Objective To investigate the effectiveness of reconstructing medial patellofemoral l igament with hamstring tendon autografts for the treatment of recurrent patellar dislocation under arthroscopy. Methods Between January 2005 and January 2010, 22 cases of recurrent patellar dislocation were treated by lateral retinacular release and reconstructionof the medial patellofemoral ligament with hamstring tendon autografts under arthroscopy. There were 5 males and 17 females, aged 15-19 years (mean, 17.3 years). The average number of dislocation was 4 (range, 3-8). The main cl inical symptoms were pain and swell ing of knee joint, weakness in the leg, and limited range of motion (ROM). The patellar tilt test, pressing pain of patellofemoral ligament insertion, and apprehension sign showed positive results. According to International Knee Documentation Committee (IKDC) scoring criteria, the subjective IKDC score was 36.7 ± 4.7, and the Lysholm score was 69.3 ± 3.8. X-ray films showed that the patella inclined outwards. Results All incisions healed by first intention. Twenty-two cases were followed up 18-49 months (mean, 34 months). Pain and swelling of knee joint and weakness were improved obviously. No recurrence was found during follow-up. The ROM of knee in flexion and extension was improved when compared with preoperative ROM. The subjective IKDC score was 92.4 ± 5.3 and the Lysholm knee score was 91.7 ± 5.2, showing significant differences when compared with preoperative scores (P lt; 0.05). Conclusion Reconstruction of the medial patellofemoral ligament with hamstring tendon autografts under arthroscopy is an effective method to treat recurrent patellar dislocation.
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.
Objective To summarize the surgical treatment methods and progress of inferior patellar pole fractures and provide reference for clinical application. Methods The literature on surgical treatment of inferior patellar pole fractures was extensively reviewed, and the relevant research progress, advantages, and limitations were summarized. Results The inferior pole of the patella is an important part of the knee extension device, which can strengthen the force arm of the quadriceps. Inferior patellar pole fractures are relatively rare and often comminuted, usually requiring surgical treatment. At present, there are various methods to treat inferior patellar pole fractures, including patellectomy of inferior pole, tension-band wiring technique, plate internal fixation, suture anchor fixation, claw-like shape memory alloy, separate vertical wiring technique. Different methods have their own characteristics, advantages, and disadvantages. The single internal fixation method has more complications and is easy to cause fixation failure. Therefore, the trend of combining various internal fixation methods is developing at present. Conclusion When the main fragment of the inferior patellar pole fracture is large and mainly distributed transversely, the combination protocol based on tension-band wiring technique can be regarded as an ideal choice. When the fragments are severely damaged and small, the comprehensive protocol based on suture fixation can result in a better postoperative functional recovery.
ObjectiveTo investigate the clinical significance of Q-angle measuring under different conditions in female recurrent patellar dislocation female patients. MethodsBetween August 2012 and March 2013, 10 female patients (11 knees) with recurrent patellar dislocation were collected as trial group; 20 female patients (20 knees) with simple meniscus injury were collected as control group at the same time. Q-angle was measured in extension, 30° flexion, 30° flexion with manual correction, and surgical correction in the trial group, and only in extension and 30° flexion in the control group. Then the difference value of Q-angle between extension and 30° flexion (Q-angle in extension subtracts Q-angle in 30 flexion) were calculated. Independent sample t-test was used to analyze Q-angle degrees in extension, 30° flexion, and the changed degrees of 2 groups. The Q-angle between manual correction and surgical correction of the trial group was analyzed by paired t-test. ResultsThe Q-angle in extension, Q-angle in 30° flexion, and difference value of Q-angle between extension and 30° flexion were (17.2±3.6), (14.3±3.0), and (2.9±1.9)° in the trial group and were (15.2±3.4), (14.4±3.5), and (0.8±1.7)° in the control group. No significant difference was found in Q-angle of extension or Q-angle of 30° flexion between 2 groups (P>0.05), but the difference value of Q-angle between extension and 30° flexion in the trial group was significantly larger than that in the control group (t=3.253, P=0.003). The Q-angle in 30° flexion with manual correction and surgical correction in the trial group was (19.8±3.4)° and (18.9±3.8)° respectively, showing no significant difference (t=2.193, P=0.053). ConclusionWhen a female patient's Q-angle in 30° flexion knee changes obviously compared with Q-angle in extension position, recurrent patellar dislocation should be considered. For female patients with recurrent patellar dislocation, the preoperative Q-angle in 30° flexion with manual correction should be measured, which can help increasing the accuracy of evaluation whether rearrangement should be performed.
Objective To compare the long-term effectiveness of patellar denervation by electrotomy combined with patellar replacement and patellar denervation by electrotomy alone in primary total knee arthroplasty (TKA). Methods A retrospective analysis was conducted on the clinical data of 30 patients treated with primary TKA of both knees between July 2013 and March 2015 who met the selection criteria. There were 11 males and 19 females, aged 56-79 years, with an average age of 67.6 years. One knee was randomly selected for patellar denervation by electrotomy combined with patellar replacement during TKA (combined group), while the other knee was treated with patellar denervation by electrotomy alone (control group). All patients adopted the same type of total knee prosthesis. After surgery, the patients were followed up regularly, and the occurrence of complications was recorded. The functions of the knee and patella were evaluated using the Knee Society Score (KSS) and Feller score, respectively. The position of the prosthesis, patella trajectory, and prosthesis loosening and wear were observed by imaging examination. Results All 30 patients were followed up 81.4-103.5 months, with an average of 90.4 months. The patellar thickness of the combined group ranged from 21 to 26 mm, with an average of 23.0 mm. The position of the prosthesis and patella trajectory in the combined group and the control group were good, without obvious loosening or wear. After operation, 2 sides (6.7%) in the combined group and 3 sides (10.0%) in the control group presented joint adhesion and poor activities. No complication such as lower limb deep vein thrombosis, aseptic fractures, and infections around the prosthesis occurred in both groups. At last follow-up, the KSS clinical score, KSS function score, and Feller score showed no significant difference between the two groups (P>0.05). According to the KSS score, 24 patients (80.0%) had no obvious preference for patellar denervation combined with patellar replacement, 3 patients (10.0%) preferred patellar replacement combined with patellar denervation, and 3 patients (10.0%) preferred no patellar replacement. Anterior knee pain occurred in 6 sides (20.0%) of both groups. Conclusion There is no significant difference in the long-term effectiveness between patellar denervation combined with patellar replacement and patellar denervation alone conducted in patients with knee osteoarthritis undergoing primary TKA.
ObjectiveTo explore the effectiveness of high strength suture fixation in treatment of patellar transverse fracture.MethodsBetween June 2014 and June 2016, 38 patients with the patellar transverse fracture were treated with high strength suture internal fixation. There were 24 males and 14 females with the age of 26 to 64 years (mean, 45 years). There were 6 cases of accident injury and 32 cases of crashing injury. The time interval between injury and surgery was 2-8 days (mean, 5 days). The preoperative visual analogue scale (VAS) score, Lysholm score, and range of motion (ROM) of patients were 84.3±8.4, 44.5±7.2, and (62±12)°, respectively.ResultsAll patients’ incisions healed by first intention after operation. There was no neurovascular injury, deep venous thrombosis of lower limbs, or local foreign matter irritation reaction. The X-ray films showed that the reduction of patella and the location of internal fixator were good at 2 days after operation. All the 38 patients were followed up 12-18 months (mean, 16 months). All fractures healed and the healing time was 2-4 months (mean, 3 months). At last follow-up, according to the Böstman criteria, 36 patients were rated as excellent and 2 as good, with an excellent and good rate of 100%. The VAS score, Lysholm score, and ROM of patients were 10.2±6.6, 93.1±6.4, and (124±14)°, respectively, showing significant differences when compared with preoperative ones (t=42.759, P=0.000; t=31.099, P=0.000; t=20.727, P=0.000).ConclusionApplication of high strength suture fixation in the treatment of patellar transverse fracture has advantages of simple to operate, effective fixation, and less complication. It can avoid reoperation of removing the internal fixators. The satisfied ROM and function of the knee joint can be obtained after operation.
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.
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.
目的 探讨空心拉力螺钉联合钢丝张力带治疗髌骨骨折的临床疗效。 方法 2005年6月－2010年9月采用空心拉力螺钉联合钢丝张力带治疗髌骨骨折38例，男29例，女9例；年龄32～69岁，平均42.2岁。其中髌骨中份横行骨折18例，斜行骨折15例，髌骨纵行骨折3例，髌骨下极骨折2例。骨折块移位0.6～3.2 cm，平均1.7 cm。受伤至手术时间1～7 d，平均2.1 d。末次随访时评估双侧膝关节主观感受、视觉模拟评分（VAS）、患侧膝关节活动度（ROM）、Lysholm评分及影像学变化。 结果 患者随访13～54个月，平均19.5个月。康复期内未出现皮肤刺痛、滑囊炎、切口延期愈合或不愈合等临床并发症。末次随访时疼痛VAS评分（1.5 ± 0.9）分，患侧膝ROM为健侧的85.2%。术后2.1～3.2个月，平均2.8个月达到临床骨性愈合。 患侧Lysholm评分优27例、良8例、可1例、差2例，优良率92.1%；健侧膝关节Lysholm评分优35例、良1例、可0例、差2例，两侧比较差异无统计学意义（P＞0.05）。 结论 空心拉力螺钉联合钢丝张力带治疗髌骨骨折可获得较好临床疗效，且术后循序渐进的康复锻炼是膝关节功能得到最大恢复的关键。