Association between posterior tibial slope and tibial torsion angle and recurrent patellar dislocation based on the full-length CT of the lower limbs / 解剖学报

Objective To measure and compare the lateral posterior tibial slope (LPTS) , medial posterior tibial slope ( MPTS) and tibial torsion angle ( TTA) between the patients of recuiTent patellar dislocation and the heathy people, and to analyze the correlation between LPTS, MPTS and TTA and the risk factors of recuiTent patellar dislocation. Methods A total of 33 patients (44 knees) with recuiTent patellar dislocation in our hospital from July 2019 to June 2021 were selected and listed as the stud)' group. Twenty-three subjects (46 knees) who were suspected iliac vascular and lower limb vascular diseases during the same period were selected and listed as the control group. All the enrolled researchers had fulllength CT scans date of the lower limbs. Three-dimensional models were reconstructed using Mimics 21. 0 software and then imported into 3-matic software. The LPTS, MPTS and TTA were measured and compared between the two groups. Results In the study group, the LPTS, MPTS and TTA were (7. 69} 1. 42) ° , ( 10. 06} 1. 71) ° , ( 36. 42}8. 13 ) ° , respectively while the control group, the LPTS, MPTS and TTA were ( 8. 42 } 1. 65 ) ° , ( 10. 44 } 0. 86 ) ° , ( 25. 77} 3. 90 ) ° , respectively. There were no signiiicant differences in the LPTS, MPTS and TTA between different genders and sides both in the stud)' group and the control group ( P > 0. 0 5 ) . Compared with the control group, the LPTS in the stud)' group was smaller, and the difference was statistically significant (P0. 05). Compared with the control group, the TTA in the stud)' group was higher, and the difference was statistically significant (P< 0. 0 5 ) . Compared with the control group, the LPTS and MPTS in the study group were significant asymmetry, and the difference was statistically significant ( P < 0 . 0 5 ). Conclusion The lateral posterior tibial slope of patients with recurrent patellar dislocation is significantly smaller than that in the healthy people, while there is no significant difference in the medial posterior tibial slope; The tibial torsion angle of patients with recurrent patellar dislocation is significantly larger than in the healthy people; The lateral posterior tibial slope and tibial torsion angle have certain correlation with recurrent patellar dislocation, which can conduct the diagnosis of recurrent patellar dislocation.

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.

Advances in peripatellar osteotomy for treating recurrent patellar dislocation / 中国修复重建外科杂志

OBJECTIVE@#To summarize the progress of research related to the surgical treatment of recurrent patellar dislocation by peripatellar osteotomy in clinical practice, in order to provide reference for clinical treatment.@*METHODS@#The recent literature on peripatellar osteotomy for recurrent patellar dislocation at home and abroad was reviewed, and the bony structural abnormalities, imaging diagnosis, and treatment status were summarized.@*RESULTS@#Abnormalities in the bony anatomy of the lower limb and poor alignment lead to patellofemoral joint instability through the quadriceps pulling force line and play an important role in the pathogenesis of recurrent patellar dislocation. Identifying the source of the deformity and intervening with peripatellar osteotomy to restore the biomechanical structure of the patellofemoral joint can reduce the risk of soft tissue surgical failure, delay joint degeneration, and achieve the target of treatment.@*CONCLUSION@#In the clinical diagnosis and treatment of recurrent patellar dislocation, the factors causing patellofemoral joint instability should be comprehensively evaluated to guide the selection of surgery and personalized treatment.

Effect of EndoButton double-bundle reconstruction of medial patellofemoral ligament in the treatment of recurrent patellar dislocation / 中国综合临床

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.

Combined operation involving tibial tubercle distalization for recurrent patellar dislocation with patella alta / 中国修复重建外科杂志

Objective: To explore the clinical effects of combined operation involving tibial tubercle distalization for the recurrent patellar dislocation with patella alta. Methods: Between April 2010 and May 2016, 14 cases of recurrent patellar dislocation with patella alta were treated with combined operation involving tibial tubercle distalization. There were 5 males and 9 females with an average age of 18.5 years (range, 13-26 years). The left knee was involved in 9 cases and the right knee in 5 cases. The patella had dislocated 3.3 times on average (range, 2-5 times). The interval between the first dislocation and admission was 19.7 months on average (range, 4-60 months), and the main symptoms were knee pain and limited knee movement. Preoperative X-ray films, CT, and MRI examinations of knee joint showed that the epiphyseal plate closed in all patients. Of all patients, 3 patients had avulsion fracture of the inner edge of patella, and 2 patients had free body in articular cavity. The tibial tuberosity-trochlear groove (TT-TG) distance, patellar-trochlear-groove distance, Caton-Deschamps index, knee range of motion (ROM), Lysholm score, International Knee Documentation Committee (IKDC) score, Kujala score, and Tegner score were compared pre- and post-operation. Results: All patients had primary wound healing. All patients were followed up 24-72 months with an average of 34.6 months. X-ray film and CT examination showed that the patellar dislocation was corrected and the osteotomy of the tibial tubercle healed with an average healing time of 3.8 months (range, 3-5 month). At 1 day and 1 year after operation, the TT-TG distance, patellar-trochlear-groove distance, and Caton-Deschamps index showed significant differences when compared with preoperative values ( P0.05). At the 1 year and 2 years after operation, the knee ROM, Lysholm score, IKDC score, Kujala score, and Tegner score showed significant differences when compared with preoperative values ( P0.05). Conclusion: Combined operation involving tibial tubercle distalization is a safe and reliable method, which has satisfactory short-term effectiveness for the recurrent patellar dislocation with patella alta.

Double bundle medial patellofemoral ligament reconstruction with anterior half tendon of peroneus longus and lateral retinacular release in treatment of recurrent patellar dislocation:A report of 12 cases and literature review / 吉林大学学报(医学版)

Objective:To observe the process and curative effect of 12 cases of recurrent patellar dislocation treated by double bundle medial patellofemoral ligament (MPFL)reconstruction with anterior half peroneus longus and lateral retinacular release,and to investigate the etiology and treatment method of recurrent patellar dislocation. Methods:A total of 12 patients with recurrent patellar dislocation were enrolled in this study,the MPFL was reconstructed with the anterior half peroneus longus,patellar fixation with suture anchors was completed with 2 parallel 5.0 mm anchors which were spaced 1.0 cm apart at the anatomic insertion site of the native MPFL,the femoral side was secured with a interference screw,and the lateral retinaculum was released at the same time.The Lysholm score,IKDC score,congruence angle,J sign,grind test,and apprehension test of the patients before and after operation were detected.Results:The mean follow-up period was 16.4 months,and the Lysholm score of the patients before operation was lower than the last follow-up (t = 9.03,P < 0.001);the IKDC score of the patients before operation was lower than the last follow-up (t = 9.75,P < 0.001);the congruence angle of the patients before operation was larger than after operation (t = 7.22,P <0.001).All of the patients demonstrated the positive results before operation in J sign,grind test,and apprehension test,and the negative results in J sign, grind test,and apprehension test after operation.No patient appeared pateela fracture and recurrence of patellar dislocation during the follow-up period.Conclusion:The curative effect of reconstruction of the MPFL with anterior half peroneus longus combined with lateral retinacular release is well in the treatment of recurrent patellar dislocation,which is suitable for clinical promotion.

Rehabilitative nursing of patients with recurrent patellar dislocation treated with retinaculum patellae mediale reconstruction under arthroscopy / 现代临床护理

Objective To explore rehabilitative nursing of patients with recurrent patellar dislocation treated with retinaculum patellae mediale reconstruction under arthroscopy. Method Systematic rehabilitative nursing was performed to 18 patients with recurrent patellar dislocation treated with retinaculum patellae mediale reconstruction under arthroscopy , including the perioperative psychological nursing, systematic and standard rehabilitative training plan, and discharge guidance. Results The symptoms of unstable retinaculum disappeared, their motor ability was improvement and there was no patellar dislocation. All patients were scheduled for follow-up three months, six months, nine months and one year after surgery, and annually thereafter. The preoperative and postoperative Kujala and Lysholm scores were with statistical difference between pre-and post-surgery (P<0.001). Conclusion Systematic and standard rehabilitative nursing can be important for the recovery of patients , including preoperative psychological nursing and postoperative functional exercise.