Clinical application and effectiveness of patellar tunnel locator in medial patellofemoral ligament reconstruction surgery / 中国修复重建外科杂志

OBJECTIVE@#To evaluate the operability and effectiveness of a self-developed patellar bone canal locator (hereinafter referred to as "locator") in the reconstruction of the medial patellofemoral ligament (MPFL).@*METHODS@#A total of 38 patients with recurrent patellar dislocation who met the selection criteria admitted between January 2022 and December 2022 were randomly divided into study group (the patellar canal was established with a locator during MPFL reconstruction) and control group (no locator was used in MPFL reconstruction), with 19 cases in each group. There was no significant difference in baseline data between the two groups ( P>0.05), such as gender, age, body mass index, disease duration, patella Wiberg classification, constituent ratio of cartilage injury, Caton index, tibia tubercle-trochlear groove, and preoperative Lysholm score, Kujal score, Tegner score, visual analogue scale (VAS) score, and so on. The Lysholm score, Kujal score, Tegner score, and VAS score were used to evaluate knee joint function before operation and at 3 days,1 month, 3 months, and 6 months after operation. The ideal prepatellar cortical thickness and canal length were measured before operation, and the actual prepatellar cortical thickness and canal length after operation were also measured, and D1 (the distance between the ideal entrance and the actual entrance), D2 (the ideal canal length minus the actual canal length), D3 (the ideal prepatellar cortical thickness minus the actual prepatellar cortical thickness) were calculated.@*RESULTS@#Patients in both groups were followed up 6-8 months (mean, 6.7 months). The incision length and intraoperative blood loss in the study group were smaller than those in the control group, but the operation time was longer than that in the control group, the differences were significant ( P<0.05). There was no complication such as incision infection, effusion, and delayed healing in both groups, and no further dislocation occurred during follow-up. One patient in the study group had persistent pain in the anserine area after operation, and the symptoms were relieved after physiotherapy. The VAS score of the two groups increased significantly at 3 days after operation, and gradually decreased with the extension of time; the change trends of Lysholm score, Kujal score, and Tegner score were opposite to VAS score. Except that the Lysholm score and Kujal score of the study group were higher than those of the control group at 3 days after operation, and the VAS score of the study group was lower than that of the control group at 3 days and 1 month after operation, the differences were significant ( P<0.05), there was no significant difference in the scores between the two groups at other time points ( P>0.05). Patellar bone canal evaluation showed that there was no significant difference in preoperative simulated ideal canal length, prepatellar cortical thickness, and postoperative actual canal length between the two groups ( P>0.05). The postoperative actual prepatellar cortical thickness of the study group was significantly smaller than that of the control group ( P<0.05). D1 and D3 in the study group were significantly higher than those in control group ( P<0.05), but there was no significant difference in D2 between the two groups ( P>0.05).@*CONCLUSION@#The locator can improve the accuracy of MPFL reconstruction surgery, reduce the possibility of intraoperative damage to the articular surface of patella and postoperative patellar fractures.

Therapeutic effects of comprehensive surgery for recurrent patellar instability in adults / 局解手术学杂志

Objective To analyze the clinical effect of medial patellofemoral ligament(MPFL)reconstruction combined with the com-prehensive surgery of anteromedial tibial tubercle transfer and distal shift in the treatment of recurrent patellar instability.Methods The clin-ical data of 60 patients(60 affected knees)with recurrent patellar instability who were admitted to the orthopedics department of Mianyang central hospital in Sichuan Province from April 2012 to September 2016 were retrospectively analyzed.All the patients were examined with knee arthroscopy,lower extremity X-ray,CT and MRI,and they were treated with MPFL reconstruction combined with anteromedial tibial tu -bercle transfer and distal shift comprehensive surgery.All patients were followed up for at least 1 year after operation.The physical indexes, imaging examination indexes and evaluation results of knee function were analyzed before operation and at the last follow -up.Results The follow-up of 60 patients showed that the results of fear test were negative,results of patellar tilt test were symmetrical,and the Q angle re-turned to normal.The activities of flexion and extension were significantly improved,and there was no fractures or dislocation of the patella. Imaging examination showed that the patellofemoral joint was well positioned.At the last follow-up,the patellofemoral congruence angle,de-gree of patellar out-shift and lateral patellar angle of the 60 patients were significantly decreased,and the tibial tuberosity-trochlear groove dis-tance(TT-TG)was also significantly decreased,the differences were significant(P<0.05),and they basically returned to the normal range. At the last follow-up,the Lysholm score and Kujala score were significantly higher than those before operation,the differences were significant (P<0.05).Conclusion The clinical effect of MPFL reconstruction combined with anteromedial tibial tubercle transfer and distal shift com -prehensive surgery is satisfying in the treatment of recurrent patellar instability,which has great significance for relieving symptoms and resto-ring the function of the knee.

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.

The Efficacy of Medial Patellofemoral Ligament Reconstruction Combined with Tibial Tuberosity Transfer in the Treatment of Patellofemoral Instability

A systematic review of the literature was undertaken to evaluate the efficacy of medial patellofemoral ligament (MPFL) reconstruction combined with tibial tuberosity transfer (TTT) in the treatment of patellofemoral instability. Using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic search was carried out to identify and review the published literature pertinent to MFPL reconstruction combined with TTT. Relevant studies were critically appraised with narrative data synthesis. Studies that met the eligibility criteria were suitable for appraisal and consisted of case series and therapeutic series (levels IV & III). All studies had inherent variations in outcomes reporting and limited follow-up. Combined treatment offers restoration of normal anatomy, thus adding clinical value to the currently recommended anatomic approach to MPFL reconstruction. Nevertheless, the current body of evidence does not determine the threshold at which patellofemoral axis requires the need for adjunctive distal realignment as opposed to MPFL reconstruction alone. This review highlighted numerous recurring limitations in the conduct and presentation of the studies, which inadvertently mitigated the interpretation of their results. Future priority should be awarded to larger randomised controlled trials utilising validated patient reported outcome measures.

Medial Patellofemoral Ligament Reconstruction Using the Autogenous Hamstring Tendon for Recurrent Patellar Instability: A Preliminary Report

PURPOSE: We present the short-term results of medial patellofemoral ligament (MPFL) reconstruction using the autogenous hamstring tendon for recurrent patellar instability. MATERIALS AND METHODS: Seven patients with recurrent patellar instability were treated with MPFL reconstruction using a semitendinosus or gracilis autograft from February 2008 to November 2008. All the patients were evaluated preoperatively and postoperatively according to the physical findings, scores and radiographs, with a mean follow-up of 13.6 months (range: 12~15 months). RESULTS: The apprehension test was positive in all the knees preoperatively and no knee was found to be positive at the follow-up. The grind test was positive in all the knees preoperatively and one knee was found to be positive at the follow-up. The Q-angle was 16.9degrees preoperatively and 18.3degrees at the follow-up. The Kujala score improved from 33.7 points to 94.1 points (p=0.018), the Lysholm score improved from 42.4 points to 92.6 points (p=0.018) and the Tegner activity level improved 2.1 to 5.1 (p=0.026). The congruence angle was 10.2degrees preoperatively and -3.4degrees at follow-up (p=0.018). The patellar height was 1.95 preoperatively and 1.6 at follow-up (p=0.028). There were no patients with recurrent dislocation. CONCLUSION: MPFL reconstruction using the autogenous hamstring tendon for recurrent patellar instability is an effective operation, according to the short term follow-up.