ABSTRACT
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.
ABSTRACT
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.
ABSTRACT
More than 100 surgical methods were described as the treatment of recurrent patella dislocation. These can be divided into two categories, the proximal, dynamic reconstruction and the distal, static reconstruction. We treated a case of recurrent patella dislocation with a new method, using gracilis. The tendon of gracilis was dissected and cut at the point about 7cm proximal to the insertion. A 'H' shaped slot was made subperiosteally in the anterior surface of patella. The both ends of cut gracilis tendon were imbedded into the 'H' shaped slot of patella and sutured. So the gracilis tendon could act as a static and dynamic stabilizer. The result was excellent at 1 year follow up.