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采用股四头肌肌腱并结合新技术及关节镜引导的微创内侧髌股韧带重建术:一例报告。

Minimal invasive medial patellofemoral ligament reconstruction using quadriceps tendon with de novo technique and arthroscopic guided: A case report.

作者信息

Dasril Demy Faheem, Hadi Ivana Ariella Nita, Guntara Aswin

机构信息

Sport and Arthroscopy Division, Department of Orthopaedic and Traumatology, Mayapada Hospital Kuningan, Jakarta, Indonesia.

General Practitioner, Orthopaedic Intern, Department of Orthopaedic and Traumatology, Mayapada Hospital Kuningan, Jakarta, Indonesia.

出版信息

Int J Surg Case Rep. 2024 Sep;122:110144. doi: 10.1016/j.ijscr.2024.110144. Epub 2024 Aug 10.

Abstract

INTRODUCTION

Medial Patellofemoral ligament (MPFL) reconstruction, the primary procedure for restoring patellar stability and preventing further dislocation, has seen numerous methods and grafts. However, a consensus on the technique and graft remains elusive. This study introduces a novel approach to MPFL reconstruction, utilizing a unique combination of minimal invasiveness, de novo method, and arthroscopic guidance to harvest a quadriceps tendon (QT) graft without the need for a harvesting tool.

CASE ILLUSTRATION

A 37-year-old female presented to the emergency room with the chief complaints of left knee pain and swelling following the third spontaneous dislocation of the patella. The patient had a few episodes of locking sensation and instability of the left knee while walking, especially while climbing stairs. A knee MRI revealed MPFL tear in the left knee. A modified minimal invasive MPFL reconstruction technique was performed. The IKDC, Lysholm, and Modified Cincinnati scores improved significantly from preoperatively 48.3 %, 49 %, and 51 % to 89.7 %, 90 %, and 95 % consecutively. No recurrent patellar dislocations or swelling were reported during follow-up.

DISCUSSION

While quadriceps graft harvesting for MPFL reconstruction is typically highly invasive, using quadriceps tendons has consistently shown excellent outcomes. This study, however, takes it a step further by demonstrating that a minimally invasive procedure for harvesting quadriceps tendons, even without specialized instrumentation, can also yield excellent results.

CONCLUSION

MPFL reconstruction using superficial quadriceps tendon autograft can be achieved using a minimally invasive technique without the use of specialized instrumentation and has shown excellent knee functional improvement.

摘要

引言

髌股内侧韧带(MPFL)重建是恢复髌骨稳定性和防止进一步脱位的主要手术方法,已有多种方法和移植物。然而,关于该技术和移植物的共识仍未达成。本研究介绍了一种MPFL重建的新方法,采用微创、原位方法和关节镜引导的独特组合,无需采集工具即可获取股四头肌腱(QT)移植物。

病例说明

一名37岁女性因左膝第三次自发性脱位后出现左膝疼痛和肿胀为主诉就诊于急诊室。患者在行走时,尤其是爬楼梯时,左膝有几次锁定感和不稳定感。膝关节MRI显示左膝MPFL撕裂。采用改良的微创MPFL重建技术。IKDC、Lysholm和改良辛辛那提评分从术前的48.3%、49%和51%连续显著提高到89.7%、90%和95%。随访期间未报告复发性髌骨脱位或肿胀。

讨论

虽然用于MPFL重建的股四头肌移植物采集通常具有高度侵入性,但使用股四头肌腱一直显示出优异的效果。然而,本研究更进一步表明,即使不使用专门器械,采用微创方法采集股四头肌腱也能产生优异的结果。

结论

使用浅表股四头肌自体肌腱进行MPFL重建可通过微创技术实现,无需使用专门器械,并且已显示出膝关节功能的显著改善。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0c22/11350252/552000b7a8a0/gr1.jpg

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