Kumar Raj, Harna Bushu, Arya Shivali
Depaertment of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India.
Joint Replacement and Sports Medicine Division, Indus International Hospital, Derabassi and Mohali, Punjab, India.
J Orthop Case Rep. 2024 Apr;14(4):99-104. doi: 10.13107/jocr.2024.v14.i04.4374.
The study discussed three patients who experienced both anterior cruciate ligament (ACL) injury and patellofemoral instability. This combination of injuries is rare and has a scarcity of published /literature. The study described the mechanism of injury, diagnostic modalities, and the decision-making process for surgical intervention. It emphasizes the importance of a comprehensive clinical evaluation and discusses surgical techniques for combined ACL and medial patellofemoral ligament (MPFL) reconstruction. The study suggests that with careful evaluation and meticulous surgical techniques, patients with concurrent ACL and MPFL injuries can achieve successful outcomes and return to normal activities.
The cases presented involve young patients who suffered twisting knee injuries, often resulting from accidents or sporting activities. The surgical technique involved the use of grafts for ACL and MPFL reconstruction. MPFL reconstruction was performed followed by ACL reconstruction. Post-operative rehabilitation included the use of a patellar stabilizing knee brace and gradual mobilization.
The patients experienced moderate pain initially but achieved a full range of motion and stability in the knee after several weeks. At the 1-year follow-up, both patients reported no symptoms of instability or pain.
The article highlights the importance of MPFL reconstruction in preventing ACL reconstruction failures and emphasizes the need for aggressive rehabilitation to prevent knee stiffness. Overall, this study presented important information and added knowledge regarding the diagnosis, surgical management, and post-operative care of patients with concurrent ACL and patellofemoral instability.
本研究讨论了三名同时经历前交叉韧带(ACL)损伤和髌股关节不稳定的患者。这种损伤组合较为罕见,且已发表的文献较少。该研究描述了损伤机制、诊断方式以及手术干预的决策过程。它强调了全面临床评估的重要性,并讨论了联合ACL和内侧髌股韧带(MPFL)重建的手术技术。该研究表明,通过仔细评估和细致的手术技术,同时患有ACL和MPFL损伤的患者可以取得成功的治疗效果并恢复正常活动。
所呈现的病例涉及年轻患者,他们常因意外事故或体育活动而遭受膝关节扭转损伤。手术技术包括使用移植物进行ACL和MPFL重建。先进行MPFL重建,然后进行ACL重建。术后康复包括使用髌股稳定膝关节支具并逐步进行活动。
患者最初经历中度疼痛,但数周后膝关节实现了全范围活动和稳定。在1年随访时,两名患者均报告无不稳定或疼痛症状。
本文强调了MPFL重建在预防ACL重建失败中的重要性,并强调积极康复以预防膝关节僵硬的必要性。总体而言,本研究提供了关于同时患有ACL和髌股关节不稳定患者的诊断、手术治疗和术后护理的重要信息并增加了相关知识。