ABSTRACT
BACKGROUND: Although there are many studies on acute patellar dislocation in adolescents, the optimal treatment strategy is under discussion.OBJECTIVE: To summarize the clinical efficacy of reconstruction of the medial patellofemoral ligament (MPFL) in the treatment of adolescent acute patellar dislocation using double-pulley technique.METHODS: Thirty cases of acute patellar dislocation were enrolled and received reconstruction of the MPFL using double-pulley technique. We proceeded to prepare the bone bed for anchor placement at the medial point of the superior edge of the patella and at the upper 1/3 patella along the long axis of the patella using arthroscopic grinding. Two double-loaded 5.0 anchors were respectively placed at the medial point of patella and at the upper 1/3 patella parallel to the patellar articular surface, and then tied using the double-pulley technique. Long longitudinal incisions were performed at the medial condyle and at the adductor tubercle to expose these two structures, the deep fascias tunnel between two incisions were penetrated to pull the tendon weave end through the tunnel until the lateral side along a femoral tunnel; finally the tendon was fixed using screws in appropriate tightness. All patients were followed for more than 10 months, and the patellar-related parameters and knee function parameters were compared before and after operation. RESULTS AND CONCLUSION: There were 12 cases of intra-articular cartilage injury and 4 cases of meniscus injury. The patella title angle, Q-angle and outward shift distance at the last follow-up were less than those before operation. Lysholm and International Knee Documentation Committee scores at the last follow-up were higher than those before operation. The mean operation time was (90±10.5) minutes. There was one patient with knee movement angle from 0° to 30° and one patient with a patellar fracture caused by slipping and treated with internal fixation. None of patients appeared with patellar dislocation, positive apprehension test infection or poor wound healing. These results indicate that the simple and mini-invasive double-pulley technique is a good treatment strategy for acute patellar dislocation, because it is consistent with patellar anatomical stability, holds patellar trajectory visibility, quick recovery and good curative effect. Additionally, osteotomy is recommended when the simple efficacy is not satisfactory.
ABSTRACT
BACKGROUND:Because of its advantages, Endobutton has been widely used in clinic. Currently, its shortcomings are increasingly recognized. Tightrope that overcomes the shortcomings of Endobutton has been gradualy accepted by a doctor skiled in sports injuries. OBJECTIVE: To analyze and compare the differences in the effects of Tightrope and Endobutton in the reconstruction of the cruciate ligament. METHODS:Totaly 60 cases of anterior cruciate ligament rupture were selected and subjected to anterior cruciate ligament reconstruction under arthroscopy, of which 30 cases were randomly assigned to reconstruction by Endobutton device and 30 cases underwent reconstruction by Tightrope device. Al operations were performed by the same surgeon. Al patients were subjected to regular functional exercise and were folowed up regularly after operation. Effects of Tightrope and Endobutton in the cruciate ligament reconstruction were evaluated by comparing various indexes in the two groups. RESULTS AND CONCLUSION:Compared to the Endobutton fixation system, the Tightrope fixation system could shorten the operation time, reduce the length of tendon incision, and decrease the loss of bone mass in the femoral bone tunnel. There were no significant differences in the maximum knee flexion, knee joint score and Tegner movement level score between the two groups at 3 and 6 months after operation. These findings indicate that the Tightrope fixation system is superior to the Endobutton fixation system, because it is more simple and convenient to operate and has less bone loss. However, their clinical efficacy has no difference after 6 months.