Mostowy Marcin, Bawor Michalina, Bujak Krzysztof, Pękala Przemysław A, LaPrade Robert F, Malinowski Konrad
Orthopedic and Trauma Department, Veterans Memorial Teaching Hospital in Lodz, Medical University of Lodz, Lodz, Poland.
Artromedical Orthopedic Clinic, Bełchatów, Poland.
Arthrosc Tech. 2024 Aug 13;14(2):103194. doi: 10.1016/j.eats.2024.103194. eCollection 2025 Feb.
Various surgical techniques for medial patellofemoral ligament (MPFL) reconstruction have been described, commonly using hamstring auto- or allografts. Despite their widespread use, these techniques have limitations due to the tubular structure of the hamstring tendons, which does not match the flat, sail-like anatomy of the MPFL. Furthermore, over- or undertensioning of the graft due to tunnel misplacement remains a significant risk, even if anatomic and radiologic landmarks are used. To address these issues, a fascia lata allograft MPFL reconstruction with assessment of angular anisometry is presented. This technique allows for reconstruction of the MPFL as close as possible to its nature with a flat and wide patellar attachment and a gradual transition of maximal tension across the graft fibers, depending on the knee flexion angle. Precise intraoperative control of predefined graft angular anisometry allows for achievement of the desired amount of tension at specific flexion angles. This mitigates the risk of under- or overtensioning and subsequently ensures proper medial-lateral mobility of the patella.
已经描述了多种用于内侧髌股韧带（MPFL）重建的手术技术，通常使用腘绳肌自体移植物或同种异体移植物。尽管这些技术被广泛应用，但由于腘绳肌腱的管状结构与MPFL扁平、帆状的解剖结构不匹配，它们存在局限性。此外，即使使用解剖学和放射学标志，由于隧道位置不当导致移植物过度或不足张紧仍然是一个重大风险。为了解决这些问题，本文介绍了一种带角度各向异性评估的阔筋膜同种异体移植物MPFL重建术。该技术允许尽可能接近其天然状态地重建MPFL，具有扁平且宽阔的髌骨附着点，并根据膝关节屈曲角度在移植物纤维上逐渐过渡最大张力。术中对预定义移植物角度各向异性的精确控制允许在特定屈曲角度实现所需的张力。这降低了张紧不足或过度的风险，并随后确保髌骨的正常内外侧活动度。
