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Title: [Optimization location of femoral attachment in medial patellofemoral ligament reconstruction assisted with arthroscopy for patellar dislocation].
Author: Zhang Y, Cheng B, Yang L.
Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2020 Oct 15; 34(10):1233-1237. PubMed ID: 33063485.
Abstract:
OBJECTIVE: To investigate the technique of optimizing the location of femoral attachment in medial patellofemoral ligament (MPFL) reconstruction assisted with arthroscopy and evaluate the effectiveness. METHODS: Between January 2014 and September 2018, 35 patients with patellar dislocation were admitted. There were 14 males and 21 females with an average age of 22.6 years (range, 16-38 years). All patients had a history of knee sprain. The disease duration ranged from 1 to 7 days (mean, 2.8 days). Patellar dislocation occurred 2-4 times (mean, 2.5 times). The preoperative Lysholm score and Kujala score were 47.60±11.24 and 48.37±9.79, respectively. The patellar congruence angle was (31.40±6.81)°, the patellar tilt angle was (29.95±5.44)°, the lateral patellofemoral angle was (-11.46±5.18)°, and the tibial tubercle-trochlear groove distance was (16.66±1.28) mm. All patients were treated by MPFL reconstruction with the semitendinosus tendon under arthroscopy. During operation, the suture anchors were inserted into the midpoint and the 1/3 point of superomedial edge of the patella. Then, the femoral tunnels were created in medial femoral condyle through limited excision. For tendon fixation, the Kirschner wires were inserted into adductor tubercle, medial epicondyle of femur, and the midpoint between the two points, as well as the anteriorly and posteriorly. Afterwards, the changes of ligament length and tension, patellar tracking, and the relationship of patella and femoral trochlea were evaluated, thereby determining the optimized femoral attachment for MPFL reconstruction. Finally, the patellar congruence angle, patellar tilt angle, and lateral patellofemoral angle were measured by imaging to assess the relationship of patella and femoral trochlea. Moreover, Lysholm score and Kujala score were used to evaluate the knee joint function. RESULTS: All incisions healed by first intention without infection. All patients were followed up 12-18 months (mean, 15.4 months). At 12 months, the Lysholm score was 94.40±3.99 and the Kujala score was 92.28±4.13, which were significant higher than those before operation ( P<0.05). No patellar dislocation occurred during follow-up. At 12 months, the patellar congruence angle was (6.57±4.59)°, the patellar tilt angle was (9.73±2.82)°, the lateral patellofemoral angle was (7.14±4.63)°, which were superior to those before operation ( P<0.05). CONCLUSION: During the MPFL reconstruction under arthroscopy, a higher positioning accuracy for the femoral attachment and satisfactory effectiveness can be obtained by evaluating MPFL length and tension, patellofemoral joint kinematics, and patellar tracking. 目的: 探讨关节镜辅助下内侧髌股韧带重建术治疗髌骨脱位股骨侧止点定位方法及效果。. 方法: 2014 年 1 月—2018 年 9 月，收治 35 例髌骨脱位患者。男 14 例，女 21 例；年龄 16～38 岁，平均 22.6 岁。患者均有膝关节扭伤史；病程 1～7 d，平均 2.8 d。髌骨脱位 2～4 次，平均 2.5 次。术前 Lysholm 评分为（47.60±11.24）分，Kujala 评分为（48.37±9.79）分。髌股适合角为（31.40±6.81）°、髌骨倾斜角为（29.95±5.44）°、外侧髌股角为（−11.46±5.18）°，胫骨结节-股骨滑车间距为（16.66±1.28）mm。于关节镜辅助下取自体半腱肌重建内侧髌股韧带，在髌骨内缘中点与中上 1/3 点应用带线锚钉固定韧带，分别在内收肌大结节、股骨内上髁及其两点间中点以及偏前、偏后位置钻入克氏针，将肌腱固定于克氏针，膝关节屈曲过程中观察韧带等长性、张力、髌骨轨迹及髌股对合关系，选择最佳股骨侧止点重建内侧髌股韧带。术后影像学检查测量髌股适合角、髌骨倾斜角、外侧髌股角，评估髌股对合关系；应用 Lysholm 评分与 Kujala 评分评价膝关节功能。. 结果: 术后切口均Ⅰ期愈合，无膝关节及切口感染发生。患者均获随访，随访时间 12～18 个月，平均 15.4 个月。术后 12 个月，Lysholm 评分为（94.40±3.99）分、Kujala 评分为（92.28±4.13）分，均较术前明显改善（ P<0.05）。随访期内均无髌骨再脱位发生。术后 12 个月髌股适合角为（6.57±4.59）°、髌骨倾斜角为（9.73±2.82）°、外侧髌股角为（7.14±4.63）°，均较术前明显改善（ P<0.05）。. 结论: 关节镜辅助下有限切开重建内侧髌股韧带时，应用股骨侧解剖标志定位，通过观察内侧髌股韧带张力、等长性以及髌股关节对合关系、髌骨轨迹，可以使股骨侧止点定位更准确，临床效果满意。.

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