Liao Yuanping, Wang Xiao, Shi Xiaotao, Cao Guorui, Tan Honglue
Department of Knee Surgery, Luoyang Orthopedic Hospital of Henan Province, Luoyang, Henan Province, People's Republic of China.
Hunan University of Chinese Medicine, ChangSha, Henan Province, People's Republic of China.
J Orthop Surg Res. 2025 Mar 18;20(1):291. doi: 10.1186/s13018-025-05652-z.
Patients who undergo reconstruction for multiligament knee injuries (MLKIs) often exhibit knee instability and poor overall knee function during postoperative follow-up. This may be related to the changes in patellar position and decline in patellofemoral function after surgery.
To evaluate the outcomes following reconstruction of MLKIs through the assessment of: (1) changes in patellar height; (2) anatomical changes in patellofemoral alignment, such as tilt or displacement; and (3) functional outcomes of the patellofemoral joint.
This retrospective study included 45 patients who underwent reconstruction for MLKIs at our hospital between November 2015 and September 2022, with complete data and meeting the inclusion criteria. These patients formed the case group. An additional 20 outpatients without ligament injuries or patellar dislocation were selected as the normal control group. Patellar height changes in the case group were assessed preoperatively and postoperatively using the Caton-Deschamps (CD) and Insall-Salvati (IS) indices on lateral X-rays. Magnetic resonance imaging (MRI) was used to measure patellofemoral alignment parameters in both groups, including the sulcus angle (SA), patellar tilt angle (PTA), lateral patellofemoral angle (LPA), congruence angle (CA), and patellofemoral index (PI), to evaluate patellofemoral positioning. Additionally, the Kujala score questionnaire was used to assess the stability function of the patellofemoral joint.
Preoperative patellar height in the case group, measured by the CD and IS indices, was (1.07 ± 0.10, 1.10 ± 0.09), showing a statistically significant difference when compared to postoperative measurements (0.96 ± 0.13, 1.05 ± 0.10) (P < 0.05). However, postoperative patellofemoral alignment parameters, including SA, PTA, LPA, CA, and PI, in the case group showed no statistically significant differences compared to the control group (P > 0.05). At the latest follow-up, the patellofemoral function score in the case group was (89.0 ± 5.3), which was not significantly different from the control group (91.0 ± 2.9) (P > 0.05).
After reconstruction of MLKIs, patellar height decreased but remained within the normal range. Patellofemoral alignment was well-maintained, and patellofemoral function was maintained.
接受多韧带膝关节损伤（MLKIs）重建手术的患者在术后随访期间常表现出膝关节不稳定和整体膝关节功能不佳。这可能与术后髌骨位置的变化以及髌股关节功能下降有关。
通过评估以下方面来评价MLKIs重建后的疗效：（1）髌骨高度的变化；（2）髌股关节对线的解剖学变化，如倾斜或移位；（3）髌股关节的功能结局。
这项回顾性研究纳入了2015年11月至2022年9月在我院接受MLKIs重建手术的45例患者，这些患者数据完整且符合纳入标准。这些患者组成病例组。另外选取20例无韧带损伤或髌骨脱位的门诊患者作为正常对照组。病例组术前和术后通过侧位X线片使用Caton-Deschamps（CD）和Insall-Salvati（IS）指数评估髌骨高度变化。两组均使用磁共振成像（MRI）测量髌股关节对线参数，包括沟角（SA）、髌骨倾斜角（PTA）、髌股外侧角（LPA）、适合角（CA）和髌股指数（PI），以评估髌股关节位置。此外，使用Kujala评分问卷评估髌股关节的稳定功能。
病例组术前通过CD和IS指数测量的髌骨高度分别为（1.07±0.10，1.10±0.09），与术后测量值（0.96±0.13，1.05±0.10）相比差异有统计学意义（P<0.05）。然而，病例组术后的髌股关节对线参数，包括SA、PTA、LPA、CA和PI与对照组相比差异无统计学意义（P>0.05）。在最近一次随访时，病例组的髌股关节功能评分为（89.0±5.3），与对照组（91.0±2.9）相比差异无统计学意义（P>0.05）。
MLKIs重建术后，髌骨高度降低但仍在正常范围内。髌股关节对线维持良好，髌股关节功能得以保持。
