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Title: [Short-term effectiveness of derotational distal femoral osteotomy combined with medial patellofemoral ligament reconstruction for recurrent patellar dislocation].
Author: Li Y, Liu J, Lei L, Zhou P, Deng F, Li Z.
Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2021 Mar 15; 35(3):343-348. PubMed ID: 33719244.
Abstract:
OBJECTIVE: To investigate the short-term effectiveness of derotational distal femoral osteotomy (DDFO) combined with medial patellofemoral ligament (MPFL) reconstruction in treatment of recurrent patellar dislocation with excessive femoral anteversion angle (FAA≥30°). METHODS: Between June 2017 and August 2019, 17 patients with recurrent patellar dislocation with FAA≥30° were treated with DDFO and MPFL reconstruction. There were 5 males and 12 females, aged 14-22 years, with an average of 17.7 years. The patella dislocated for 2 to 8 times (mean, 3.6 times). The disease duration was 2-7 years (mean, 4.6 years). The patellar apprehension tests were positive. Preoperative pain visual analogue scale (VAS) score, Lysholm score, Tegner score, and Kujala score were 4.2±1.1, 47.8±8.1, 3.6±1.1, and 56.8±5.7, respectively. FAA, mechanical lateral distal femoral angle (mLDFA), lateral patella displacement (LPD), tibial tuberosity-trochlear groove distance (TT-TG) were (34.9±3.4)°, (85.8±3.0)°, (13.7±3.8) mm, and (23.1±2.1) mm, respectively. RESULTS: All incisions healed by first intention, and there was no complications such as knee stiffness, infection, and re-dislocation of the patella. All patients were followed up 13-25 months, with an average of 17.7 months. The imaging review showed that 1 case of osteotomy did not union, and achieved satisfactory results after the secondary revision and strengthening fixation; the osteotomies of other patients healed completely after 3 to 4 months of operation. The patellar apprehension tests were negative. At last follow-up, the FAA, mLDFA, LPD, and TT-TG were (15.6±2.7)°, (83.0±2.1)°, (5.0±2.6) mm, and (20.5±2.5) mm, respectively; the VAS score, Lysholm score, Tegner score, and Kujala score were 2.4±1.4, 93.4±7.8, 6.8±1.5, and 89.0±8.0, respectively. There were significant differences in the above indicators between pre- and post-operation ( P<0.05). CONCLUSION: DDFO combined with MPFL reconstruction for the recurrent patellar dislocation with excessive FAA (≥30°) can achieve good short-term effectiveness, significantly reduce knee pain, and improve function. 目的: 探讨股骨远端去旋转截骨（derotational distal femoral osteotomy，DDFO）联合内侧髌股韧带（medial patellofemoral ligament，MPFL）重建术治疗股骨前倾角（femoral anteversion angle，FAA）过大（≥30°）的复发性髌骨脱位的早期疗效。. 方法: 2017 年 6 月—2019 年 8 月，收治 17 例 FAA≥30° 的复发性髌骨脱位患者，均行 DDFO 联合 MPFL 重建术治疗。男 5 例，女 12 例，年龄 14～22 岁，平均 17.7 岁。髌骨脱位 2～8 次，平均 3.6 次。病程 2～7 年，平均 4.6 年。膝关节恐惧试验均为阳性。术前疼痛视觉模拟评分（VAS）以及 Lysholm 评分、Tegner 评分、Kujala 评分分别为（4.2±1.1）、（47.8±8.1）、（3.6±1.1）、（56.8±5.7）分，影像学测量 FAA、股骨远端外侧机械角（mechanical lateral distal femoral angle，mLDFA）、外侧髌骨移位值（lateral patella displacement，LPD）、胫骨结节-股骨滑车间距（tibial tuberosity-trochlear groove distance，TT-TG）分别为（34.9±3.4）°、（85.8±3.0）°、（13.7±3.8）mm、（23.1±2.1）mm。. 结果: 患者切口均Ⅰ期愈合，无膝关节僵硬、感染及髌骨再次脱位等并发症发生。患者均获随访，随访时间 13～25 个月，平均 17.7 个月。影像学复查显示，1 例截骨不愈合，经二次手术翻修加强固定后愈合；其余患者截骨均于术后 3～4 个月完全愈合。末次随访时，膝关节恐惧试验均为阴性；FAA、mLDFA、LPD 以及 TT-TG 分别为（15.6±2.7）°、（83.0±2.1）°、（5.0±2.6）mm、（20.5±2.5）mm，VAS 评分、Lysholm 评分、Tegner 评分以及 Kujala 评分分别为（2.4±1.4）、（93.4±7.8）、（6.8±1.5）、（89.0±8.0）分，上述指标与术前比较差异均有统计学意义（ P<0.05）。. 结论: DDFO 联合 MPFL 重建术治疗 FAA 过大（≥30°）的复发性髌骨脱位可获得良好早期疗效，膝关节疼痛明显减轻、功能明显改善。.

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