Objective: To investigate the effectiveness of arthroscopic medial patellofemoral ligament (MPFL) reconstruction combined with tibial tuberosity transfer for recurrent patellar dislocation.
Methods: Between February 2012 and December 2013, 24 patients (24 knees) with recurrent patellar dislocation were treated with arthroscopic MPFL reconstruction combined with tibial tuberosity transfer. There were 7 males and 17 females, with a mean age of 23.2 years (range, 18-37 years). One patient had recurrence dislocation after operation in the other hospital, and the others were the first operation. The disease duration ranged from 6 months to 20 years (mean, 5.6 years). The patellar apprehension tests were positive. The preoperative Lysholm score was 49.79±11.67 and the Kujala score was 49.63±6.28. X-ray films showed that 13 patients had dysplasia of the patella and femoral trochlea; 8 patients had high tibia (Caton-Deschamps index>1.2); the congruence angle was (23.96±5.54)°. CT examination showed that the tibial tuberosity-trochlear groove distance (TT-TG) value was (23.71±2.35) mm.
Results: All incisions healed by first intention. Twenty-two patients were followed up 59-81 months, with an average of 66.8 months. No dislocation occurred during the follow-up period. The patellar apprehension tests were negative. At 1 week after operation, the results of X-ray films and CT showed that the congruence angle angle was (-1.96±4.65)°, and the TT-TG value was (13.75±1.89) mm, which were significantly lower than those before operation ( P<0.05). At 6 months, 1 year, and last follow-up, Lysholm scores were 81.13±17.76, 91.35±3.60, and 92.23±2.71, respectively; and Kujala scores were 84.04±3.98, 91.48±3.64, and 91.45±3.29, respectively. The Lysholm and Kujala scores were significantly increased after operation when compared with the preoperative scores ( P<0.05). At last follow-up, the effectiveness was excellent in 11 cases, good in 8 cases, and fair in 3 cases, with an excellent and good rate of 86%.
Conclusion: Arthroscopic MPFL reconstruction combined with tibial tuberosity transfer for recurrent patellar dislocation can effectively improve the patellofemoral joint matching relationship and has a satisfactory short- and medium-term effectiveness.
目的: 探讨关节镜下内侧髌股韧带（medial patellofemoral ligament，MPFL）重建联合胫骨结节移位术治疗复发性髌骨脱位的疗效。.
方法: 2012 年 2 月—2013 年 12 月，关节镜下行自体半腱肌双束等长重建 MPFL 联合胫骨结节移位术治疗 24 例（24 膝）复发性髌骨脱位患者。男 7 例，女 17 例；年龄 18～37 岁，平均 23.2 岁。1 例曾于外院手术后脱位复发，其余均为首次手术。病程 6 个月～20 年，平均 5.6 年。恐惧试验及髌骨外推试验均为阳性。术前 Lysholm 评分为（49.79±11.67）分，Kujala 评分为（49.63±6.28）分。X 线片示 13 例髌骨及股骨滑车存在发育不良；8 例存在高位髌骨（Caton-Deschamps 指数>1.2）；髌股适合角为（23.96±5.54）°。CT 检测示胫骨结节-股骨滑车沟间距（tibial tuberosity-trochlear groove distance，TT-TG）值为（23.71±2.35）mm。.
结果: 术后切口均 Ⅰ 期愈合。22 例获随访，随访时间 59～81 个月，平均 66.8 个月。随访期间均未出现再脱位；恐惧试验及髌骨外推试验均为阴性。术后 1 周 X 线片及 CT 复查，髌股适合角为（–1.96±4.65）°，TT-TG 值为（13.75±1.89）mm，均较术前明显减小（ P<0.05）。术后 6 个月、1 年及末次随访时，Lysholm 评分分别为（81.13±17.76）、（91.35±3.60）、（92.23±2.71）分，Kujala 评分分别为（84.04±3.98）、（91.48±3.64）、（91.45±3.29）分；术后各时间点评分均较术前明显增加（ P<0.05）。末次随访时按照 Insall 评价标准评定疗效，获优 11 例、良 8 例、可 3 例，优良率为 86%。.
结论: 关节镜下自体半腱肌重建 MPFL 联合胫骨结节移位术治疗复发性髌骨脱位，可以有效改善髌股关节匹配关系，早中期疗效满意。.
Keywords: Recurrent patellofemoral dislocation; arthroscopy; ligament reconstruction; medial patellofemoral ligament; tibial tuberosity transfer.