Camanho Gilberto Luis, Gobbi Riccardo Gomes, Andrade Marta Halasz de
Departamento de Ortopedia e Traumatologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
Rev Bras Ortop (Sao Paulo). 2021 Dec 13;57(2):308-313. doi: 10.1055/s-0041-1729570. eCollection 2022 Apr.
To evaluate major complications after a minimum of 5 years of follow-up after acute or recurrent patellar dislocation treated with medial patellofemoral ligament (MPFL) reconstruction with the medial third of the patellar tendon, with or without associated medialization of the tibial anterior tuberosity (TAT). A total of 50 patients were included, with a minimum follow-up of 5 years. The patients were evaluated regarding complications such as joint stiffness, recurrence of patellar dislocation, subjective instability reported by patients, and inability to return to the previous level of physical activity. The mean follow-up was of 8.9 ± 2.6 years, with a minimum of 6 and maximum of 15 years; 64% of the patients were women, with a mean age of 27 ± 11.2 years old; 24% were submitted to TAT osteotomy for simultaneous medialization; and 46% were acute cases. Only 9 poor results (18%) were found, all resulting from recurrence of dislocation (12%) and complaint of subjective instability (6%) at between 36 and 60 months of follow-up. No other complications occurred. Among the poor results, five occurred in cases of acute dislocation, and four in recurrent cases, and only one had undergone TAT osteotomy. Reconstruction of the MPFL with the medial third of the patellar tendon, associated or not with TAT medialization osteotomy, is an alternative in the treatment of acute or chronic patellar instability, with a failure rate of only 18% in at least 5 years of follow-up. In addition, it is safe treatment, that does not present other complications.
评估采用髌腱内侧三分之一重建内侧髌股韧带（MPFL）治疗急性或复发性髌骨脱位，无论是否伴有胫骨结节内移（TAT），至少随访5年后的主要并发症。共纳入50例患者，随访时间至少5年。对患者进行了关节僵硬、髌骨脱位复发、患者报告的主观不稳定以及无法恢复到先前体力活动水平等并发症的评估。平均随访时间为8.9±2.6年，最短6年，最长15年；64%的患者为女性，平均年龄为27±11.2岁；24%的患者同时接受了TAT截骨术以进行内移；46%为急性病例。仅发现9例效果不佳（18%），均为随访36至60个月时脱位复发（12%）和主观不稳定主诉（6%）所致。未发生其他并发症。在效果不佳的病例中，5例发生在急性脱位患者中，4例发生在复发性脱位患者中，且仅1例接受了TAT截骨术。采用髌腱内侧三分之一重建MPFL，无论是否联合TAT内移截骨术，都是治疗急性或慢性髌骨不稳定的一种选择，在至少5年的随访中失败率仅为18%。此外，这是一种安全的治疗方法，不会出现其他并发症。
