Wright Margaret L, Paul Ryan W, Freedman Kevin B
Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA.
Jefferson Medical College, Rothman Institute Orthopaedics, Bryn Mawr, Pennsylvania, USA.
Video J Sports Med. 2021 Oct 14;1(5):26350254211040821. doi: 10.1177/26350254211040821. eCollection 2021 Sep-Oct.
Patellar instability is a relatively common condition in the young, active population and causes disruption of the medial patellofemoral ligament (MPFL). MPFL reconstruction is often performed to restore this medial stabilizer and reduce the risk of recurrent instability.
Isolated MPFL reconstruction has been shown to reduce the risk of recurrent patellar dislocation. It is indicated in our patients who have had more than 1 dislocation in the absence of other significant bony malalignment or cartilage defects that require concurrent surgery.
Diagnostic arthroscopy is first performed to evaluate the patellar and trochlear cartilage surfaces. A medial approach to the patella is then performed and the 2 free limbs of the allograft are secured to the patella at the 9 to 11 (or 1 to 3) o'clock position. A small approach to the femoral insertion site of the MPFL is performed and confirmed with fluoroscopy, and the graft is secured to the femur with a biotenodesis screw. Postoperative examination confirms improved stability of the patella, and the patient performs a gradual return to play protocol.
Recent studies have demonstrated overall good clinical outcomes after MPFL reconstruction, with improved patellar stability and high patient satisfaction. One systematic review found an 85% rate of return to sport with a low risk (7%) of recurrent subluxation or dislocation.
DISCUSSION/CONCLUSION: MPFL reconstruction is a reliable option for improving patellar stability in patients with recurrent dislocations. We believe our technique, which optimizes the fixation and footprint of the graft on the patella and allows for easy visualization of femoral anatomy on fluoroscopy, can improve the reproducibility of the procedure and provide optimal clinical outcomes.
髌骨不稳定在年轻活跃人群中较为常见，会导致髌股内侧韧带（MPFL）断裂。常进行MPFL重建以恢复这种内侧稳定结构并降低复发性不稳定的风险。
已证实孤立的MPFL重建可降低复发性髌骨脱位的风险。适用于我们那些在无其他需要同时手术的明显骨排列不齐或软骨缺损情况下发生过1次以上脱位的患者。
首先进行诊断性关节镜检查以评估髌骨和滑车软骨表面。然后采用髌骨内侧入路，将同种异体移植物的两个游离端固定在髌骨的9至11点（或1至3点）位置。对MPFL的股骨插入部位进行小切口并通过荧光透视确认，然后用生物锚钉将移植物固定在股骨上。术后检查证实髌骨稳定性得到改善，患者逐步恢复运动方案。
近期研究表明MPFL重建术后总体临床效果良好，髌骨稳定性提高，患者满意度高。一项系统评价发现运动恢复率为85%，复发性半脱位或脱位风险较低（7%）。
讨论/结论：MPFL重建是改善复发性脱位患者髌骨稳定性的可靠选择。我们认为我们的技术优化了移植物在髌骨上的固定和附着点，并在荧光透视下便于观察股骨解剖结构，可提高手术的可重复性并提供最佳临床效果。
