Klasan Antonio, Kreuzthaler Harald, Schwarz Angelika, Kammerlander Christian, Neri Thomas, Ernat Justin J
AUVA UKH Steiermark Graz Austria.
Johannes Kepler University Linz Linz Austria.
J Exp Orthop. 2025 Apr 11;12(2):e70228. doi: 10.1002/jeo2.70228. eCollection 2025 Apr.
Multiligament knee injury (MLKI) is considered major trauma. What is currently undescribed is the incidence of concomitant patella dislocation in a setting of MLKI, which is needed for a better understanding of concomitant injuries that are a consequence of the dislocated patella - rupture of the medial patellofemoral ligament (MPFL) and cartilage lesions. The present study aimed to investigate the incidence of patellar dislocation in the MLKI setting.
Magnetic resonance imaging (MRI) and operative note review of two major trauma centres for 2016-2023 were performed. MLKIs, defined as a disruption of at least two major knee ligaments, are classified as either ACL- or PCL-based or cruciate. All cases had a preoperative MRI and were treated surgically. Patella dislocation on MRI was defined as: (1) dislocated patella, (2) lateralization >2/3 with a bone bruise/cartilage injury, (3) bony or intrasubstance MPFL rupture with or without a bone bruise/cartilage injury. Note was also made on whether the patella was displaceable during surgery. The incidence of MPFL reconstructions was noted via the operative notes.
A total of 364 MKLIs were included. Mean age was 36.0 ± 13.4 years, 131 patients were female (36.0%). Observed incidence of patella instability was 29.7%: disruption of the MPFL was 75 cases (20.6%), lateralization of the patella in combination with bone bruise/cartilage injury in 30 cases (8.2%) as well as one case of a dislocated patella on MRI (0.27%). MPFL reconstruction was performed in 14 cases, and in 2 cases, a repair was performed (4.4%).
The present study demonstrates that the incidence of patella dislocation in the setting of MLKI can be as high as 29.1%. The clinical relevance of currently diagnosing and managing patellar dislocation in the setting of MLKI requires further research.
Level III, retrospective study.
膝关节多韧带损伤（MLKI）被视为严重创伤。目前尚未描述的是在MLKI情况下髌骨脱位的发生率，而了解因髌骨脱位导致的伴随损伤（内侧髌股韧带（MPFL）断裂和软骨损伤）需要这一数据。本研究旨在调查MLKI情况下髌骨脱位的发生率。
对两个主要创伤中心2016年至2023年的磁共振成像（MRI）和手术记录进行回顾。MLKI定义为至少两条主要膝关节韧带断裂，分为以前交叉韧带（ACL）或后交叉韧带（PCL）为主或交叉韧带损伤。所有病例术前均行MRI检查并接受手术治疗。MRI上的髌骨脱位定义为：（1）髌骨脱位；（2）髌骨外移>2/3且伴有骨挫伤/软骨损伤；（3）MPFL骨或实质内断裂，伴或不伴有骨挫伤/软骨损伤。同时记录手术中髌骨是否可移位。通过手术记录记录MPFL重建的发生率。
共纳入364例MLKI患者。平均年龄为36.0±13.4岁，131例为女性（36.0%）。观察到的髌骨不稳定发生率为29.7%：MPFL断裂75例（20.6%），髌骨外移伴骨挫伤/软骨损伤30例（8.2%），以及MRI上1例髌骨脱位（0.27%）。14例行MPFL重建，2例行修复（4.4%）。
本研究表明，MLKI情况下髌骨脱位的发生率可高达29.1%。目前在MLKI情况下诊断和处理髌骨脱位的临床意义需要进一步研究。
III级，回顾性研究。
