Moran Thomas E, Manley Brock J, Blanchard Neil P, Tagliero Adam J, Ramamurti Pradip, Reahl Brad, Diduch David R
Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, USA.
Orthop J Sports Med. 2025 Mar 28;13(3):23259671251320971. doi: 10.1177/23259671251320971. eCollection 2025 Mar.
There is a paucity of literature comparing clinical outcomes and complications between the use of 2 smaller (3.2 mm), short, oblique patellar tunnels with looped graft for patellar-sided graft fixation during medial patellofemoral ligament reconstruction (MPFLR) and the use of 2 suture anchors.
To compare clinical outcomes and complications in large series between the use of dual patellar suture anchors and dual, small, short, oblique bone tunnels for patellar-sided graft fixation during MPFLR.
Retrospective cohort study; Level of evidence, 3.
A retrospective chart review identified all patients at a single academic institution who underwent primary MPFLR between March 2010 and December 2021, with a minimum 2-year follow-up. Operative notes, postoperative clinical follow-up notes, and radiographs were used to ascertain laterality, graft type, surgical technique, concomitant procedures, as well as the incidence of recurrent patellar instability, revision MPFLR, and patellar fracture. The follow-up was limited to a review of the postoperative clinic or emergency department visits, and patients were not contacted at the time of the study.
A total of 635 knees were included for final analysis. Patellar-sided graft fixation was achieved with small, short, oblique bone tunnels with looped grafts in 342 knees (53.9%) and suture anchors in 293 knees (46.1%). The small, oblique tunnels and suture anchor techniques both yielded a low incidence of patellar fracture, with rates of 0.3% and 0%, respectively. No significant difference in rates of patellar fracture existed between cohorts (≥ .999). There were similar rates of recurrent patellar instability events in patients in whom patellar-sided graft fixation was performed with dual, small, short, oblique bone tunnels (n = 9; 2.6%) compared with dual suture anchors (n = 15; 5.1%; = .103). Similarly, no significant difference was found in revision MPFLR rates between groups (dual small, short, oblique patellar tunnels: n = 5; 1.5%; dual suture anchors: n = 8; 2.7%).
Two small (3.2 mm), short, oblique patellar tunnels with looped grafts and dual patellar suture anchors are similar in safety and efficacy for achieving patellar-sided graft fixation during MPFLR.
在髌股内侧韧带重建术（MPFLR）中，使用2个较小（3.2毫米）、短的、斜向的髌骨隧道并采用袢状移植物进行髌骨侧移植物固定，与使用2个缝线锚钉相比，比较临床结果和并发症的文献较少。
比较在MPFLR期间使用双髌骨缝线锚钉和双小、短、斜向骨隧道进行髌骨侧移植物固定的大样本系列中的临床结果和并发症。
回顾性队列研究；证据等级为3级。
通过回顾性图表审查，确定了一家学术机构中2010年3月至2021年12月期间接受初次MPFLR且至少随访2年的所有患者。手术记录、术后临床随访记录和X线片用于确定手术侧、移植物类型、手术技术、伴随手术，以及复发性髌骨不稳定、翻修MPFLR和髌骨骨折的发生率。随访仅限于对术后门诊或急诊科就诊情况的审查，研究期间未与患者联系。
共有635例膝关节纳入最终分析。342例膝关节（53.9%）采用小、短、斜向骨隧道并使用袢状移植物进行髌骨侧移植物固定，293例膝关节（46.1%）使用缝线锚钉固定。小斜隧道和缝线锚钉技术导致的髌骨骨折发生率均较低，分别为0.3%和0%。两组间髌骨骨折发生率无显著差异（≥.999）。与双缝线锚钉组（n = 15；5.1%；P =.103）相比，采用双小、短、斜向骨隧道进行髌骨侧移植物固定的患者复发性髌骨不稳定事件发生率相似（n = 9；2.6%）。同样，两组间MPFLR翻修率无显著差异（双小、短、斜向髌骨隧道组：n = 5；1.5%；双缝线锚钉组：n = 8；2.7%）。
在MPFLR期间，两个小（3.2毫米）、短、斜向的髌骨隧道并采用袢状移植物与双髌骨缝线锚钉在实现髌骨侧移植物固定方面的安全性和有效性相似。
