）。10 例出现失败，需要手术翻修复发性髌骨不稳定（4.7%）。单因素和多因素分析均突出了 2 个术前失败的危险因素：高位髌骨（CDI≥1.3；比值比，4.9；P=0.02）和术前 J 征阳性（比值比，3.9；P=0.04）。
在复发性髌骨不稳定的情况下，孤立性 MPFL 重建似乎是一种安全有效的手术方法，失败率较低。本研究确定的术前失败危险因素是 CDI≥1.3 的高位髌骨和术前 J 征阳性。
