Shatrov Jobe, Colas Antoine, Fournier Gaspard, Batailler Cécile, Servien Elvire, Lustig Sébastien
Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France.
Sydney Orthopaedic Research Institute (SORI) - St. Leonards, Sydney, Australia.
Arthroplast Today. 2022 Jun 4;16:130-139. doi: 10.1016/j.artd.2022.04.006. eCollection 2022 Aug.
The aim of this study was to describe outcomes of patients who had undergone medial patellofemoral ligament reconstruction (MPFLr) to treat patellofemoral instability (PFI) following total knee arthroplasty (TKA).
This is a retrospective case series of consecutive patients treated for PFI after TKA. Patients were included if they had radiographic documentation of patella dislocation or subluxation and component position was adequate. MPFLr was performed using a quadriceps tendon autograft. The graft was fixed with either an interference or additional suspensory fixation. A tibial tubercle osteotomy was performed in select indications. Patients were assessed with Kujala and International Knee Score (IKS) at a minimum 12-month follow-up and radiographically with plain radiographs.
A total of 22 patients (23 procedures) were included. The mean follow-up period was 38 months (range 12-72). Average preoperative femoral component rotation on computed tomography was 0.10° external rotation (range 3° internal rotation to 3° external rotation). All patients had improved clinical and radiographic outcomes postoperatively. At the last follow-up, the mean IKS knee score was 77.6 ± 13.1, mean IKS function score was 75.2 ± 23.3, and mean Kujala score was 60.2/100 ± 10.9. There was 1 mechanical failure, which occurred following MPFLr with interference fixation. There were 6 complications (28.1%) postoperatively. Patients receiving double fixation of the MPFLr graft had higher clinical and radiographic scores; however, this difference was not statistically significant. MPFLr had a patella-lowering effect, 0.97 preoperatively to 0.74 postoperatively ( = .069).
MPFLr in appropriately selected patients is a satisfactory option to treat PFI following TKA.
本研究的目的是描述接受内侧髌股韧带重建术（MPFLr）治疗全膝关节置换术（TKA）后髌股关节不稳（PFI）患者的治疗结果。
这是一组对TKA术后PFI患者进行连续治疗的回顾性病例系列研究。如果患者有髌骨脱位或半脱位的影像学记录且假体位置合适，则纳入研究。采用股四头肌肌腱自体移植进行MPFLr。移植物采用嵌压固定或附加悬吊固定。根据具体指征进行胫骨结节截骨术。在至少12个月的随访中，采用库贾拉评分和国际膝关节评分（IKS）对患者进行评估，并通过X线平片进行影像学评估。
共纳入22例患者（23例手术）。平均随访时间为38个月（范围12 - 72个月）。术前计算机断层扫描显示平均股骨假体旋转角度为0.10°外旋（范围为3°内旋至3°外旋）。所有患者术后临床和影像学结果均有改善。在最后一次随访时，IKS膝关节平均评分为77.6±13.1，IKS功能平均评分为75.2±23.3，库贾拉平均评分为60.2/100±10.9。发生1例机械性失败，发生在采用嵌压固定的MPFLr术后。术后有6例并发症（28.1%）。接受MPFLr移植物双重固定的患者临床和影像学评分更高；然而，这种差异无统计学意义。MPFLr有降低髌骨的作用，术前为0.97，术后为0.74（P = 0.069）。
对于适当选择的患者，MPFLr是治疗TKA后PFI的一种令人满意的选择。
