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中华关节外科杂志(电子版) ›› 2021, Vol. 15 ›› Issue (06) : 732 -737. doi: 10.3877/cma.j.issn.1674-134X.2021.06.013

综述

髌骨脱位治疗新篇章
高雨1, 张卓1, 杨默笛1,(), 高忠礼1   
  1. 1. 130033 长春,吉林大学中日联谊医院骨关节与运动医学科
  • 收稿日期:2021-09-17 出版日期:2021-12-01
  • 通信作者: 杨默笛

New chapter in treatment of patellar dislocation

Yu Gao1, Zhuo Zhang1, Modi Yang1,(), Zhongli Gao1   

  1. 1. Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun 130033, China
  • Received:2021-09-17 Published:2021-12-01
  • Corresponding author: Modi Yang
引用本文:

高雨, 张卓, 杨默笛, 高忠礼. 髌骨脱位治疗新篇章[J/OL]. 中华关节外科杂志(电子版), 2021, 15(06): 732-737.

Yu Gao, Zhuo Zhang, Modi Yang, Zhongli Gao. New chapter in treatment of patellar dislocation[J/OL]. Chinese Journal of Joint Surgery(Electronic Edition), 2021, 15(06): 732-737.

关于髌骨脱位的手术治疗方式近年来多集中在单纯的髌骨内侧支持带(MPFL)重建和创伤性较大骨性手术,如胫骨结节转位术、滑车成形术、股骨远端去旋转截骨术等。然而随着对髌股关节内侧解剖结构理解的不断加深,在髌股关节内侧限制结构中除了起水平限制作用的髌骨内侧支持带,起源于髌骨下级,斜向内下方走行的髌骨-胫骨韧带(MPTL)也同样发挥了重要的限制作用。鉴于此,本文通过回顾相关文献,总结了MPTL的解剖学、生物力学和各种重建方法,分析了MPFL联合MPTL重建治疗髌骨脱位的可行性及优势。

In recent years, the surgical treatment of patellar dislocation has mainly focused on simple reconstruction of the medial patellofemoral ligament (MPFL) and traumatic bone surgery, such as tibial tuberosity transposition, trochloplasty and distal femoral osteotomy. However, as our understanding of the anatomy of the medial patellofemoral structure increased, we found that in addition to the MPFL, which plays a role of horizontal limitation. The medial patellotibial ligament (MPTL), which originated in the lower pole of the patella and runs diagonally downward, also plays an important role of limitation. In view of this, this paper summarized the anatomy, biomechanics and various reconstruction methods of MPTL by reviewing relevant literature, and analyzed the feasibility and advantages of MPFL combined with MPTL reconstruction in the treatment of patellar dislocation.

图2 膝关节核磁共振影像下的髌股内侧限制结构
图4 取自体股薄肌/半腱肌联合重建髌骨内侧支持带(MPFL)和髌骨-胫骨韧带(MPTL)手术设计模拟图
[1]
Fithian DC, Paxton EW, Stone ML, et al. Epidemiology and natural history of acute patellar dislocation[J]. Am J Sports Med, 2004, 32(5): 1114-1121.
[2]
Arendt EA, Fithian DC, Cohen E. Current concepts of lateral patella dislocation[J]. Clin Sports Med, 2002, 21(3): 499-519.
[3]
Bollier M, Fulkerson JP. The role of trochlear dysplasia in patellofemoral instability[J]. J Am Acad Orthop Surg, 2011, 19(1): 8-16.
[4]
Dejour D, Le Coultre B. Osteotomies in patello-femoral instabilities[J]. Sports Med Arthrosc, 2007, 15(1): 39-46.
[5]
Lewallen L, Mcintosh A, Dahm D. First-time patellofemoral dislocation: risk factors for recurrent instability[J]. J Knee Surg, 2015, 28(4): 303-309.
[6]
Erickson BJ, Mascarenhas R, Sayegh ET, et al. Does operative treatment of first-time patellar dislocations Lead to increased patellofemoral stability? A systematic review of overlapping meta-analyses[J]. Arthroscopy, 2015, 31(6): 1207-1215.
[7]
Nwachukwu B, So C, Schairer WW, et al. Economic decision model for first-time traumatic patellar dislocations in adolescents[J]. Am J Sports Med, 2017, 45(10): 2267-2275.
[8]
Weber AE, Nathani A, Dines JS, et al. An algorithmic approach to the management of recurrent lateral patellar dislocation[J]. J Bone Joint Surg Am, 2016, 98(5): 417-427.
[9]
Dejour DH. Editorial commentary: trochleoplasty: is it really that fearsome and dangerous a technique?[J]. Arthroscopy, 2020, 36(8): 2246-2248.
[10]
Erickson BJ, Nguyen J, Gasik K, et al. Isolated medial patellofemoral ligament reconstruction for patellar instability regardless of tibial tubercle-trochlear groove distance and patellar height: outcomes at 1 and 2 years[J]. Am J Sports Med, 2019, 47(6): 1331-1337.
[11]
Atkin DM, Fithian DC, Marangi KS, et al. Characteristics of patients with primary acute lateral patellar dislocation and their recovery within the first 6 months of injury[J]. Am J Sports Med, 2000, 28(4): 472-479.
[12]
Nietosvaara Y, Aalto K, Kallio PE. Acute patellar dislocation in children: incidence and associated osteochondral fractures[J]. J Pediatr Orthop, 1994, 14(4): 513-515.
[13]
Chouteau, J. Surgical reconstruction of the medial patellofemoral ligament[J]. Orthop Traumatol Surg Res2016102(1 Suppl):S189-S194.
[14]
Laprade RF, Cram TR, James EW, et al. Trochlear dysplasia and the role of trochleoplasty[J]. Clin Sports Med, 2014, 33(3): 531-545.
[15]
Nakagawa K, Wada Y, Minamide M, et al. Deterioration of long-term clinical results after the elmslie-trillat procedure for dislocation of the patella[J]. J Bone Joint Surg Br, 2002, 84(6): 861-864.
[16]
Carney JR, Mologne TS, Muldoon M, et al. Long-term evaluation of the Roux-Elmslie-Trillat procedure for patellar instability: a 26-year follow-up[J]. Am J Sports Med, 2005, 33(8): 1220-1223.
[17]
Hall MJ, Mandalia VI. Tibial tubercle osteotomy for patello-femoral joint disorders[J]. Knee Surg Sports Traumatol Arthrosc, 2016, 24(3): 855-861.
[18]
Longo UG, Rizzello G, Ciuffreda M, et al. Elmslie-Trillat, maquet, fulkerson, roux goldthwait, and other distal realignment procedures for the management of patellar dislocation: systematic review and quantitative synthesis of the literature[J]. Arthroscopy, 2016, 32(5): 929-943.
[19]
付国建,李苏皖,刘朝晖,等.胫骨结节内移抬高术联合关节镜下髌骨支持带调整术治疗复发性髌骨脱位的疗效研究[J/CD].中华关节外科杂志(电子版)2014000(4):450-455.
[20]
Matzkin E. Medial patellofemoral ligament Reconstruction: indications, technique, and outcomes[J]. Arthroscopy, 2019, 35(11): 2970-2972.
[21]
Aulisa AG, Falciglia F, Giordano M, et al. Galeazzi's modified technique for recurrent patella dislocation in skeletally immature patients[J]. J Orthop Sci, 2012, 17(2): 148-155.
[22]
Shah JN, Howard JS, Flanigan DC, et al. A systematic review of complications and failures associated with medial patellofemoral ligament reconstruction for recurrent patellar dislocation[J]. Am J Sports Med, 2012, 40(8): 1916-1923.
[23]
纪刚,王飞,董江涛,等.双束解剖重建内侧髌股韧带联合胫骨结节转移术治疗复发性髌骨脱位的临床研究[J/CD].中华关节外科杂志(电子版)20137(1):7-12.
[24]
Hinckel BB, Gobbi RG, Demange MK, et al. Medial patellofemoral ligament, medial patellotibial ligament, and medial patellomeniscal ligament: anatomic, histologic, radiographic, and biomechanical study[J]. Arthroscopy, 2017, 33(10): 1862-1873.
[25]
Kruckeberg BM, Chahla J, Moatshe G, et al. Quantitative and qualitative analysis of the medial patellar ligaments: an anatomic and radiographic study[J]. Am J Sports Med, 2018, 46(1): 153-162.
[26]
Conlan T, Garth WJ, Lemons JE. Evaluation of the medial soft-tissue restraints of the extensor mechanism of the knee[J]. J Bone Joint Surg Am, 1993, 75(5): 682-693.
[27]
Kaleka CC, Aihara LJ, Rodrigues A, et al. Cadaveric study of the secondary medial patellar restraints: patellotibial and patellomeniscal ligaments[J]. Knee Surg Sports Traumatol Arthrosc, 2017, 25(1): 144-151.
[28]
Philippot R, Chouteau J, Wegrzyn J, et al. Medial patellofemoral ligament anatomy: implications for its surgical reconstruction[J]. Knee Surg Sports Traumatol Arthrosc, 2009, 17(5): 475-479.
[29]
Terry GC. The anatomy of the extensor mechanism[J]. Clin Sports Med, 1989, 8(2): 163-177.
[30]
Laprade MD, Kallenbach SL, Aman ZS, et al. Biomechanical evaluation of the medial stabilizers of the patella[J]. Am J Sports Med, 2018, 46(7): 1575-1582.
[31]
Fithian DC, Gupta N. Patellar instability: principals of soft tissue repair and reconstruction[J]. Techniques in Knee Surgery, 2006, 5(1):19-26.
[32]
Desio SM, Burks RT, Bachus KN. Soft tissue restraints to lateral patellar translation in the human knee[J]. Am J Sports Med, 1998, 26(1): 59-65.
[33]
Joo SY, Park KB, Kim BR, et al. The ′four-in-one′ procedure for habitual dislocation of the patella in children: early results in patients with severe generalised ligamentous laxity and aplasis of the trochlear groove[J]. J Bone Joint Surg Br, 2007, 89(12): 1645-1649.
[34]
Panagiotopoulos E, Strzelczyk P, Herrmann M, et al. Cadaveric study on static medial patellar stabilizers: the dynamizing role of the vastus medialis obliquus on medial patellofemoral ligament[J]. Knee Surg Sports Traumatol Arthrosc, 2006, 14(1): 7-12.
[35]
Testa EA, Camathias C, Amsler F, et al. Surgical treatment of patellofemoral instability using trochleoplasty or MPFL reconstruction: a systematic review[J]. Knee Surg Sports Traumatol Arthrosc, 2017, 25(8): 2309-2320.
[36]
Philippot R, Boyer B, Testa R, et al. The role of the medial ligamentous structures on patellar tracking during knee flexion[J]. Knee Surg Sports Traumatol Arthrosc, 2012, 20(2): 331-336.
[37]
Ebied AM, El-Kholy W. Reconstruction of the medial patello-femoral and patello-tibial ligaments for treatment of patellar instability[J]. Knee Surg Sports Traumatol Arthrosc, 2012, 20(5): 926-932.
[38]
Drez D, Jr, Edwards TB, et al. Results of medial patellofemoral ligament reconstruction in the treatment of patellar dislocation[J]. Arthroscopy, 2001, 17(3): 298-306.
[39]
Brown GD, Ahmad CS. Combined medial patellofemoral ligament and medial patellotibial ligament reconstruction in skeletally immature patients[J]. J Knee Surg, 2008, 21(4): 328-332.
[40]
Hinckel BB, Gobbi RG, Bonadio MB, et al. Reconstruction of medial patellofemoral ligament using quadriceps tendon combined with Reconstruction of medial patellotibial ligament using patellar tendon: initial experience[J]. Rev Bras Ortop, 2016, 51(1): 75-82.
[41]
Giordano M, Falciglia F, Aulisa AG, et al. Patellar dislocation in skeletally immature patients: semitendinosous and gracilis augmentation for combined medial patellofemoral and medial patellotibial ligament reconstruction[J]. Knee Surg Sports Traumatol Arthrosc, 2012, 20(8): 1594-1598.
[42]
Sobhy MH, Mahran M, Kamel EM. Midterm results of combined patellofemoral and patellotibial ligaments reconstruction in recurrent patellar dislocation[J]. Eur J Orthop Surg Traumatol, 2013, 23(4): 465-470.
[43]
Goutallier D, Raou D, Van Driessche S. Retro-trochlear wedge reduction trochleoplasty for the treatment of painful patella syndrome with protruding trochleae. Technical note and early results[J]. Rev Chir Orthop Reparatrice Appar Mot, 2002, 88(7): 678-685.
[44]
Von KF, Böhm T, Bürgi ML, et al. Trochleaplasty for recurrent patellar dislocation in association with trochlear dysplasia. A 4-to 14-year follow-up study[J]. J Bone Joint Surg Br, 2006, 88(10): 1331-1335.
[45]
Dejour D, Byn P, Ntagiopoulos PG. The Lyon's sulcus-deepening trochleoplasty in previous unsuccessful patellofemoral surgery[J]. Int Orthop, 2013, 37(3): 433-439.
[46]
Ntagiopoulos PG, Byn P, Dejour D. Midterm results of comprehensive surgical reconstruction including sulcus-deepening trochleoplasty in recurrent patellar dislocations with high-grade trochlear dysplasia[J]. Am J Sports Med, 2013, 41(5): 998-1004.
[47]
Goutallier D. Comments on: " recession wedge trochleoplasty as an additional procedure in the surgical treatment of patellar instability with major trochlear dysplasia:early results" by M. thaunat,C.bessiere,N.pujol, P.boisrenoult, P.beaufils, published in Orthop Traumatol Surg Res 2011;97(8):833-45[J]. Orthop Traumatol Surg Res, 2012, 98(8): 936-937.
[48]
Verdonk R, Jansegers E, Stuyts B. Trochleoplasty in dysplastic knee trochlea[J]. Knee Surg Sports Traumatol Arthrosc, 2005, 13(7): 529-533.
[49]
Marsh JS, Daigneault JP, Sethi P, et al. Treatment of recurrent patellar instability with a modification of the Roux-Goldthwait technique[J]. J Pediatr Orthop, 2006, 26(4): 461-465.
[50]
Hinton RY, Sharma KM. Acute and recurrent patellar instability in the young athlete[J]. Orthop Clin North Am, 2003, 34(3): 385-396.
[51]
Steensen RN, Bentley JC, Trinh TQ, et al. The prevalence and combined prevalences of anatomic factors associated with recurrent patellar dislocation a magnetic resonance imaging study[J]. Am J Sport Med, 2015, 43(4): 921-927.
[52]
Fabricant PD, Ladenhauf HN, Salvati E, et al. Medial patellofemoral ligament (MPFL) reconstruction improves radiographic measures of patella alta in children[J]. Knee, 2014, 21(6): 1180-1184.
[53]
Lykissas MG, Li T, Eismann EA, et al. Does medial patellofemoral ligament reconstruction decrease patellar height? A preliminary report[J]. J Pediatr Orthop, 2014, 34(1): 78-85.
[54]
Wolfe S, Varacallo M, Thomas JD, et al. Patellar tendon length--the factor in patellar instability?[J]. Knee, 2002, 9(1): 3-6.
[55]
高志涛,李彦林,王国梁,等. 内侧髌股韧带重建治疗髌骨脱位影响因素研究进展[J]. 中国修复重建外科杂志201832(8):5.
[56]
Luceri F, Roger J, Randelli PS, et al. How does isolated medial patellofemoral ligament reconstruction influence patellar height?[J]. Am J Sports Med, 2020, 48(4): 895-900.
[57]
Zhang Z, Zhang H, Song G, et al. A high-grade J sign is more likely to yield higher postoperative patellar laxity and residual maltracking in patients with recurrent patellar dislocation treated with derotational distal femoral osteotomy[J]. Am J Sports Med, 2020, 48(1): 117-127.
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