Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084, Baronissi, Italy.
Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, 84131, Salerno, Italy.
J Orthop Surg Res. 2020 Nov 12;15(1):529. doi: 10.1186/s13018-020-02072-z.
The medial patellofemoral ligament (MPFL) works in association with the medial patellotibial ligament (MPTL) and the medial patellomeniscal ligament (MPML) to impart stability to the patellofemoral joint. The anatomy and biomechanical characteristics of the MPFL have been well described but little is known about the MPTL and MPML. Several reconstruction procedures of the MPFL with semitendinosus, gracilis, patellar and quadriceps tendons, allografts and synthetic grafts have been described. No clear superiority of one surgical technique over another is evident.
A systematic review of the literature was conducted using PRISMA guidelines. Inclusion criteria were articles that reported clinical outcomes of combined reconstruction of MPTL and MPFL. The methodological quality of the articles was determined using the modified Coleman Methodology Score (CMS).
Nine articles were included, reporting the clinical outcomes of 197 operated knees. The surgical procedures described include hamstrings grafting and transfer of the medial patellar and quadriceps tendons with or without bony procedures to reconstruct the MPTL in association with the MPFL. Overall, good and excellent outcomes were achieved. The median CMS is 70.6 ± 14.4 (range 38 to 84).
Different techniques are reported, and outcomes are good with low rates of recurrence. The quality of the articles is variable, ranging from low to high. Appropriately powered randomized controlled trials are needed to better understand what the adequate indications for surgery in patients with patellar instability and clinical outcomes are. Combined reconstruction of MPFL and MPTL leads to favourable clinical outcomes, supporting its role as a valid surgical procedure for patellar stabilization.
内侧髌股韧带（MPFL）与内侧髌胫韧带（MPTL）和内侧髌半月板韧带（MPML）一起作用，为髌股关节提供稳定性。MPFL 的解剖结构和生物力学特性已得到很好的描述，但对 MPTL 和 MPML 的了解甚少。已经描述了几种使用半腱肌、股薄肌、髌腱和股四头肌肌腱、同种异体移植物和合成移植物重建 MPFL 的手术技术。没有明显的一种手术技术优于另一种。
使用 PRISMA 指南进行了系统的文献回顾。纳入标准为报告 MPTL 和 MPFL 联合重建临床结果的文章。使用改良 Coleman 方法学评分（CMS）确定文章的方法学质量。
共纳入 9 篇文章，报告了 197 例手术膝关节的临床结果。描述的手术程序包括腘绳肌移植物和内侧髌腱和股四头肌肌腱的转移，有或没有骨手术，以重建 MPTL 与 MPFL 相关联。总体而言，获得了良好和优秀的结果。CMS 的中位数为 70.6±14.4（范围 38 至 84）。
报道了不同的技术，结果良好，复发率低。文章的质量参差不齐，从低到高。需要进行适当的、有影响力的随机对照试验，以更好地了解在髌股关节不稳定的患者中手术的适当适应证和临床结果。MPFL 和 MPTL 的联合重建可获得良好的临床结果，支持其作为一种有效的髌股稳定手术方法。
