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Objective:To evaluate the clinical efficacy of modified all-arthroscopic reconstruction of medial patella femoral ligament (MPFL) for the treatment of recurrent patellar dislocation.Methods:A retrospective case series study was conducted to analyze the clinical data of 38 patients (46 knees) with recurrent patellar dislocation, who were treated at First Affiliated Hospital of Shenzhen University from January 2017 to January 2020. The patients included 12 males (12 knees) and 26 females (34 knees), aged 14-40 years [(24.6±5.4)years]. All patients underwent the modified all-arthroscopic MPFL reconstruction procedure. The femoral tunnel locations were assessed by 3D-CT immediately after surgery. The MRI was performed at 6 and 12 months after operation to assess the healing morphology of the reconstructed MPFL. The Lysholm score and Kujala score were used to assess the knee function before operation, at 6 months after operation, at 12 months after operation and at the last follow-up. The time to return to sports as well as complications were observed.Results:All patients were followed up for 26-48 months [(32.4±8.6)months]. Postoperative 3D-CT examination showed that the femoral tunnels were located in the groove area of the medial epicondyle of the femur and the adductor tubercle. At 6 and 12 months after operation, MRI T2 images showed that the reconstructed MPFL had a low signal and well tensioned ligament tissue, indicating that the MPFL was healed well. The Lysholm scores at 6 and 12 months postoperatively and at the last follow-up were (81.1±12.0)points, (91.2±3.8)points, and (92.2±9.8)points, respectively, being significantly higher than the preoperative (52.4±10.6)points (all P<0.01). The Kujala scores at 6 and 12 months postoperatively and at the last follow-up were (85.4±3.9)points, (91.4±3.6)points, and (93.1±8.5)points, respectively, being significantly higher than the preoperative (55.2±6.8)points (all P<0.01). Compared with 6 months postoperatively, the Lysholm score and Kujala score were significantly improved at 12 months postoperatively and at the last follow-up (all P<0.05). All patients returned to sports, with the time to return to sports for 3-12 months [(8.7±2.3)months] after operation. One patient had poor wound healing but was healed after dressing changes. No wound infection, nerve injury, joint stiffness, patella re-dislocation or other complications occurred. Conclusion:For recurrent patellar dislocation, the modified all-arthroscopic MPFL reconstruction has advantages of accurate bone tunnel positioning, good ligament healing, good function recovery, early return to sports, and less postoperative complications.
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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.
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Humans , Patella/surgery , Patellar Dislocation/surgery , Patellofemoral Joint/surgery , Knee Joint/surgery , Joint Dislocations , Ligaments, Articular/surgeryABSTRACT
Resumen: Introducción: Las alteraciones de la articulación patelofemoral son una de las causas más comunes de dolor e inflamación así como de daño articular e inestabilidad de la rodilla. La inestabilidad patelofemoral es una entidad común multifactorial que requiere de una realineación mediante técnicas proximales, distales o una combinación de ellas. Entre los procedimientos proximales en tejidos blandos se encuentra la plastía del ligamento patelofemoral medial (LPFM), la cual tiene como objetivo realinear la patela hacia medial y restaurar la anatomía entre el tendón cuadricipital, patela y tubérculo de la tibia. Objetivo: Demostrar que la plastía del LPFM con autoinjerto de cuádriceps es una técnica efectiva y con bajo nivel de complicaciones. Material y métodos: Estudio observacional, longitudinal, retrospectivo, descriptivo, básico y clínico. Se presenta una serie de 15 pacientes operados con esta técnica entre Octubre de 2014 y Septiembre de 2019. Resultados: La plastía del LPFM con autoinjerto del cuadricipital es una técnica segura que no utiliza implantes, lo cual reduce el riesgo de complicaciones y restaura la anatomía del aparato extensor de la rodilla. Conclusión: Nuestra técnica con autoinjerto de cuádriceps es segura, con buenos resultados a mediano plazo y baja incidencia de complicaciones. Los pacientes han regresado a sus actividades deportivas previas sin episodios de reluxación.
Abstract: Introduction: Alterations of the patellofemoral joint are one of the most common causes of pain and inflammation as well as joint damage and instability of the knee. Patellofemoral instability is a common multifactorial entity, requiring realignment by proximal, distal, or a combination of techniques. Within the proximal procedures in soft tissues, is the medial patellofemoral ligament plasty (MPFL), which aims to realign the patella medially and restore the anatomy between the quadricipital tendon, patella and tubercle of the tibia. Objective: To demonstrate that the plasty of the LPFM with quadriceps autograft is an effective technique with a low level of complications. Material and methods: Observational, longitudinal, retrospective, descriptive, basic and clinical study. We present a series of 15 patients operated with this technique between October 2014 and September 2019. Results: LPFM plasty with autograft quadricipital is a safe technique, which does not use implants, which reduces the risk of complications and restores the anatomy of the extensor apparatus of the knee. Conclusion: Our technique of repair of the medial patellofemoral ligament, with quadriceps autograft is a safe, reproducible technique, with good results in the medium term, as well as a low incidence of complications. Patients have returned to their previous sports activities without episodes of re-dislocation.
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INTRODUCCIÓN: La inestabilidad rotuliana recurrente puede conducir a malos resultados funcionales y daño articular progresivo a largo plazo, y con frecuencia se aborda mediante la reconstrucción del ligamento patelofemoral medial (RLPFM), con múltiples técnicas que suelen diferir en el método de fijación de la rótula. OBJETIVO: Evaluar los resultados de RLPFM utilizando una técnica novedosa de fijación rotuliana mediante suturas transóseas. El objetivo principal es determinar las tasas de reluxación y los resultados funcionales incluyendo retorno deportivo. Los objetivos secundarios incluyen la evaluación de las complicaciones y de otras variables relacionadas, y la comparación entre los resultados de RLPFM aislada y asociada a una osteotomía de la tuberosidad tibial. MÉTODOS: Estudio transversal de 34 pacientes sometidos a RLPFM desde 2013 hasta 2019 con un seguimiento mínimo de 12 meses. La reconstrucción fue realizada por el mismo primer cirujano con autoinjerto de gracilis de doble banda en todos los casos. La fijación del injerto en la cara medial de la rótula se realizó utilizando dos puntos de fijación transóseos independientes con suturas de alta resistencia, y la fijación femoral anatómica, con un tornillo interferencial mediante referencias anatómicas y radiológicas. Hubo 27 pacientes con RLPFM aislada, y 7 con osteotomía de la tuberosidad tibial asociada. RESULTADOS: La edad media fue de 22,8 años (desviación estándar [DE]: 9,1). El 50% eran hombres. El seguimiento desde la cirugía hasta el cuestionario fue de 30,4 meses (rango: 12 a 72 meses). La puntuación media de Kujala en el seguimiento fue de 89,4 (DE: 12,8; mediana: 93,5; rango: 51 a 100). No hubo casos de reluxación. No se identificaron otras complicaciones durante el seguimiento. El 81% de los pacientes regresó a los deportes, y el 47% regresó a su nivel previo de participación. No se encontraron diferencias significativas al comparar RLPFM aislada con grupos de osteotomía asociada. CONCLUSIÓN: La RLPFM mediante sutura transósea para fijación en la rótula mostró que la estabilidad rotuliana fue restaurada en el corto y mediano plazo. Esta técnica es segura, tiene excelentes resultados funcionales, y evita posibles complicaciones de los túneles rotulianos o morbilidad asociada al uso de implantes.
INTRODUCTION: Recurrent patellar instability can lead to poor functional results and progressive articular damage in the long term, and is frequently addressed by medial patellofemoral ligament reconstruction (MPFLR), with multiple techniques that most commonly differ regarding the method of patellar fixation. OBJECTIVE: To evaluate the results of MPFLR using a novel technique of patellar fixation using transosseous sutures. The main objective is to determine the redislocation rates and functional results. The secondary goals include an assessment of complications and of other related variables, and a comparison between isolated MPFLR and MPFLR associated to tibial tubercle osteotomy. METHODS: A cross-sectional study of 34 patients who underwent MPFLR from 2013 to 2019 with a minimum of 12 months of follow-up. The reconstruction was performed by the same first surgeon with double-bundle gracilis autograft in all cases. Fixation of the graft to themedial aspect of the patella was performed with two independent transosseous fixation points with high resistance sutures, and anatomic femoral fixation with an interference screw using anatomical and radiological landmarks. There were 27 patients with isolated MPFR, and 7 with associated tibial tubercle osteotomy. RESULTS: The mean age was of 22.8 years (standard deviation [SD]: 9.1). Men comprised 50% of the sample. The mean follow-up from surgery to the application of the questionnaire was of 30.4 months (range: 12 to 72 months). The mean Kujala score at follow-up was of 89.4 (SD: 12.8; median: 93.5; range: 51 to 100). There were no cases of redislocation. No other complications were identified during the follow-up. In total, 81% of patients returned to sports, with 47% returning to their previous level of participation. No significant differences were found when comparing isolated MPFLR with MPFLR associated osteotomy groups. CONCLUSION: The MPFLR procedure using transosseous patellar fixation showed that patellar stability was restored in the short term to the midterm. This technique is safe and has excellent functional outcomes, and it prevents potential complications of patellar tunnels or the morbidity associated to the use of implants.
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Humans , Male , Female , Adolescent , Adult , Patellar Ligament/surgery , Plastic Surgery Procedures/methods , Patellofemoral Joint/surgery , Exercise , Cross-Sectional Studies , Surveys and Questionnaires , Treatment OutcomeABSTRACT
Objective: To observe the effectiveness of arthroscopic reconstruction of medial patellofemoral ligament (MPFL) with a single bundle of autogenous half peroneal longus tendon, and medial displacement of lateral hemitibial tuberosity for the treatment of recurrent dislocation of patella. Methods: Retrospectively analyse the clinical data of 24 patients (24 knees) with recurrent patellar dislocation with tibial tuberosity-trochlear groove distance (TT-TG) values more than 15 mm who were admitted between September 2014 and September 2018. Of which 7 were male and 17 were female; aged 16-35 years old with an average of 25.8 years. The disease duration ranged from 15 to 46 months, with an average of 26.7 months. All patients had a history of knee trauma, and a positive result of apprehension test on the affected knee. All patients underwent the surgery of arthroscopic reconstruction of MPFL with a single bundle of autogenous half peroneal longus tendon, and medial displacement of lateral hemitibial tuberosity. Before and after operation, Kujala score was used to evaluate patellofemoral joint function, Lysholm score was used to evaluate knee joint function; CT and MRI were used to measure and compare the changes of congruence angle (CA), patellar tilt angle (PTA), and lateral patella displacement (LPD) in order to evaluate patella stability. Results: All incisions healed by first intention, and no infection or neurovascular injury occurred. Deep vein thrombosis of the lower extremities occurred in 2 cases at 4 and 7 days after operation respectively, and the thrombosis disappeared after symptomatic treatment. All the 24 patients were followed up 12-14 months (mean, 12.9 months). During follow-up, no patellar dislocation reoccurred in the affected knee. At last follow-up, the apprehension test was negative in every patients. The TT-TG, CA, PTA, and LPD were significantly improved when compared with those before operation ( P<0.05). The Kujala score and Lysholm score at 1 month and last follow-up were significantly better than those before operation, and the above scores at last follow-up were significantly better than those at 1 month after operation ( P<0.05). According to Lysholm score, the patients' knee joint functions were excellent in 13 cases, good in 10 cases, and fair in 1 case, and the excellent and good rate was 95.8%. Conclusion: Arthroscopic reconstruction of MPFL with a single bundle of autogenous half peroneal longus tendon combined with medial displacement of lateral hemitibial tuberosity has the advantages of minimal invision and reliable effectiveness. It can be used as one of the effective surgical methods for the treatment of recurrent dislocation of patella.
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Objective To investigate the recovery of knee joint function in patients with recurrent patellar dislocation treated by reconstruction of medial patellofemoral ligament with EndoButton double bundles.Methods A retrospective analysis was performed for 26 patients with recurrent patellar islocation who were treated in The Second Hospital of Tangshan from February 2014 to July 2016,with a total of 26 knees,aged 14-29 years.All patients underwent medial patellofemoral ligament reconstruction with autologous semitendinosus muscle.Double tunnel technique was used in medial patella and single tunnel technique was used in femoral side.Twenty-four patients were followed up for 12 to 24 months.The recovery of knee joint function was evaluated by Kujala score,Lysholm score,patellar fitness angle and patellar tilt angle before and after treatment.Results None of the follow-up patients had dislocation again,and the fear test was negative.The preoperative Kujala score and Lysholm score were (59.67 ± 5.28) and (61.75 ± 5.45) respectively.The corresponding scores at the last follow-up were (87.21±4.21) and (90.13±2.47).There were significant differences between the two scores (t =-19.98,-23.24,all P ＜0.01).The patellar fit angle changed from (23.17±3.63)degrees before operation to (14.17±2.01)degrees after operation.There was significant difference between the two scores.(t =10.62,P＜ 0.01);Patellar tilt angle changed from preoperative (18.33±3.92)degree to postoperative (2.45± 1.10)degree,the difference was significant (t =19.10,＜0.01).Conclusion EndoButton double-bundle reconstruction of medial patellofemoral ligament is effective in the treatment of patellar dislocation with satisfactory recovery of knee joint function.
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Objective To evaluate the therapeutic effects of early reconstruction of medial patellofemoral ligament (MPFL) in acute traumatic patellar dislocation of knee joint.Methods 15 acute traumatic patellar dislocation of knee joint patient underwent early MPFL reconstruction, and were regular follow-up after operation.At the final follow-up, evaluated the stability of patellar and compared the Lysholm score, Kujala score and Tegner score between pre-injury and last follow.Results The average follow up was 18.6 months.All the patient had no recurrent patellar dislocation, and showed negative apprehension test.The preinjury Lysholm score, Kujala score and Tegner score were 90.6±13.1, 92.3±12.4 and 5.9±1.3, respectively;the postoperative Lysholm score, Kujala score and Tegner score were 91.2±12.5, 95.1±13.2 and 6.2±1.6.There were no significant difference between before injury and postoperation on Lysholm score, Kujala score and Tegner score at last follow-up (P＞0.05).Conclusion Early MPFL reconstruction for acute traumatic patellar dislocation can restore the stability and function of patellar.
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Objective To compare the clinical efficacy between arthroscopic riveting with line and lateral retinacular release plus medial patellofemoral ligament reconstruction in the treatment of habitual patellar dislocation.Methods A retrospective study was conducted of the 40 children with habitual patellar dislocation who had been treated at Department of Pediatric Orthopaedics,Foshan Hospital of Traditional Chinese Medicine from January 2016 to December 2016.They were divided evenly into an observation group and a control group according to the treatment methods (n =20).In the observation group which was treated by lateral retinacular release plus medial patellofemoral ligament reconstruction,there were 14 boys and 6 girls,with an age of 14.2 ± 1.2 years and an average number of dislocations of 5.3 ± 1.1 times.In the control group which was treated by arthroscopic riveting with line,there were 13 boys and 7 girls,with an age of 13.8 ± 1.3 years and an average number of dislocations of 5.5 ± 1.2 times.The 2 groups were compared in terms of visual analogue score (VAS),Q-angle,knee motion,Lysholm score and Kujala score of the knee at the last follow-ups.Results The 2 groups were comparable due to insignificant differences in preoperative general data between them (P ＞ 0.05).The observation and control groups were followed up for 13.3 ± 1.2 months and 12.9 ± 1.2 months,respec-tively,showing no significant difference between them(P ＞ 0.05).At the last follow-ups,the observation group had a significantly lower VAS score (2.2 ± 0.8 pints),a significantly smaller Q-angle (14.5°± 1.2°),significantly larger knee motion (30.3° ± 3.8°),and significantly higher Lysholm (91.6 ± 5.3 points) and Kujala scores (93.2 ±2.8 points) than the control group (4.3 ± 1.1 points,17.8°± 1.6°,23.4°±3.4°,81.4 ±4.4 points and 82.0 ± 5.4 points,respectively) (all P ＜ 0.05).Conclusion In the treatment of habitual patellar dislocation,lateral retinacular release plus medial patellofemoral ligament reconstruction can lead to improvements in knee function and clinical symptoms and better clinical outcomes than arthroscopic riveting with line.
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Objective: To introduce the method of prior-localization femoral tunnel by using a special positioning tool under the C-arm radiographic machine before surgery, and to study the effect on the knee function recovery after medial patellofemoral ligament (MPFL) reconstruction. Methods: Between January 2014 and January 2016, 32 patients with recurrent unilateral knee patellar dislocation were treated by arthroscopic patellofemoral lateral retinaculum release and MPFL reconstruction. The femoral tunnel position during MPFL reconstruction was prior-localizated under C-arm radiographic machine before operation. There were 8 males and 24 females, aged from 15 to 37 years, with an average of 23.8 years. The time from injury to admission ranged from 1 to 24 months, with an average of 9.7 months. Isometric point distance was measured on CT three-dimensional reconstruction image after operation to evaluate whether the position of femoral tunnel was isometric, and knee joint function was evaluated by Lysholm score. Spearman correlation analysis was performed between isometric point distance and Lysholm score. Results: All the 32 patients were followed up 12-18 months (mean, 14.2 months). No symptoms of patellar subluxation or dislocation was found during follow-up. Patellar extrapolation test and patellar extrapolation fear test were negative. The isometric point distance was 1.5-5.9 mm (mean, 3.44 mm) at 3 days after operation. All femoral tunnels were located in equidistant tunnels. At last follow-up, the Lysholm score of the patients was 92.8±2.1, which was significantly improved when compared with preoperative score (54.4±2.8) ( t=61.911, P=0.000). Isometric point distance was negatively correlated with Lysholm score ( r=-0.454, P=0.009). Conclusion: C-arm radiographic machine can locate the femoral tunnel position of MPFL easily and accurately before operation. The short-term and medium-term effectiveness are satisfactory, and the ionizing radiation injury caused by multiple fluoroscopy during operation is avoided.
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Objective: To investigate the effectiveness of arthroscopic medial patellofemoral ligament (MPFL) reconstruction combined with tibial tuberosity transfer for recurrent patellar dislocation. Methods: Between February 2012 and December 2013, 24 patients (24 knees) with recurrent patellar dislocation were treated with arthroscopic MPFL reconstruction combined with tibial tuberosity transfer. There were 7 males and 17 females, with a mean age of 23.2 years (range, 18-37 years). One patient had recurrence dislocation after operation in the other hospital, and the others were the first operation. The disease duration ranged from 6 months to 20 years (mean, 5.6 years). The patellar apprehension tests were positive. The preoperative Lysholm score was 49.79±11.67 and the Kujala score was 49.63±6.28. X-ray films showed that 13 patients had dysplasia of the patella and femoral trochlea; 8 patients had high tibia (Caton-Deschamps index>1.2); the congruence angle was (23.96±5.54)°. CT examination showed that the tibial tuberosity-trochlear groove distance (TT-TG) value was (23.71±2.35) mm. Results: All incisions healed by first intention. Twenty-two patients were followed up 59-81 months, with an average of 66.8 months. No dislocation occurred during the follow-up period. The patellar apprehension tests were negative. At 1 week after operation, the results of X-ray films and CT showed that the congruence angle angle was (-1.96±4.65)°, and the TT-TG value was (13.75±1.89) mm, which were significantly lower than those before operation ( P<0.05). At 6 months, 1 year, and last follow-up, Lysholm scores were 81.13±17.76, 91.35±3.60, and 92.23±2.71, respectively; and Kujala scores were 84.04±3.98, 91.48±3.64, and 91.45±3.29, respectively. The Lysholm and Kujala scores were significantly increased after operation when compared with the preoperative scores ( P<0.05). At last follow-up, the effectiveness was excellent in 11 cases, good in 8 cases, and fair in 3 cases, with an excellent and good rate of 86%. Conclusion: Arthroscopic MPFL reconstruction combined with tibial tuberosity transfer for recurrent patellar dislocation can effectively improve the patellofemoral joint matching relationship and has a satisfactory short- and medium-term effectiveness.
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Objective@#To compare the clinical efficacy between arthroscopic riveting with line and lateral retinacular release plus medial patellofemoral ligament reconstruction in the treatment of habitual patellar dislocation.@*Methods@#A retrospective study was conducted of the 40 children with habitual patellar dislocation who had been treated at Department of Pediatric Orthopaedics, Foshan Hospital of Traditional Chinese Medicine from January 2016 to December 2016. They were divided evenly into an observation group and a control group according to the treatment methods (n=20). In the observation group which was treated by lateral retinacular release plus medial patellofemoral ligament reconstruction, there were 14 boys and 6 girls, with an age of 14.2±1.2 years and an average number of dislocations of 5.3±1.1 times. In the control group which was treated by arthroscopic riveting with line, there were 13 boys and 7 girls, with an age of 13.8±1.3 years and an average number of dislocations of 5.5±1.2 times. The 2 groups were compared in terms of visual analogue score (VAS), Q-angle, knee motion, Lysholm score and Kujala score of the knee at the last follow-ups.@*Results@#The 2 groups were comparable due to insignificant differences in preoperative general data between them (P>0.05). The observation and control groups were followed up for 13.3±1.2 months and 12.9±1.2 months, respectively, showing no significant difference between them(P>0.05). At the last follow-ups, the observation group had a significantly lower VAS score (2.2±0.8 pints), a significantly smaller Q-angle (14.5°±1.2°), significantly larger knee motion (30.3°±3.8°), and significantly higher Lysholm (91.6±5.3 points) and Kujala scores (93.2±2.8 points) than the control group (4.3±1.1 points, 17.8°±1.6°, 23.4°±3.4°, 81.4±4.4 points and 82.0±5.4 points, respectively) (all P<0.05).@*Conclusion@#In the treatment of habitual patellar dislocation, lateral retinacular release plus medial patellofemoral ligament reconstruction can lead to improvements in knee function and clinical symptoms and better clinical outcomes than arthroscopic riveting with line.
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Introducción En los últimos años ha cobrado importancia la reconstrucción del LPFM. La técnica más utilizada es con autoinjerto de tendones isquiotibiales. En algunas series los reportes de complicaciones son mayores al 26%. Este trabajo pretende demostrar la utilidad del autoinjerto del cuádriceps para la reconstrucción del LPFM, sin túneles rotulianos y sin el uso de fluoroscopia intraoperatoria. Materiales y métodos Se incluyeron pacientes con historia clínica de al menos dos episodios de luxación. Se tomaron en todas los pacientes serie radiográfica, TAC axial rótulas, TAC 3D y RNM. Se obtuvo registro de manera retrospectiva de puntuaciones en las escalas de Lysholm, Tegner y Kujala en el posoperatorio con controles a los 6,12 y 18 meses. Resultados Cumplieron con los criterios de selección 24 pacientes, 16 mujeres y 8 hombres, edad promedio de 23 años.En nuestro estudio se observó la mejoría de puntuaciones en las escalas de Lysholm, Tegner y Kujala en el posoperatorio con controles a los 6,12 y 18 meses. Sin presentarse nuevos episodios de luxación rotuliana u otras complicaciones relevantes. Hubo un retorno en todos los casos a la actividad deportiva. Discusión Este estudio reafirma que el tendón cuadricipital es un injerto que reproduciendo mejor la anatomía del LPFM, presenta cifras comparables o mejores funcionalmente con los otros injertos utilizados en la actualidad. Con el protocolo preoperatorio de TAC3D se ha conseguido identificar en forma individual y con la especificidad anatómica de cada paciente, al tubérculo aductor y epicóndilo medial, dando mayor certeza en la ubicación anatómica de la inserción femoral LPFM. Con las ventajas adicionales de disminuir el tiempo quirúrgico, y evitar radiación innecesaria en el equipo quirúrgico.
Background The reconstruction of the medial patellar-femoral ligament (MPFL) has become increasingly important in recent years. The most used technique is a hamstring tendons autograft. Complications of greater than 26% have been reported in some series. The aim of this study is to demonstrate the use of quadriceps autograft for the reconstruction of the MPFL, without patellar tunnels and without the use of intraoperative fluoroscopy. Methods A Case Series study was performed. Patients with a clinical history of at least two episodes of dislocation were included. A series of x-rays, axial Computed Tomography (CT), patellae, 3D CT, and MR image were taken in all patients. Scores on the Lysholm, Tegner, and Kujala scales were used in the postoperative period, with controls at 6, 12 and 18 months being recorded Results A total of 24 patients, 16 women and 8 men, with a mean age of 23 years, met the selection criteria. An improvement was observed in the scores on the Lysholm, Tegner, and Kujala scales in the postoperative period, with controls at 6, 12, and 18 months. No new episodes of patellar dislocation or other relevant complications were observed. There was a return to sports activity in all cases. Discussion This study reaffirms that the quadriceps tendon is a graft that reproduces the anatomy of the MPFL better, shows figures comparable or functionally better than with the other grafts used at present. Using the preoperative protocol of 3-D CT scans, the adductor and medial epicondyle tubules have been identified individually and with the anatomical specificity of each patient, giving greater certainty in the anatomical location of the MPFL femoral insert. This also has the additional advantages of decreasing surgical time, and avoiding unnecessary radiation in the surgical team.
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Humans , Patellofemoral Joint , Transplantation, Autologous , Tomography, X-Ray Computed , LigamentsABSTRACT
PURPOSE@#The medial patellofemoral ligament (MPFL) acts as primary restraint to lateral patellar dislocation and its rupture has been reported in almost all cases of acute patellar dislocation. Various surgical techniques have been described for MPFL reconstruction, using many femoral and patellar fixation techniques and different grafts. This article details our technique for MPFL reconstruction using semitendinosus graft which avoids the use of implant at patellar end.@*METHODS@#Twenty patients (8 males and 12 females) with complaints regarding acute and chronic lateral patellar instability were evaluated and treated by MPFL reconstruction procedure. The mean age of patients was 21 years (range 17-34 years). MPFL reconstruction was performed using semitendinosus graft passing through two parallel, obliquely directed tunnels created in patella. Fixation of graft was done with an interference screw only at the femoral end. Mean follow-up period after intervention was 26.4 months (range 23-30 months). Results were evaluated using Kujala score.@*RESULTS@#All patients gained adequate patellar stability and full arc of motion. No incidence of patella fracture was noted. There were no postoperative complications related to the procedure. There was no recurrence of instability in patella at final follow-up.@*CONCLUSION@#Passing the graft through the tunnels in patella without use of any implant has given excellent functional outcome and moreover has the advantages of less implant-related complications and cost-effectiveness.
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Objective: To investigate the effectiveness of the arthroscopic lateral retinacular release combined with medial patellofemoral ligament (MPFL) reconstruction for patellar dislocation.
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Objective: To review the influencing factors of medial patellofemoral ligament (MPFL) reconstruction for patellar dislocation. Methods: The literature of MPFL reconstruction for patellar dislocation at home and abroad in recent years were summarized and analyzed. Results: The influencing factors such as the location of the femoral insertion point, the tension and the fixed angle of the grafts, the dysplasia of the femoral trochlear before operation, the abnormal tuberositas tibiae-trochlear groove value, the high position of the patellar, and the tilting angle of the patellar, are all the factors affecting the effectiveness of MPLF reconstruction. Conclusion: During MPFL reconstruction, the surgical techniques and elimination of other factors that caused patellar instability need to be focused in order to reduce the complications and operation failure.
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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.
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OBJECTIVE: To evaluate the correlation between the injury patterns of the medial patellofemoral ligament (MPFL) on magnetic resonance imaging in an acute first-time lateral patellar dislocation (LPD) and incidence of a second-time LPD. MATERIALS AND METHODS: Magnetic resonance images were prospectively analyzed in 147 patients after an acute first-time LPD with identical nonoperative management. The injury patterns of MPFL in acute first-time LPDs were grouped by location and severity for the analysis of the incidence of second-time LPD in a 5-year follow-up. Independent t tests, chi-square tests and Kruskal-Wallis tests were performed as appropriate. RESULTS: Forty-six cases (46/147, 31.3%) of second-time LPD were present at the 5-year follow-up. Fourteen (14/62, 22.6%) and 31 cases (31/80, 38.8%) were present in the partial and complete MPFL tear subgroups, respectively. Twenty-five cases (25/65, 38.5%), 11 cases (11/26, 42.3%), and 8 cases (8/47, 17%) were present in the isolated femoral-side MPFL tear (FEM), combined MPFL tear (COM), and isolated patellar-side MPFL tear (PAT) subgroups, respectively. Compared with the partial MPFL tears, complete tears showed higher incidence of a second-time LPD (p = 0.04). The time interval between the two LPDs was shorter in the complete MPFL tear subgroup (24.2 months) than in the partial tear subgroup (36.9 months, p = 0.001). Compared with the PAT subgroup, the FEM and COM subgroups showed a higher incidence of a second-time LPD (p = 0.025). The time intervals between the two LPDs were shorter in the FEM and COM subgroups (20.8 months and 19.2 months) than in the PAT subgroup (32.5 months, p = 0.049). CONCLUSION: A complete MPFL tear, isolated femoral-side tear and combined tear in a first-time LPD predispose a second-time LPD.
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Humans , Follow-Up Studies , Incidence , Knee , Ligaments , Magnetic Resonance Imaging , Patellar Dislocation , Prospective Studies , Recurrence , TearsABSTRACT
Objective To explore the efficacy of the soft-tissue fixation in reconstruction of the medial patellofemoral ligament(MPFL) in treating the recurrent dislocation of patella in adolescents.Methods A total of 12 adolescents undergoing MPFL reconstruction for the recurrent dislocation of patella between March 2014 and October 2015 were included.The autologous hamstring tendon was harvested and fixated using the soft-tissue fixation method in the MPFL reconstruction.A rapid rehabilitation program was carried out postoperatively.Clinical outcomes were evaluated using the Lysholm,international knee documentation committee(IKDC),Kujala knee scores preoperatively and during the postoperative follow-up.Moreover,the degree of satisfaction to the surgery and the restoration of sports activities were also surveyed.Results All patients were followed up for 6 to 18 months,with an average of 12 months.There was no recurrence of dislocation.During the final follow-up,all patients restored the full range of activity and normal medial patellar stability.The Lysholm,IKDC and Kujala knee scores were significantly improved postoperatively compared with those preoperatively (P＜0.01).Ten patients were very satisfied with the operation and the other 2 were satisfied with the surgery.Among all the patients (non-professional athletes),75％(9/12) fully regained their sport abilities in 6 months after the surgery.Conclusions Reconstruction of MPFL with the soft-tissue fixation method has achieved remarkable clinical results without severe complications associated with bony procedures.For the adolescent patients with open growth plates,this is a safe,effective and reliable surgical technique.
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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.
Subject(s)
Adult , Young Adult , Joint Instability/surgery , Ligaments, Articular/surgery , Patellar Dislocation/surgery , Patellofemoral Joint/surgery , Plastic Surgery Procedures/methods , RecurrenceABSTRACT
Objective:To explore the clinical outcomes of anatomical double-bundle medial patellofemoral ligament (MPFL) reconstruction with double suture anchor technique in treating patellofemoral instability in adolescent.Methods:Twenty-five young people with patellofemoral instability (25 knees) in our department from January 2013 to December 2014 were enrolled for this study.All patients were performed anatomical double-bundle MPFL reconstruction with arthroscopic-assisted suture anchors technique in the patella,and fixed in the femoral socket with absorbable interference screw.All patients are evaluated by different methods,including patient's satisfaction,patellar apprehension test,recurrent subluxation/dislocation,CT assessment of bone tunnel and patellar tilt angle.Lysholm scores,Tegner scores and Kujala scores were recorded at the final follow-up.Results:The mean follow-up was 24 (range 20-40) months.All cases were observed in negative patellar apprehension test.Infection,recurrent subluxation/dislocation and patellar fracture were not found at the last follow-up.CT results demonstrated that the tunnel position were good.The patellar tilt angle was decreased from 21.6°±2.3° to 10.5°±1.6° (P＜0.05);the Lysholm scores was increased from 51.7±5.3 to 93.8±6.5 (P＜0.05).Tegner scores was increased from 4.1± 1.1 to 5.5±0.6 (P＜0.05).Kujala scores was increased from 53.5±6.4 to 94.6±4.3 (P＜0.05).Conclusion:Arthroscopic-assisted anatomical double-bundle MPFL reconstruction with the suture anchors technique is a safe,minimal invasive and effective surgical option for treating patellofemoral instability in adolescent.