Zhang Yong, Cheng Biao, Yang Lin
Department of Orthopedics, Shanghai Tenth People's Hospital, Clinical College of Nanjing Medical University, Shanghai, 201700, P.R.China;Department of Orthopedics, General Hospital of Ping Mei Shen Ma Medical Group, Pingdingshan Henan, 467000, P.R.China.
Department of Orthopedics, Shanghai Tenth People's Hospital, Clinical College of Nanjing Medical University, Shanghai, 201700, P.R.China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2020 Oct 15;34(10):1233-1237. doi: 10.7507/1002-1892.202003050.
To investigate the technique of optimizing the location of femoral attachment in medial patellofemoral ligament (MPFL) reconstruction assisted with arthroscopy and evaluate the effectiveness.
Between January 2014 and September 2018, 35 patients with patellar dislocation were admitted. There were 14 males and 21 females with an average age of 22.6 years (range, 16-38 years). All patients had a history of knee sprain. The disease duration ranged from 1 to 7 days (mean, 2.8 days). Patellar dislocation occurred 2-4 times (mean, 2.5 times). The preoperative Lysholm score and Kujala score were 47.60±11.24 and 48.37±9.79, respectively. The patellar congruence angle was (31.40±6.81)°, the patellar tilt angle was (29.95±5.44)°, the lateral patellofemoral angle was (-11.46±5.18)°, and the tibial tubercle-trochlear groove distance was (16.66±1.28) mm. All patients were treated by MPFL reconstruction with the semitendinosus tendon under arthroscopy. During operation, the suture anchors were inserted into the midpoint and the 1/3 point of superomedial edge of the patella. Then, the femoral tunnels were created in medial femoral condyle through limited excision. For tendon fixation, the Kirschner wires were inserted into adductor tubercle, medial epicondyle of femur, and the midpoint between the two points, as well as the anteriorly and posteriorly. Afterwards, the changes of ligament length and tension, patellar tracking, and the relationship of patella and femoral trochlea were evaluated, thereby determining the optimized femoral attachment for MPFL reconstruction. Finally, the patellar congruence angle, patellar tilt angle, and lateral patellofemoral angle were measured by imaging to assess the relationship of patella and femoral trochlea. Moreover, Lysholm score and Kujala score were used to evaluate the knee joint function.
All incisions healed by first intention without infection. All patients were followed up 12-18 months (mean, 15.4 months). At 12 months, the Lysholm score was 94.40±3.99 and the Kujala score was 92.28±4.13, which were significant higher than those before operation ( <0.05). No patellar dislocation occurred during follow-up. At 12 months, the patellar congruence angle was (6.57±4.59)°, the patellar tilt angle was (9.73±2.82)°, the lateral patellofemoral angle was (7.14±4.63)°, which were superior to those before operation ( <0.05).
During the MPFL reconstruction under arthroscopy, a higher positioning accuracy for the femoral attachment and satisfactory effectiveness can be obtained by evaluating MPFL length and tension, patellofemoral joint kinematics, and patellar tracking.
探讨关节镜辅助下内侧髌股韧带（MPFL）重建术中优化股骨附着点定位的技术并评估其疗效。
2014年1月至2018年9月，收治35例髌骨脱位患者。其中男性14例，女性21例，平均年龄22.6岁（范围16 - 38岁）。所有患者均有膝关节扭伤史。病程1至7天（平均2.8天）。髌骨脱位发生2至4次（平均2.5次）。术前Lysholm评分和Kujala评分分别为47.60±11.24和48.37±9.79。髌股适合角为（31.40±6.81）°，髌骨倾斜角为（29.95±5.44）°，外侧髌股角为（-11.46±5.18）°，胫骨结节 - 滑车沟距离为（16.66±1.28）mm。所有患者均在关节镜下采用半腱肌腱进行MPFL重建。手术中，将缝线锚钉插入髌骨上缘中点和上1/3点。然后，通过有限切除在内侧股骨髁创建股骨隧道。为了固定肌腱，将克氏针插入内收肌结节、股骨内上髁以及两点之间的中点，以及前后方向。之后，评估韧带长度和张力、髌骨轨迹以及髌骨与股骨滑车关系的变化，从而确定MPFL重建的优化股骨附着点。最后，通过影像学测量髌股适合角、髌骨倾斜角和外侧髌股角，以评估髌骨与股骨滑车的关系。此外，采用Lysholm评分和Kujala评分评估膝关节功能。
所有切口均一期愈合，无感染。所有患者均随访12 - 18个月（平均15.4个月）。术后12个月，Lysholm评分为94.40±3.99，Kujala评分为92.28±4.13，均显著高于术前（<0.05）。随访期间未发生髌骨脱位。术后12个月，髌股适合角为（6.57±4.59）°，髌骨倾斜角为（9.73±2.82）°，外侧髌股角为（7.14±4.63）°，均优于术前（<0.05）。
在关节镜下MPFL重建术中，通过评估MPFL长度和张力、髌股关节运动学以及髌骨轨迹，可获得更高的股骨附着点定位精度和满意的疗效。
