Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China.
Knee Surg Sports Traumatol Arthrosc. 2023 Jul;31(7):2888-2896. doi: 10.1007/s00167-022-07264-0. Epub 2022 Dec 1.
The purpose of this study was to evaluate and compare clinical and radiological outcomes between isolated medial patellofemoral ligament reconstruction (MPFLR) and MPFLR combined with derotational distal femoral osteotomy (DDFO) for patellar dislocation with increased femoral anteversion (FA).
Between 2014 and 2019, 36 patients who underwent isolated MPFLR and 31 patients who underwent MPFLR combined with DDFO were retrospectively included. Clinical outcomes included physical examinations, functional outcomes (Kujala, Lysholm, International Knee Documentation Committee (IKDC), and Banff Patella Instability Instrument (BPII) scores), activity level (Tegner activity score and return to sports), complications, and patellar re-dislocation rate. Radiological outcomes included patella tilt angle, patellar congruence angle, and patella-trochlear groove distance.
All clinical outcomes improved significantly in both groups, but the DDFO group had significantly better postoperative scores than the MPFLR group (Kujala: 85.1 ± 7.7 vs. 80.5 ± 8.4, P = 0.023; Lysholm: 86.8 ± 8.2 vs. 81.9 ± 9.1, P = 0.026; IKDC: 86.2 ± 10.0 vs. 81.7 ± 8.1, P = 0.045; and BPII: 68.0 ± 12.5 vs. 62.3 ± 10.0, P = 0.039). Both groups achieved successful return to sports (90.3% vs. 91.7%). No re-dislocation or major complications occurred. Radiological outcomes improved significantly in both groups, but the DDFO group had better outcomes (P < 0.05). The tibial tubercle-trochlear groove distance was only improved after DDFO from 17.0 ± 2.3 mm to 15.1 ± 2.0 mm (P = 0.001).
Both isolated MPFLR and MPFLR combined with DDFO yielded satisfactory clinical and radiological outcomes in the treatment of patellar dislocation with increased FA. However, combined DDFO had better outcomes and should be considered a priority.
Level III.
本研究旨在评估和比较单纯内侧髌股韧带重建（MPFLR）与 MPFLR 联合股骨远端旋转截骨术（DDFO）治疗股骨前倾角增加（FA）所致髌骨脱位的临床和影像学结果。
2014 年至 2019 年，回顾性纳入 36 例单纯行 MPFLR 及 31 例 MPFLR 联合 DDFO 的患者。临床结果包括体格检查、功能结果（Kujala、Lysholm、国际膝关节文献委员会（IKDC）和 Banff 髌骨不稳定评分表（BPII）评分）、活动水平（Tegner 活动评分和重返运动）、并发症和髌骨再脱位率。影像学结果包括髌骨倾斜角、髌骨吻合角和髌骨滑车沟距离。
两组患者的所有临床结果均显著改善，但 DDFO 组的术后评分明显优于 MPFLR 组（Kujala：85.1±7.7 比 80.5±8.4，P=0.023；Lysholm：86.8±8.2 比 81.9±9.1，P=0.026；IKDC：86.2±10.0 比 81.7±8.1，P=0.045；BPII：68.0±12.5 比 62.3±10.0，P=0.039）。两组患者均成功重返运动（90.3%比 91.7%）。无再脱位或严重并发症发生。两组影像学结果均显著改善，但 DDFO 组改善更明显（P<0.05）。DDFO 后胫骨结节-滑车沟距离从 17.0±2.3mm 改善至 15.1±2.0mm（P=0.001）。
单纯 MPFLR 和 MPFLR 联合 DDFO 治疗 FA 增加所致髌骨脱位均能取得满意的临床和影像学结果，但联合 DDFO 效果更好，应优先考虑。
III 级。
