目的:探讨带线锚钉治疗急性创伤性髌骨脱位后髌骨内侧缘撕脱骨折伴内侧髌股韧带损伤的疗效。方法:自2003年9月至2008年7月共收治28例急性髌骨脱位后髌骨内侧缘撕脱骨折伴内侧髌股韧带损伤患者。对28例患者均采用开放手术下带线锚钉固定髌骨骨折及修复内侧髌股韧带损伤。术后1年进行术后的髌骨骨折Levack功能评分。结果:所有患者术后随访时间12~30个月,平均(16±3.50)个月。术后1年的髌骨骨折Levack功能评分标准优23例,可3例,差2例,优秀率达82.14%。无再次髌骨脱位或伴脱位患者。结论:开放手术下带线锚钉治疗对髌骨骨折固定及内侧髌股韧带修复可靠,是治疗急性创伤性髌骨脱位后髌骨内侧缘撕脱骨折伴内侧髌股韧带损伤的有效方法。
Objective To investigate the effectiveness of transosseous suture in medial patellofemoral ligament (MPFL) double bundle reconstruction. Methods The clinical data of 75 patients with recurrent patella dislocation who met the selection criteria between January 2014 and December 2017 were retrospectively analyzed. All of them were treated with MPFL double bundle reconstruction, and divided into study group (39 cases, using new transosseous suture technique) and control group (36 cases, using traditional suture anchor fixation) depending on the intraoperative fixation technique. There was no significant difference in gender, age, body mass index, affected knee side, preoperative tibial tuberosity-trochlear groove distance, Insall-Salvati ratio, knee range of motion, Kujala score, International Knee Documentation Committee (IKDC) score, congruence angle, and tilt angle between the two groups (P>0.05). The operation time, intraoperative blood loss, hospital stay, and postoperative complications were recorded and compared between the two groups. Kujala score, IKDC score, and knee range of motion were used to evaluate the functional improvement of patients before and after operation. The congruence angle and tilt angle were measured on X-ray films. Results There was no significant difference in operation time, intraoperative blood loss, and hospital stay between the two groups (P>0.05). Patients in both groups were followed up 24-36 months, with an average of 29.4 months. There was no complication such as incision infection, fat liquefaction, patellar redislocation, and prepatellar pain during follow-up. At last follow-up, the Kujala score, IKDC score, knee range of motion, congruence angle, and tilt angle of two groups significantly improved when compared with those before operation (P<0.05), while there was no significant difference between the two groups (P>0.05). ConclusionThe application of suture anchor or transosseous suture to complete MPFL double bundle reconstruction can restore patellar stability, and there is no significant difference in the short-term effectiveness between them.
ObjectiveTo 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°). MethodsBetween 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. ResultsAll 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). ConclusionDDFO 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.
Objective To investigate the effectiveness of modified single patellar tunnel medial patella femoral ligament (MPFL) reconstruction in the treatment of recurrent patellar dislocation. MethodsBetween January 2023 and June 2023, a total of 61 patients with recurrent patellar dislocation who underwent MPFL reconstruction with autologous semitendinosus were enrolled and divided into 2 groups using random number table method. In the patellar anchor group, 31 patients were treated with MPFL reconstruction with double medial patellar anchors, and 30 patients in the patellar tunnel group were treated with MPFL reconstruction with single patellar tunnel. The femoral ends of both groups were fixed with absorbable compression screws. There was no significant difference in baseline data such as gender, age, side, tibial tubercle-trochlear groove (TT-TG), Q angle, Caton-Deschamps index, number of dislocation, and preoperative Kujala score, preoperative patellar inclination angle (P>0.05). Patellar tunnel, patellar anchor position, patellar reduction, and the patellar inclination angle were measured by CT scan after operation. Kujala score was used to evaluate the function of knee joint before operation, at 2 weeks and 1, 3, 6, 12 months after operation. Incision aesthetic satisfaction score was performed at 3 months after operation. The signal-to-noise quotient (SNQ) of the transplanted tendon was measured by knee MRI at 12 months after operation to compare the maturity of the graft between the two groups. Results There was no significant difference in operation time and intraoperative blood loss between the two groups (P>0.05). Knee CT reexamination showed that the patellar tunnel and the patellar anchor position were consistent with the intraoperative fluoroscopy. There was no significant difference in the difference of the patellar inclination angle between the two groups before and after operation (P>0.05). All patients were followed up 12-14 months (mean, 12.8 months). There was 1 case of patellar anchor suture rejection in patellar anchor group, and the wound healed after debridement and dressing change. During the follow-up, there was no complication such as recurrence of patellar dislocation, infection and postoperative stiffness. The Kujala scores of the two groups significantly improved at each time point after 1 month of operation when compared with those before operation (P<0.05), and the Kujala scores of the two groups returned to normal levels at 3 months after operation. The Kujala score in the patellar tunnel group was significantly higher than that in the patellar anchor group in the very early stage (2 weeks) (P<0.05), and there was no significant difference between the two groups at other time points (P>0.05). Patients in the patellar tunnel group were significantly better than those in the patellar anchor group in the score of incision aesthetic satisfaction at 3 months after operation and the SNQ at 12 months after operation (P<0.05). Conclusion Modified single patellar tunnel MPFL reconstruction was used to treat patients with recurrent patellar dislocation without pathological TT-TG. The slide-fixation structure formed by single patellar tunnel positioning provides a variable degree of freedom for the reconstructed MPFL, which shows good effectiveness in the very early stage of the rehabilitation process.
Objective To evaluate an improving operative procedure and the cl inical results of arthroscopically assisted treatment for acute patellar dislocation. Methods Between April 2006 and March 2009, 22 patients (25 knees) with primary acute complete dislocation of the patella underwent an improving arthroscopic operation, release of lateral retinaculum and suture of medial capsule and retinaculum structure. There were 5 males and 17 females with an average age of 23.6 years (range, 14-34 years). Three patients had bilateral procedure. Eleven left knees and 14 right knees were involved. The disease duration was 1-10 days with an average of 5.9 days. All patients had lateral dislocation; of them, 14 patients showed reduction without treatment, and 8 patients showed dislocation at admission and were given close manipulative reduction. The results were positive for apprehension test in all patients with the l imitation of passive motion and for Ballottable Patella Sign in 15 cases. Lysholm score, visual analogue scale (VAS) score, and Insall scale were adopted to evaluate the effect. Results All incisions healed by first intention. All the patients were followed up 12-36 months (17 months on average). During the first 3 months after operation, sunken skin in the puncture point medial to the patella was observed in 12 knees; 10 knees suffered pain of the soft tissue lateral to the patella; 15 knees felt tense in the soft tissue medial to the patella, however, all these problems disappeared or recovered gradually after rehabil itation and conservative treatment. No recurrence of dislocation was observed during the follow-up. Lysholm score was significantly improved from preoperative 67.3 ± 5.7 to postoperative 96.6 ± 4.5 (t=3.241, P=0.003) and VAS score from 6.5 ± 0.5 to 1.8 ± 0.4 (t=2.154, P=0.040). According to Insall scale, the results were excellent in 18 knees, good in 5 knees, and fair in 2 knees at 1 year after operation with an excellent and good rate of 92%. Conclusion The improving procedure of arthroscopically assisted treatment for acute patellar dislocation is a minimally invasive operation and has a number of benefits. Its short-term cl inical outcome was satisfactory.
ObjectiveTo explore the treatment methed of recurrent patellar dislocation associated with old osteochondral fracture and to evaluate its effectiveness. MethodsBetween August 2010 and August 2014, 12 cases of recurrent patellar dislocation with old osteochondral fracture were treated. There were 4 males and 8 females with an average age of 18.3 years (range, 15-24 years). The left knee was involved in 7 cases and the right knee in 5 cases. All the patients had a history of patellar dislocation, the average interval from injury to first hospitalization was 7.6 months (range, 6-13 months). At preoperation, the range of motion (ROM) of the injured knee was (89.17±13.11)°; the Lysholm score was 56.67±18.91; the Q-angle was (17.50±5.28)°; and tibial tuberosity-trochlear groove (TT-TG) distance was (18.33±4.03) mm. The Q-angle was more than 20° and TT-TG distance was more than 20 mm in 6 of 12 cases. There were 6 cases of patellar osteochondral fracture, 5 cases of lateral femoral condylar osteochondral fracture, and 1 case of patellar osteochondral fracture combined with lateral femoral condylar osteochondral fracture. After osteochondral fracture fragments were removed under arthroscope, lateral patellar retinaculum releasing and medial patellar retinaculum reefing was performed in 2 cases, medial patellofemoral ligament (MPFL) reconstruction combined with both lateral patellar retinaculum releasing and medial patellar retinaculum reefing in 4 cases, and MPFL reconstruction, lateral patellar retinaculum releasing, medial patellar retinaculum reefing, and tibial tubercle transfer in 6 cases. ResultsAll wounds healed by first intention with no complication of infection, haematoma, skin necrosis, or bone nonunion. All patients were followed up 12-60 months with an average of 24.2 months. At 3 months after operation, all patellar dislocations were corrected; the Q-angle was (13.33±1.37)° and the TT-TG distance was (12.17±1.17) mm in 6 patients undergoing tibial tubercle transfer, showing significant differences when compared with preoperative values[(22.50±2.17)° and (21.33±2.34) mm] (t=15.25, P=0.00; t=8.27, P=0.00). All patients achieved relief of knee pain and knee locking; the knee ROM and the Lysholm score at last follow-up were (120.42±11.57)° and 89.25±9.71, showing significant differences when compared with preoperative ones (t=-11.61, P=0.00; t=-8.66, P=0.00). ConclusionIt has satisfactory short-term effectiveness to remove old osteochondral fragments that can not be reset and to correct patellar dislocation for recurrent patellar dislocation with old osteochondral fracture.
From 1974 to 1993, 20 patients with dislocation of patella in 26 knees were treated by surgical technique, including 11 males and 9 females, aged from 10 to 67,averaged 31 year old. Thirteen cases (16 knees) were available for followup with an average period of 6.4 years. Using the criteria of Insall, the result were excellent in 5 knees, good in 5 knees, fair in 3 knees and poor in 3 knees with a success rate of 62%. Based on the biomechanism of patella movement and the findings in this study, the mechanism of dislocation of patella and its biomechanical reconstruction principle as well as the factors influencing the operative results were discussed.
ObjectiveTo 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. MethodsThe 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. ResultsAbnormalities 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. ConclusionIn 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.
Objective To review research progress on femoral attachment positioning during medial patellofemoral ligament (MPFL) reconstruction, so as to provide a reference for accurate positioning in clinic. Methods The literature at home and abroad on femoral attachment positioning during MPFL reconstruction was extensively reviewed and summarized. Results MPFL is the main ligament that restricts patellar outward migration, so MPFL reconstruction is the main treatment for patellar dislocation, but the accuracy of intraoperative femoral attachment positioning will significantly affect the effectiveness. At present, there are three main methods for femoral attachment positioning in MPFL reconstruction, including imaging positioning, bony landmark positioning, and new technology. Among them, the main imaging positioning method is the “Schöttle point” method, but it has high requirements for fluoroscopic positioning, and can only be accurately positioned under standard lateral fluoroscopy of the femur. The bony landmark positioning method mainly locates the femoral attachment by touching or dissecting the bony landmarks such as adductor tubercles and medial epicondyle of femur, but its disadvantages are that the positioning is not accurate enough, the intraoperative visual field exposure requirements are high, and a large incision is required. In order to avoid the problem that the simple bony landmark positioning method, in recent years, the combination of bony landmarks combined with arthroscopy, three-dimensional (3D) printing technology, and robot-assisted positioning methods have begun to be used in clinical practice. New technology localization methods have shown good results by preparing guides before operation, planning positioning paths in advance, or directly using robots to assist positioning during operation. Conclusion The accurate positioning of the femoral attachment in MPFL reconstruction is crucial, and the method of accurate and rapid intraoperative determination needs to be further improved and optimized. In the future, it is expected that the combination of computer image recognition correction technology and intraoperative position assistance will solve this problem.
ObjectiveTo investigate the technique of optimizing the location of femoral attachment in medial patellofemoral ligament (MPFL) reconstruction assisted with arthroscopy and evaluate the effectiveness.MethodsBetween 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.ResultsAll 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).ConclusionDuring 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.