Bedard Thomas A, Johnson Christopher K, Amendola Richard L, Scuderi Matthew G, Ordway Nathaniel R, Werner Frederick W, Cannizzaro John P
Department of Orthopedic Surgery, SUNY Upstate Medical University, 750 E. Adams St., Syracuse, New York 13210, USA.
Department of Orthopedic Surgery, SUNY Upstate Medical University, 750 E. Adams St., Syracuse, New York 13210, USA.
Clin Biomech (Bristol). 2025 Feb;122:106401. doi: 10.1016/j.clinbiomech.2024.106401. Epub 2024 Nov 30.
Implant free medial patellofemoral ligament reconstruction is an increasingly popular technique to address patellar instability. There remains sparse literature on the biomechanical differences between the most common femoral attachment fixation points including Schottle's point, superficial medial collateral ligament, and adductor magnus tendon. This study compared these reconstruction techniques as well as a novel triangle reconstruction integrating both superficial medial collateral ligament and adductor magnus tendon.
Eight cadaveric knees were tested in a muscle activated knee simulator which mimicked a standing, shallow knee bend movement. Patella lateral displacement, external rotation and flexion were measured with and without a lateral load applied under the following conditions: 1) intact, 2) medial patellofemoral ligament cut, 3) Schottle's point reconstruction, 4) adductor magnus tendon reconstruction, 5) superficial medial collateral ligament reconstruction, 6) triangle reconstruction. Differences were analyzed using a repeated measures analysis of variance at 20, 30, 45 and 60 degrees of knee flexion.
All reconstruction techniques had significantly less lateral displacement compared to the cut condition when a lateral load was applied. Between reconstruction conditions, there was significantly less lateral displacement using Schottle's point and superficial medial collateral ligament as compared to adductor magnus tendon (p < 0.05). All reconstruction techniques had a trend towards medial constraint as compared to intact.
An over constrained position of the patella through early flexion of the knee may increase the likelihood of secondary patellofemoral arthritis. Although there were differences in magnitude of displacement/constraint, further studies are needed to assess clinical differences regarding constraint.
无植入物的内侧髌股韧带重建是治疗髌骨不稳定日益流行的技术。关于最常见的股骨附着固定点（包括朔特尔点、浅层内侧副韧带和大收肌腱）之间的生物力学差异，文献仍然稀少。本研究比较了这些重建技术以及一种整合了浅层内侧副韧带和大收肌腱的新型三角形重建技术。
在肌肉激活的膝关节模拟器中对八个尸体膝关节进行测试，该模拟器模拟站立时的浅屈膝运动。在以下条件下，施加和不施加侧向负荷时测量髌骨的外侧移位、外旋和屈曲：1）完整状态，2）内侧髌股韧带切断，3）朔特尔点重建，4）大收肌腱重建，5）浅层内侧副韧带重建，6）三角形重建。在膝关节屈曲20、30、45和60度时，使用重复测量方差分析分析差异。
当施加侧向负荷时，与切断状态相比，所有重建技术的外侧移位均显著减少。在重建条件之间，与大收肌腱相比，使用朔特尔点和浅层内侧副韧带时的外侧移位显著减少（p<0.05）。与完整状态相比，所有重建技术都有向内侧约束的趋势。
通过膝关节早期屈曲使髌骨处于过度约束位置可能会增加继发性髌股关节炎的可能性。尽管在移位/约束程度上存在差异，但仍需要进一步研究来评估关于约束的临床差异。
