Luxación recidivante de rótula: reconstrucción del ligamento patelofemoral medial / Recurrent patellar dislocation: medial patellofemoral ligament reconstruction

Introducción: Se han descripto múltiples técnicas quirúrgicas para estabilizar la patela. Se realizó un estudio retroprospectivo analizando los resultados al año del tratamiento de la luxación recidivante de rótula mediante reconstrucción del ligamento patelofemoral medial (LPFM) con injerto de semitendinoso autólogo. Material y Métodos: Entre enero de 2010 y abril de 2012 se operaron 37 pacientes (24 hombres y 13 mujeres con edad promedio de 21 años) por inestabilidad patelofemoral recurrente. Se incluyeron los que se les realizó reconstrucción del ligamento patelofemoral medial con injerto autólogo de semitendinoso. Se excluyeron 4 pacientes a los que se les realizó una ostetomía de TAT. Mediante un riguroso exámen fisico y estudios de imágenes (Rx, TAC y RNM), se evaluó estabilidad articular, ángulo Q, versión femoral y rotación tibial, daño osteocondral. Los pacientes fueron evaluados a las 6 semanas, 3 meses y al año. En el preoperatorio y el último seguimiento se realizó una evaluación con score de Lysholm y de Kujala. Resultados: Ninguno presentó recidivas hasta el año postoperatorio. 31 pacientes comenzaron la actividad deportiva 6 meses después de la cirugía. Como complicaciones se registraron: dos infecciones de herida quirúrgica y un caso con hipotrofia muscular cuadricipital. No se registraron fracturas ni trombosis venosa profunda. Ninguno necesitó reintervenciones. El score Kujala promedio mejoró de 48 en el preoperatorio a 90, 32 al año de seguimiento y el score de Lysholm de 53 el preoperatorio a 87,5 al año. Discusión: El LPFM actua como una rienda restringiendo la traslación externa de la patela desde la extensión hasta los 30 grados de flexión para luego relajarse en el resto de la flexión. En nuestra serie, la reconstrucción de LPFM con injerto autólogo de semitendinoso, mejoró los scores funcionales, presentando un bajo índice de complicaciones y sin recidivas al año de seguimiento.

Introduction: Multiple surgical techniques have been described to stabilize the patella. This retrospective study analyzes the results at one year follow up of the medial patello femoral ligament (MPFL) reconstruction, with autologous semitendinosus tendon graft, for the treatment of recurrent patella dislocation. Methods: 37 patients with recurrent patella dislocation were operated between January 2010 and April 2012 (24 men and 13 women with an average age of 21 years). We included 33 patients with isolated MPFL reconstruction using an autologous semitendinosus graft. Four patients were excluded because of concomitant tibial tubercle osteotomy. With a thorough physical examination and imaging studies (Xray, CT scan and MRI) we evaluated the stability, Q angle, femoral and tibial rotation and osteochondral damage. The 33 patients were evaluated at 6 weeks, 3 months and one year. Lysholm and Kujala scores were performed before the surgery and at one year follow up. Results: There were no postoperative patella dislocation at the final follow up. 31 patients started sporting activity 6 months after surgery. The complications were two wound infections and one muscular quadriceps hypotrophy. No postoperative fractures, or DVT were registered. No patient required reinterventions. The mean Kujala score was 48 before surgery and of 90.32 at the 12 months follow up. The mean Lysholm score was 53 the before surgery and 87.5 at 12 months follow up. Discussion: The MPFL acts as a rein restraining the patella from lateral translation between maximum extension until 30 degrees of flexion and then, it loosens in the rest of flexion. In our series, MPFL reconstruction with autologous semitendinosus graft shows improvement in the functional scores, with a low complication rate and no recurrent dislocation at one-year follow-up.

Reconstruction of the medial patellofemoral ligament by means of the anatomical double-bundle technique using metal anchors / Reconstrução do ligamento patelofemoral medial pela técnica anatômica do duplo-feixe com âncoras metálicas

OBJECTIVE: To evaluate double-bundle reconstruction of the medial patellofemoral ligament (MPFL) using a graft from the semitendinosus tendon and fixation with metal anchors over the medium term. METHODS: This was a prospective cross-sectional study. After approval from the research ethics committee, 31 patients with patellofemoral instability who underwent MPFL reconstruction by means of the anatomical double-bundle technique, with fixation using metal anchors, were analyzed between May 2010 and January 2015. To evaluate the effectiveness of the MPFL reconstruction surgery, the Kujala scale and the Tegner-Lysholm score were assessed before the procedure and one year afterwards, along with clinical data such as pain levels, range of motion and J sign. The data were tabulated in the Excel(r) software and were analyzed using the SPSS Statistics(r) software, version 21. The statistical analysis was performed using the Wilcoxon T test and the McNemar test. RESULTS: The mean preoperative score from the Kujala test was 45.64 ± 1.24 and the postoperative score was 94.03 ± 0.79 (p < 0.001). The preoperative Tegner-Lysholm score was 40.51 ± 1.61 and the postoperative score was 91.64 ± 0.79 (p < 0.001). The preoperative range of motion was 125.96 ± 2.11 and the postoperative range was 138.38 ± 1.49 (p < 0.05). CONCLUSION: MPFL reconstruction by means of the anatomical double-bundle technique is easily reproducible, without episodes of recurrence, with satisfactory results regarding restoration of stability and function of the patellofemoral joint.

OBJETIVO: Avaliar, em médio prazo, a reconstrução do ligamento patelofemoral medial (LPFM) com duplo-feixe com enxerto do tendão semitendíneo e fixação com âncoras metálicas. MÉTODOS: Estudo prospectivo de corte transversal. De maio de 2010 a janeiro de 2015, após aprovação do comitê de ética em pesquisa, foram analisados 31 pacientes com instabilidade patelofemoral, submetidos à cirurgia de reconstrução do ligamento patelofemoral medial (LPFM) com a técnica anatômica do duplo-feixe com fixação com âncoras metálicas. Para avaliar a eficácia da cirurgia de reconstrução do LPFM, foram utilizadas a escala de Kujala e o escore de Tegner-Lysholm, antes do procedimento e após um ano. Foram avaliados os dados clínicos como o arco de movimento, presença do Sinal do J e nível de dor. Os dados foram tabulados no programa Excel(r) e analisados com o programa SPSS Statistics(r) versão 21. A análise estatística foi feita com o teste T de Wilcoxon e o teste de McNemar. RESULTADOS: A média dos resultados obtidos no pré-operatório com o teste de Kujala foi de 45,64 ± 1,24 e no pós-operatório de 94,03 ± 0,79 (p < 0,001). O escore do joelho de Tegner-Lysholm alcançado foi de 40,51 ± 1,61 no pré-operatório, para 91,64 ± 0,79 (p < 0,001) no pós-operatório. O arco de movimento obteve média de 125,96 ± 2,11 no pré-operatório e 138,38 ± 1,49 no pós-operatório (p < 0,05). CONCLUSÃO: A reconstrução do LPFM com duplo-feixe é uma técnica de fácil reprodução, sem episódios de recidiva, e com resultados adequados para a restauração da estabilidade.

Resultado de la reconstrucción del ligamento cruzado anterior con el ligamento patelar bajo control artroscópico con un seguimiento superior a 15 años / Arthroscopic reconstruction of the ACL using the patellar tendon follow-up more than 15 years

Los resultados a largo plazo de las reconstrucciones del LCA por artroscopia son raros. Nosotros presentamos los resultados de un estudio de 57 pacientes con un seguimiento superior a 15 años. La reconstrucción es realizada bajo control artroscópico. Nosotros utilizamos un injerto hueso ligamento rotuliano hueso. El túnel femoral es realizado de afuera hacia adentro. La fijación femoral obtenida por "pressfit" y la fijación tibial es realizada con un tornillo de interferencia metálico. 240 pacientes fueron operados con esta técnica en 1992. Nosotros pudimos ver 57 de estos pacientes con un seguimiento promedio de 182 meses. Todos los pacientes fueron evaluados con el formulario IKDC. La laxitud diferencial fue medida con el Rolimeter (aircast). Un examen radiológico completo fue realizado a todos los pacientes. A 15 años de seguimiento 43 por ciento de pacientes fueron clasificados como A, 40 por ciento B, 10 por ciento C 5 por ciento y D según el formulario IKDC objetivo. El IKDC subjetivo promedio fue de 85,8/100. La laxitud diferencial instrumental promedio fue de 1,8 mm. 86 por ciento de los pacientes presentaron radiografías normales y solamente 5 por ciento de artrosis. Este estudio demuestra que esta técnica permite obtener buenos resultados en cuanto a la laxitud y la artrosis.

The results of the ACL by arthroscopy in the long term are rare. The following are the results of a study we made of 57 patients with a folloe-up of more than 15 years. The reconstruction was carried out by arthroscopy. We used a patellar ligament bone graft. The femoral tunnel procedure is outside-inside. The femoral attachment was by "pressfit", and the tibial attachment using a metalic interference screw. 240 patients were operated on in 1992 using this technique. We reviewed 57 of these patient with a mean follow-up time of 182 months. All the patients were evaluated using the IKDC formula. The laxity differential was measured using the Rolimeter (aircast). A complete radiological examination was carried out on all the patients. After 15 years follow-up 43 percent of the patients were classified A 40 percent, B 10 percent, C 5 percent and D using the IKDC formula objective. The mean IKDC subjective score was 85,8/100. The mean instrumental laxity diferrential was 1,8 mm. 86 percent of the patients had normal X-rays and only 5 percent had arthritis. This study demonstrates that using this technique good resultd can be obtained with regard to laxity and arthritis.

Differences of clinical results of anterior cruciate ligament reconstruction between two different transplants / 中国矫形外科杂志

0.05).[Conclusion]Patients undergoing ACL reconstruction with non-irradiated deep-frozen allograft or autograft had similar clinical outcomes.Non-irradiated allograft is a reasonable alternative choice to autograft for ACL reconstruction.