Forsythe Brian, Berlinberg Elyse J, Sivasundaram Lakshmanan, Poirier Jon-Luc R, Patel Harsh H, Khan Zeeshan A, Chahla Jorge, Hevesi Mario
Midwest Orthopaedics at Rush, Chicago, Illinois, USA.
Indiana University School of Medicine, Indianapolis, Indiana, USA.
Video J Sports Med. 2023 Feb 10;3(1):26350254221135245. doi: 10.1177/26350254221135245. eCollection 2023 Jan-Feb.
Medial patellofemoral ligament (MPFL) injury occurs in up 96% of lateral patellar dislocations, commonly affecting those less than 20 years old. The MPFL can be reconstructed using either a double-limb or single-limb technique. While both techniques achieve similar patient outcomes, a single-limb technique may require less operative time.
The MPFL reconstruction is indicated in patients with recurrent patellar subluxations, dislocations, or unresolved apprehension. Care should be exercised in identifying whether patients require additional procedures in addition to MPFL reconstruction such as tibial tubercle osteotomy or trochleoplasty. These considerations include TT-TG >17 to 20 mm and Dejour B/D trochlear dysplasia.
Following diagnostic arthroscopy, a medial peripatellar incision is made. Layers 1 and 2 are sharply dissected over the patellar periosteum, and tissue planes are subsequently developed using Metzenbaum scissors. A plane between layers 2 and 3 extending from the medial patella to the medial femoral epicondyle is developed. Using fluoroscopy, Schöttle point is identified, and a femoral tunnel is drilled. Two PEEK anchors are placed at the junction of the proximal one-third and distal two-thirds of the patella. In parallel, a tibialis anterior graft is sized, whipstitched, and tensioned on the back table. One end of the prepared graft is secured in the femoral tunnel with a PEEK tenodesis screw. The graft is then shuttled between layers 2 and 3, followed by fixation on the patellar side using the previously placed suture anchors. Isometry of the graft is confirmed under direct and arthroscopic visualization.
In multiple systematic reviews of single-limb versus double-limb MPFL reconstruction, no differences were observed in terms of patient-reported outcome scores, repeat dislocation, and reoperation. Furthermore, a recent meta-analysis suggests a trend toward less postoperative stiffness (1.2% vs 3.5%, = .09) for single-bundle techniques.
DISCUSSION/CONCLUSION: Single-limb MPFL reconstruction is reproducible and effective, with clinically satisfactory outcomes and low failure rates. Single-limb MPFL reconstruction demonstrates similar outcomes as double-limb reconstruction, with a potential decrease in surgical time and postoperative stiffness.
The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
髌股内侧韧带（MPFL）损伤在96%的髌骨外侧脱位中出现，常见于20岁以下人群。MPFL可采用双束或单束技术重建。虽然两种技术的患者预后相似，但单束技术可能需要更短的手术时间。
MPFL重建适用于复发性髌骨半脱位、脱位或未缓解的恐惧患者。在确定患者除MPFL重建外是否需要其他手术（如胫骨结节截骨术或滑车成形术）时应谨慎。这些考虑因素包括胫骨结节 - 股骨滑车沟间距（TT - TG）>17至20毫米以及Dejour B/D型滑车发育不良。
在诊断性关节镜检查后，做一个髌骨内侧切口。在髌骨骨膜上锐性解剖第1层和第2层，随后用梅氏剪刀分离组织平面。在第2层和第3层之间形成一个从髌骨内侧延伸至股骨内侧髁的平面。使用荧光透视确定Schöttle点，并钻一个股骨隧道。在髌骨近端三分之一和远端三分之二交界处放置两个聚醚醚酮（PEEK）锚钉。同时，在手术台上测量、缝合并张紧一条胫骨前肌腱移植物。将准备好的移植物一端用PEEK固定螺钉固定在股骨隧道中。然后将移植物在第2层和第3层之间穿梭，接着使用先前放置的缝线锚钉在髌骨侧固定。在直视和关节镜观察下确认移植物的等长性。
在多项单束与双束MPFL重建的系统评价中，患者报告的预后评分、再次脱位和再次手术方面未观察到差异。此外，最近的一项荟萃分析表明，单束技术术后僵硬程度有降低趋势（1.2%对3.5%，P = 0.09）。
讨论/结论：单束MPFL重建具有可重复性且有效，临床预后令人满意，失败率低。单束MPFL重建与双束重建效果相似，可能会减少手术时间和术后僵硬程度。
作者证明已获得本出版物中出现的任何患者的同意。如果个体可识别，作者已随本投稿附上患者的豁免声明或其他书面批准形式以供发表。
