Department of Artificial Joints and Biomaterials, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Knee Surg Sports Traumatol Arthrosc. 2021 Nov;29(11):3809-3817. doi: 10.1007/s00167-020-06403-9. Epub 2021 Jan 18.
The purpose of this study is two-fold: (1) to describe the femoral reference point of the medial patellofemoral ligament (MPFL) on a virtual true lateral radiograph reconstructed from a three-dimensional computed tomography (3D-CT) image and (2) to compare this point with that of patients without patellofemoral instability and with Schöttle's point.
A total of 26 consecutive patients (29 affected knees) with recurrent patellar dislocation (RPD), who underwent MPFL reconstruction were included in this study (4 males; 22 females; mean age, 24.0 years old). Using a true lateral 3DCT image, the MPFL femoral insertion was identified and marked with a 2-mm circle, and this image was reconstructed as a virtual true lateral radiograph. Following Schöttle's method, the point of intersection was described by their anterior-posterior and proximal-distal positions. As a control population, 29 age- and gender-matched patients with anterior cruciate ligament (ACL) injuries were also analysed.
The points in RPD patients were located significantly posterior (-2.5 ± 2.3 mm, p < 0.01) to the line representing an extension of the posterior cortex of the femur and distal (- 6.9 ± 2.4 mm, p < 0.01) to the posterior origin of the medial femoral condyle compared with those in the control population. The mean reference point of RPD patients was located in a 3.8-mm posterior and 4.4-mm distal position compared with Schöttle's point.
An anatomical and radiographic femoral reference point of the MPFL on a true lateral virtual radiograph was described with our method. In patients with RPD, this reference point was identified to be more posterior and distal to Schöttle's point. More anatomical and individualized MPFL reconstruction will be secured using our method.
Level IV.
本研究旨在双重目的：（1）描述在从三维 CT（3D-CT）图像重建的虚拟真实侧位 X 线片上的内侧髌股韧带（MPFL）的股骨参考点，以及（2）将该点与没有髌股不稳定的患者和 Schöttle 点进行比较。
本研究共纳入 26 例（29 个患膝）复发性髌骨脱位（RPD）患者，这些患者均接受了 MPFL 重建（4 名男性；22 名女性；平均年龄 24.0 岁）。使用真实的侧位 3DCT 图像，识别并以 2mm 圆圈标记 MPFL 股骨插入点，并将该图像重建为虚拟真实的侧位 X 线片。按照 Schöttle 方法，描述交点的前后和远近位置。作为对照人群，还分析了 29 例年龄和性别匹配的前交叉韧带（ACL）损伤患者。
与对照组相比，RPD 患者的点明显位于（-2.5±2.3mm，p<0.01）代表股骨后皮质延伸的线后方和（-6.9±2.4mm，p<0.01）距内侧股骨髁后起点更远。RPD 患者的平均参考点位于比 Schöttle 点更后和更远端的 3.8mm 处和 4.4mm 处。
我们的方法描述了真实侧位虚拟 X 线片上 MPFL 的解剖和放射学股骨参考点。在 RPD 患者中，该参考点位于 Schöttle 点更靠后和更远的位置。使用我们的方法可以确保更准确的解剖和个体化的 MPFL 重建。
IV 级。
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