Xu Haiyun, Yan Fangfang, Shen Ji, Deng Yunyang, Chen Mengyu, Li Mei
Department of Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Orthopedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Quant Imaging Med Surg. 2023 Jan 1;13(1):271-281. doi: 10.21037/qims-22-71. Epub 2022 Nov 16.
Limited research has evaluated imaging results following a combination of operations for recurrent patella dislocation (RPD) based on medial patellofemoral ligament (MPFL) reconstruction. Therefore, this study aimed to retrospectively compare the imaging and clinical results of RPD following 2 types of combined surgical techniques.
Patients who underwent combined surgery for RPD from January 2008 to December 2019 were enrolled in the study and allocated into 2 groups. MPFL reconstruction combined with lateral retinacular release (LRR) was performed in groups A and B, and an additional tibial tuberosity transfer (TTT) was performed in group B only. Patients in group A with a tibial tuberosity trochlear groove (TT-TG) distance greater than 15 mm were included in subgroup A*. Congruence angle (CA), patellar tilt angle (PTA), lateral patellofemoral angle (LPA), lateral patellar displacement (LPD), TT-TG, Insall-Salvati Index (ISI), the Dejour type of trochlear dysplasia, and knee function were assessed. All groups were followed up in the short-term (1-2 years), and group B was also followed up in the mid-term (over 5 years).
A total of 40 knees (36 patients) were included in group A, 26 knees (24 patients) in subgroup A*, and 27 knees (26 patients) in group B. In group A, CA, PTA, and LPD had increased at the short-term follow-up, yet LPA had decreased compared to the results 3 days after surgery. In group B, at the mid-term follow-up, PTA (12.54±6.88 . 15.23±6.10; P=0.002) increased while LPD (7.08±6.48 . 4.69±6.28; P=0.049) decreased compared with the short-term outcomes. The more severe the femoral trochlear dysplasia, the lower the mid-term Kujala scores in group B (P=0.007). The short-term TT-TG (17.32±4.288 . 12.84±3.758; P<0.001) and ISI [1.25 (1.1075, 1.300) . 1.06 (1.00, 1.16); P<0.001] in group B were lower than those in group A, who had a higher Kujala score (P<0.001). The CA, LPD, ISI, TT-TG, and Kujala score in subgroup A* were higher than those in group B at the short-term follow-up (P<0.05).
Both types of combination treatments were successful in altering the patellofemoral joint in a satisfactory manner, and the knee function improved in both groups. A TTT might not be necessary for patients with a TT-TG distance greater than 15 mm.
基于髌股内侧韧带（MPFL）重建的复发性髌骨脱位（RPD）联合手术的影像学结果评估研究有限。因此，本研究旨在回顾性比较两种联合手术技术治疗RPD后的影像学和临床结果。
纳入2008年1月至2019年12月接受RPD联合手术的患者，并分为两组。A组和B组均行MPFL重建联合外侧支持带松解（LRR），仅B组加做胫骨结节移位（TTT）。A组中胫骨结节-滑车沟（TT-TG）距离大于15mm的患者纳入A*亚组。评估了适合角（CA）、髌骨倾斜角（PTA）、髌股外侧角（LPA）、髌骨外侧移位（LPD）、TT-TG、Insall-Salvati指数（ISI）、滑车发育不良的Dejour分型以及膝关节功能。所有组均进行短期（1-2年）随访，B组还进行了中期（超过5年）随访。
A组共纳入40膝（36例患者），A亚组纳入26膝（24例患者），B组纳入27膝（26例患者）。A组在短期随访时CA、PTA和LPD增加，但与术后3天的结果相比LPA降低。B组在中期随访时，与短期结果相比PTA（12.54±6.88°对15.23±6.10°；P=0.002）增加而LPD（7.08±6.48mm对4.69±6.28mm；P=0.049）降低。股骨滑车发育不良越严重，B组的中期Kujala评分越低（P=0.007）。B组的短期TT-TG（17.32±4.288mm对12.84±3.758mm；P<0.001）和ISI[1.25（1.1075，1.300）对1.06（1.00，1.16）；P<0.001]低于A组，A组的Kujala评分更高（P<0.001）。在短期随访时，A亚组的CA、LPD、ISI、TT-TG和Kujala评分高于B组（P<0.05）。
两种联合治疗均成功以令人满意的方式改变了髌股关节，两组膝关节功能均有改善。对于TT-TG距离大于15mm的患者，可能无需进行TTT。
