Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Department of Sports and Para-Sports Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajiicho 465, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan.
Int Orthop. 2021 May;45(5):1215-1222. doi: 10.1007/s00264-020-04765-w. Epub 2020 Aug 7.
Medial patellofemoral ligament (MPFL) reconstruction using the hamstring tendon is widely performed to treat recurrent patellar dislocation. MPFL reconstruction includes a post-operative process of necrosis and reperfusion of the hamstring tendon graft. We hypothesise that the patella gradually shifts laterally because of this process, ultimately affecting the patellofemoral joint alignment. This study aimed to analyse the chronological changes in the patellofemoral joint alignment and the outcomes of MPFL reconstruction.
In this retrospective case-series study, the Knee Society, Lysholm, and Kujala scores were evaluated in 24 consecutive patients (27 knees). To evaluate patellar tracking defects, radiographic indices including the tilting angle, the lateral shift ratio, and the congruence angle were measured before, immediately after, and three, 12, and 36 months after MPFL reconstruction.
Post-operative Kujala, Knee Society, and Lysholm scores for the study population significantly improved relative to the pre-operative scores. The tilting and congruence angles at three months after the operation significantly increased relative to those recorded immediately after the operation. The tilting and congruence angles were not significantly different at three, 12, and 36 months after the operation.
The post-operative outcomes of MPFL reconstruction for recurrent patellar dislocation were favourable. Insufficient union between the bone tunnel and tendon graft, along with an elongation of the necrotic tendon graft, may change the alignment of the patellofemoral joint within three months after the operation. Therefore, we believe it is necessary to refrain from knee rotation that places lateral stress on the patella until three months after the operation.
采用腘绳肌腱进行内侧髌股韧带（MPFL）重建术被广泛应用于治疗复发性髌骨脱位。MPFL 重建术包括腘绳肌腱移植物的坏死和再灌注的术后过程。我们假设由于这个过程，髌骨逐渐向外侧移位，最终影响髌股关节对线。本研究旨在分析髌股关节对线的时间变化和 MPFL 重建的结果。
在这项回顾性病例系列研究中，对 24 例连续患者（27 膝）进行了膝关节学会评分、Lysholm 评分和 Kujala 评分评估。为了评估髌骨跟踪缺陷，在 MPFL 重建前、重建后即刻以及 3、12 和 36 个月时，测量了包括倾斜角、外侧移位比和吻合角在内的放射学指数。
与术前评分相比，研究人群的术后 Kujala、膝关节学会和 Lysholm 评分显著提高。术后 3 个月的倾斜角和吻合角与术后即刻相比显著增加。术后 3、12 和 36 个月时的倾斜角和吻合角无显著差异。
复发性髌骨脱位的 MPFL 重建术后结果良好。骨隧道与肌腱移植物之间的愈合不足以及坏死肌腱移植物的延长，可能会在术后 3 个月内改变髌股关节的对线。因此，我们认为有必要避免在术后 3 个月内对髌骨施加外侧压力的膝关节旋转。
