Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Luisenstrasse 64, 10117, Berlin, Germany.
Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Ludwigshafen am Rhein, Germany.
Knee Surg Sports Traumatol Arthrosc. 2023 Jan;31(1):264-271. doi: 10.1007/s00167-022-07104-1. Epub 2022 Aug 16.
To evaluate the results for reconstruction of the medial patellofemoral ligament using synthetic nonresorbable sutures (S-MPFL-R) in comparison to MPFL-R using quadriceps tendon autograft (QT-MPFL-R) in patients undergoing simultaneous correction of anatomic risk factors for lateral patellar instability (LPI) at a minimum of 2 years of follow-up.
Between November 2018 and June 2019, 19 patients (male/female 8/11; mean age 26 ± 7 years) underwent S-MPFL-R (FiberTape) in combination with the correction of predisposing risk factors for LPI. The control group of 38 patients (male/female 16/22, mean age 26 ± 6 years) who underwent QT-MPFL-R was matched 1:2 by sex, age, anatomic risk factors, and concomitant surgical correction of bony risk factors. The Banff Patella Instability Instrument 2.0 (BPII 2.0) and a numerical analog scale (NAS 0-10) for patellofemoral pain and subjective knee joint function were used to assess patients' reported quality of life before and after surgery.
The BPII 2.0 score increased from 35.0 ± 21.7 points to 79.7 ± 13.3 points (p < 0.0001) in the S-MPRL-R group and from 44.3 ± 19.6 points to 80.9 ± 15 points (p < 0.0001) in the QT-MPFL-R group from preoperatively to postoperatively, respectively, without any significant difference between the groups. In the S-MPFL-R group and QT-MPFL-R group, 95% (18/19) and 92% (35/38) of patients, respectively, crossed the minimally clinically important difference reported for the BPII 2.0. NAS values for pain and subjective knee joint function improved significantly in both groups (p < 0.0001, p < 0.0001) without any significant difference between the groups at the final follow-up.
This study demonstrates that nonresorbable sutures can serve as a viable option for MPFL-R, yielding comparable outcomes compared to quadriceps tendon autograft reconstruction when performed concomitantly with the correction of anatomic risk factors for LPI. This option reduces the need for autologous tendon harvesting or the use of allografts for MPFL-R.
Level III.
评估使用合成不可吸收缝线（S-MPFL-R）重建内侧髌股韧带（MPFL）与使用股四头肌腱自体移植物（QT-MPFL-R）的结果，在至少 2 年的随访中，对同时纠正外侧髌股不稳定（LPI）解剖危险因素的患者进行比较。
2018 年 11 月至 2019 年 6 月，19 例患者（男/女 8/11；平均年龄 26±7 岁）接受了 S-MPFL-R（FiberTape）联合 LPI 解剖危险因素的矫正治疗。38 例患者（男/女 16/22，平均年龄 26±6 岁）作为对照组，按性别、年龄、解剖危险因素和伴发的骨危险因素手术矫正进行 1:2 配对。Banff 髌股不稳定评分 2.0（BPII 2.0）和数字模拟量表（NAS 0-10）用于评估髌股疼痛和主观膝关节功能，以评估患者术前和术后的生活质量。
S-MPRL-R 组的 BPII 2.0 评分从术前的 35.0±21.7 分增加到术后的 79.7±13.3 分（p<0.0001），QT-MPFL-R 组从术前的 44.3±19.6 分增加到术后的 80.9±15.0 分（p<0.0001），两组之间无显著差异。在 S-MPFL-R 组和 QT-MPFL-R 组中，分别有 95%（18/19）和 92%（35/38）的患者 BPII 2.0 报告的最小临床重要差异超过了临界值。两组的 NAS 疼痛和主观膝关节功能评分均显著改善（p<0.0001，p<0.0001），但在末次随访时两组之间无显著差异。
本研究表明，不可吸收缝线可作为 MPFL-R 的一种可行选择，与同时纠正 LPI 解剖危险因素的股四头肌腱自体移植物重建相比，可获得相当的结果。这种选择减少了对自体肌腱采集或使用同种异体移植物进行 MPFL-R 的需求。
III 级。
