Rauschning W, Amici F
Ital J Orthop Traumatol. 1982 Jun;8(2):167-74.
The authors describe the results obtained in fifteen athletes suffering from recurrent monolateral subluxation of the patella by a new technique which should represent a considerable improvement over existing methods, both in surgical and rehabilitation phases. The treatment consists of: a) a surgical stage comprising extensive lateral mobilisation by section of the lateral capsule and the external alar ligament, extensive manual detachment of the vastus lateralis muscle, and osteotomy performed obliquely to the frontal plane with antero-medial transposition of the tibial tuberosity to realign the extensor apparatus; b) a post-operative stage characterised by immediate mobilisation of the knee without the application of a plaster cast. The aim of this method is to eliminate above all the instability caused by recurrent subluxation of the patella, to cancel out any abnormal stress exerted on the femoral condyle by the patella, to normalize the extensor apparatus, to bring about the regression of any incipient chondromalacic lesions, and to prevent femoro-patellar arthrosis by restoring the anatomical and functional equilibrium of the femoro-patellar joint. The clinical and radiographic results determined by follow up examinations performed between one year and two and a half years after the operation were so satisfactory that the authors extended the method to recurrent subluxations in non-athletes.
作者描述了采用一种新技术治疗15例复发性单侧髌骨半脱位运动员所取得的结果，该技术在手术和康复阶段均应比现有方法有显著改进。治疗包括：a）手术阶段，包括通过切开外侧关节囊和外侧翼状韧带进行广泛的外侧松解，广泛手动分离股外侧肌，以及与额状面成斜角进行截骨，并将胫骨结节向内侧移位以重新调整伸肌装置；b）术后阶段，其特点是膝关节立即活动，不使用石膏固定。该方法的目的首先是消除髌骨反复半脱位引起的不稳定，消除髌骨对股骨髁施加的任何异常应力，使伸肌装置正常化，促使任何早期软骨软化病变消退，并通过恢复髌股关节的解剖和功能平衡来预防髌股关节病。术后1年至2年半之间进行的随访检查所确定的临床和影像学结果非常令人满意，以至于作者将该方法扩展至非运动员的复发性半脱位。
