Zhao Yun, Huang Jingmin, Li Dongchao, Hu Wenjin
Department of Orthopedics, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin, 300131, P.R.China.
The Second Department of Sport Injury and Arthroscopy, Tianjin Hospital, Tianjin, 300211,
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2019 Aug 15;33(8):960-964. doi: 10.7507/1002-1892.201811111.
To investigate the effectiveness of arthroscopic medial patellofemoral ligament (MPFL) reconstruction combined with tibial tuberosity transfer for recurrent patellar dislocation.
Between February 2012 and December 2013, 24 patients (24 knees) with recurrent patellar dislocation were treated with arthroscopic MPFL reconstruction combined with tibial tuberosity transfer. There were 7 males and 17 females, with a mean age of 23.2 years (range, 18-37 years). One patient had recurrence dislocation after operation in the other hospital, and the others were the first operation. The disease duration ranged from 6 months to 20 years (mean, 5.6 years). The patellar apprehension tests were positive. The preoperative Lysholm score was 49.79±11.67 and the Kujala score was 49.63±6.28. X-ray films showed that 13 patients had dysplasia of the patella and femoral trochlea; 8 patients had high tibia (Caton-Deschamps index>1.2); the congruence angle was (23.96±5.54)°. CT examination showed that the tibial tuberosity-trochlear groove distance (TT-TG) value was (23.71±2.35) mm.
All incisions healed by first intention. Twenty-two patients were followed up 59-81 months, with an average of 66.8 months. No dislocation occurred during the follow-up period. The patellar apprehension tests were negative. At 1 week after operation, the results of X-ray films and CT showed that the congruence angle angle was (-1.96±4.65)°, and the TT-TG value was (13.75±1.89) mm, which were significantly lower than those before operation ( <0.05). At 6 months, 1 year, and last follow-up, Lysholm scores were 81.13±17.76, 91.35±3.60, and 92.23±2.71, respectively; and Kujala scores were 84.04±3.98, 91.48±3.64, and 91.45±3.29, respectively. The Lysholm and Kujala scores were significantly increased after operation when compared with the preoperative scores ( <0.05). At last follow-up, the effectiveness was excellent in 11 cases, good in 8 cases, and fair in 3 cases, with an excellent and good rate of 86%.
Arthroscopic MPFL reconstruction combined with tibial tuberosity transfer for recurrent patellar dislocation can effectively improve the patellofemoral joint matching relationship and has a satisfactory short- and medium-term effectiveness.
探讨关节镜下内侧髌股韧带（MPFL）重建联合胫骨结节移位治疗复发性髌骨脱位的疗效。
2012年2月至2013年12月，对24例（24膝）复发性髌骨脱位患者采用关节镜下MPFL重建联合胫骨结节移位治疗。其中男性7例，女性17例，平均年龄23.2岁（18 - 37岁）。1例患者在其他医院术后复发脱位，其余为初次手术。病程6个月至20年（平均5.6年）。髌骨恐惧试验均为阳性。术前Lysholm评分为49.79±11.67，Kujala评分为49.63±6.28。X线片显示，13例患者存在髌骨和股骨滑车发育不良；8例患者胫骨高位（Caton-Deschamps指数>1.2）；适合角为（23.96±5.54）°。CT检查显示胫骨结节-滑车沟距离（TT-TG）值为（23.71±2.35）mm。
所有切口均一期愈合。22例患者获随访59 - 81个月，平均66.8个月。随访期间无脱位发生。髌骨恐惧试验阴性。术后1周，X线片及CT结果显示适合角为（-1.96±4.65）°，TT-TG值为（13.75±1.89）mm，均显著低于术前（<0.05）。术后6个月、1年及末次随访时，Lysholm评分分别为81.13±17.76、91.35±3.60、92.23±2.71；Kujala评分分别为84.04±3.98、91.48±3.64、91.45±3.29。术后Lysholm和Kujala评分与术前相比均显著提高（<0.05）。末次随访时，疗效优11例，良8例，可3例，优良率为86%。
关节镜下MPFL重建联合胫骨结节移位治疗复发性髌骨脱位可有效改善髌股关节匹配关系，具有满意的中短期疗效。
