TRANSPATELLAR RECONSTRUCTION OF MEDIAL PATELLOFEMORAL LIGAMENT BY SEMITENDINOUS TENDON AUTOGRAFT

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Purpose of the study — to evaluate surgical treatment outcomes of the patients with chronical patella instability who underwent double bundle transpatellar reconstruction of medial patella-femoral ligament (MPFL) by a semitendinous tendon autograft.

 Material and methods. 26 patients with minimal 12 months follow up were included into the study. In all cases semitendinous tendon autograft was inserted through a vertical tunnel in the patella, formed in a loop, and fixed in femoral tunnel by a biodegradable screw. Preoperative MRIs were used to evaluate trochlear dysplasia type by D. Dejour classification, tibial tubercle to trochlear groove distance (TT-TG) and Insall-Salvati ratio. Postoperative x-rays were used to measure femoral tunnel angle (FTA), postoperative MRIs — to measure diameter of patella tunnel (d_Pat), distance from tunnel to medial border of patella (MPM) and diameter of tunnel in medial femoral condyle (d_Fem). Functional outcomes were evaluated by Kujala Score, Lysholm and IKDC, also the authors assessed the level of sports activity prior to and after the surgery.

 Results. Age median of the patients at the moment of procedure was 22 years. MRI data prior to surgery reported that the majority of patients suffered from B type of trochlear dysplasia, median TT-TG distance was 14.6 mm, median Insall-Salvati ratio was 1.1 mm. Postoperative x-rays and MRIs demonstrated median FTA of 18°, d_Pat median — 5.4 mm, MPM median — 7.0 mm, d_Fem median — 8.2 mm, no implant migrations were observed. Subjective assessment scores demonstrated excellent outcomes: Kujala Score — 96, IKDC — 87.4, Lysholm — 91. No secondary dislocations during follow up were reported, 48% of patients returned to sports on the pre-surgery or higher level, 52% of patients returned to sports with decreased activity.

 Conclusion. Transpatellar reconstruction of MPFL by semitendinous tendon autograft proved to be the efficient treatment method of chronical patella instability.

作者简介

A. Korolev

European Clinic of Sports Traumatology and Orthopaedics (ECSTO); Peoples Friendship University of Russia.

编辑信件的主要联系方式.
Email: fake@neicon.ru

Andrey V. Korolev — Dr. Sci. (Med.), chief doctor and medical director; professor, Department of Traumatology and Orthopaedic.

7, Orlovsky per., 129110, Moscow; 6, ul. Miklukho-Maklaya, 117198, Moscow.

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N. Magnitskaya

European Clinic of Sports Traumatology and Orthopaedics (ECSTO).

Email: fake@neicon.ru

Nina E. Magnitskaya — Cand. Sci. (Med.), orthopaedics surgeon.

7, Orlovsky per., 129110, Moscow.

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M. Ryazantsev

European Clinic of Sports Traumatology and Orthopaedics (ECSTO).

Email: fake@neicon.ru

Mikhail S. Ryazantsev — Cand. Sci. (Med.), orthopaedics surgeon.

7, Orlovsky per., 129110, Moscow.

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M. Sinitskiy

European Medical Center (ЕМС).

Email: fake@neicon.ru

Mikhail A. Sinitskiy — radiologist.

7, Orlovsky per., 129110, Moscow.

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P. Kadantsev

European Clinic of Sports Traumatology and Orthopaedics (ECSTO); Peoples Friendship University of Russia.

Email: fake@neicon.ru

Pavel M. Kadantsev — resident; trainee.

7, Orlovsky per., 129110, Moscow; 6, ul. Miklukho-Maklaya, 117198, Moscow.

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A. Afanas’yev

European Clinic of Sports Traumatology and Orthopaedics (ECSTO).

Email: fake@neicon.ru

Aleksei P. Afanas’yev — Cand. Sci. (Med.), orthopedic surgeon.

7, Orlovsky per., 129110, Moscow.

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D. Il’in

European Clinic of Sports Traumatology and Orthopaedics (ECSTO).

Email: fake@neicon.ru

Dmitrii O. Il’in — Cand. Sci. (Med.), orthopaedics surgeon.

7, Orlovsky per., 129110, Moscow.

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参考

  1. Герасименко М.А., Белецкий А.В., Жук Е.В., Залепугин С.Д. Диагностика ортопедической патологии пател-лофеморального сустава. Современный взгляд на проблему. Медицинский журнал. 2007;3(21):16-20.
  2. Amis A.A., Bull A.M.J., Farahmand F., Senavongse W., Shih Y.F. Patellofemoral joint biomechanics. In: Patellofemoral Disorders: Diagnosis and Treatment. 2004. рр. 37-53. doi: 10.1002/0470011165.ch3.
  3. Loudon J.K. Biomechanics and pathomechanics of the patellofemoral joint. Int J Sports Phys Ther. 2016;11(6):820-830. doi: 10.1007/978-3-642-71625-6_4.
  4. Zaffagnini S., Colle F., Lopomo N., Sharma B., Bignozzi S., Dejour D., Marcacci M. The influence of medial patellofemoral ligament on patellofemoral joint kinematics and patellar stability. Knee Surg Sports Traumatol Arthrosc. 2013;21(9):2164-2171. doi: 10.1007/s00167-012-2307-9.
  5. Petri M., Von Falck C., Broese M., Liodakis E., Balcarek P., Niemeyer P. et al. Influence of rupture patterns of the medial patellofemoral ligament (MPFL) on the outcome after operative treatment of traumatic patellar dislocation. Knee Surg Sports Traumatol Arthrosc. 2013;21(3):683-689. doi: 10.1007/s00167-012-2037-z.
  6. Senavongse W., Amis A.A. The effects of articular, retinacular, or muscular deficiencies on patellofemoral joint stability: a biomechanical study in vitro. J Bone Joint Surg Br. 2005;87(4):577-582. doi: 10.1302/0301-620x.87b4.14768.
  7. Amis A.A., Firer P., Mountney J., Senavongse W., Thomas N.P. Anatomy and biomechanics of the medial patellofemoral ligament. The Knee. 2003;10(3):215-220.
  8. Bicos J., Fulkerson J.P., Amis A. Current concepts review. Am J Sports Med. 2007;35(3):484-492. doi: 10.1177/0363546507299237.
  9. Conlan T., Garth W.P., Lemons J.E. Evaluation of the medial soft-tissue restraints of the extensor mechanism of the knee. J Bone Joint Surg Am. 1993;75(5):682-693. doi: 10.2106/00004623-199305000-00007.
  10. LaPrade R.F., Engebretsen A.H., Ly T.V., Johansen S., Wentorf F.A., Engebretsen L. The anatomy of the medial part of the knee. J Bone Joint Surg Am. 2007;89(9):2000-2010. doi: 10.2106/jbjs.f.01176.
  11. Zaffagnini S., Dejour D., Grassi A., Bonanzinga T., Muccioli G.M.M., Colle F. et al. Patellofemoral anatomy and biomechanics: current concepts. Joints. 2013;1(2):15-20.
  12. Atkin D.M., Fithian D.C., Marangi K.S., Stone M.L., Dobson B.E., Mendelsohn C. Characteristics of patients with primary acute lateral patellar dislocation and their recovery within the first 6 months of injury. Am J Sports Med. 2000;28(4):472-479. doi: 10.1177/03635465000280040601.
  13. Balcarek P., Jung K., Ammon J., Walde T.A., Frosch S., Schüttrumpf J.P. et al. Anatomy of lateral patellar instability: trochlear dysplasia and tibial tubercle– trochlear groove distance is more pronounced in women who dislocate the patella. Am J Sports Med. 2010;38(11):2320-2327. doi: 10.1177/0363546510373887.
  14. Gravesen K.S., Kallemose T., Blønd L., Troelsen A., Barfod K.W. High incidence of acute and recurrent patel-lar dislocations: a retrospective nationwide epidemio-logical study involving 24.154 primary dislocations. Knee Surg Sports Traumatol Arthrosc. 2018;26(4):1204-1209. doi: 10.1007/s00167-017-4594-7.
  15. Panni A.S., Vasso M., Cerciello S. Acute patellar dislocation. What to do? Knee Surg Sports Traumatol Arthrosc. 2012;21(2):275-278. doi: 10.1007/s00167-012-2347-1.
  16. Abbasi D., May M.M., Wall E.J., Chan G., Parikh S.N. MRI findings in adolescent patients with acute traumatic knee hemarthrosis. J Pediatr Orthop. 2012;32(8):760-764. doi: 10.1097/bpo.0b013e3182648d45.
  17. Stefancin J.J., Parker R.D. First-time traumatic patellar dislocation: a systematic review. Clin Orthop. 2007;455:93-101. doi: 10.1097/blo.0b013e31802eb40a.
  18. Клименко И.Г. Диспластический синдром нарушения равновесия надколенника. Сибирский медицинский журнал (Иркутск). 2009;88(5):120-130.
  19. Amis A.A., Oguz C., Bull A.M.J., Senavongse W., Dejour D. The effect of trochleoplasty on patellar stability and kinematics. J Bone Joint Surg Br. 2008;90(7):864-869. doi: 10.1302/0301-620x.90b7.20447.
  20. Blackburne J.S., Peel T.E. A new method of measuring patellar height. J Bone Joint Surg Br.1977;59(2):241-242. doi: 10.1302/0301-620x.59b2.873986.
  21. Dejour H., Walch G., Nove-Josserand L., Guier C.H. Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc. 1994;2(1):19-26. doi: 10.1007/bf01552649.
  22. Insall J., Goldberg V., Salvati E. Recurrent dislocation and the high-riding patella. Clin Orthop. 1972;88:67-69. doi: 10.1097/00003086-197210000-00012.
  23. Oestern S., Varoga D., Lippross S., Kaschwich M., Finn J., Buddrus B., Seekamp A. [Patella dislocation]. Unfallchirurg. 2011;114(4):345-358. (in German). doi: 10.1007/s00113-011-2012-z.
  24. Fithian D.C., Paxton E.W., Stone M.L., Silva P., Davis D.K., Elias D.A., White L.M. Epidemiology and natural history of acute patellar dislocation. Am J Sports Med. 2004;32(5):1114-1121. doi: 10.1177/0363546503260788.
  25. Nietosvaara Y., Aalto K., Kallio P.E. Acute patellar dislocation in children: incidence and associated osteochondral fractures. J Pediatr Orthop. 1994;14(4): 513-515. doi: 10.1097/01241398-199407000-00018.
  26. Hasler C.C., Studer D. Patella instability in children and adolescents. EFORT Open Rev. 2017;1(5):160-166. doi: 10.1302/2058-5241.1.000018.
  27. Duthon V.B. Acute traumatic patellar dislocation. Orthop Traumatol Surg Res. 2015;101(1 Suppl):S59-S67. doi: 10.1016/j.otsr.2014.12.001.
  28. Буравцов П.П., Гореванов Э.А., Мурадисинов С.О. Методы лечения вывиха надколенника в отечественных и зарубежных публикациях (обзор литературы). Гений Ортопедии. 2006;(3):69-72.
  29. Лазишвили Г.Д., Кузьменко В.В., Гиршин С.Г. Раннее хирургическое лечение свежих наружных вывихов надколенника. Вестник травматологии и ортопедии им. Н.Н. Приорова. 1999;(3):16-21.
  30. Dragoo J.L., Nguyen M., Gatewood C.T., Taunton J.D., Young S. Medial patellofemoral ligament repair versusreconstruction for recurrent patellar instability: two-year results of an algorithm-based approach. Orthop J Sports Med. 2017;5(3):2325967116689465. doi: 10.1177/2325967116689465.
  31. Matsushita T., Oka S., Araki D., Nishida K., Tanaka T., Kanzaki N., Nishida K., Kuroda R. Patient-based outcomes after medial patellofemoral ligament reconstruction. Int Orthop. 2017;41(6):1147-1153. doi: 10.1007/s00264-017-3433-2.
  32. Королев А.В., Афанасьев А.П., Аксенов С.Ю., Герасимов Д.О. Особенности диагностики и лечения пациентов с хронической посттравматической латеральной нестабильностью надколенника. Врач-аспирант. 2012;51(2.3):495-502.
  33. Lenschow S., Schliemann B., Gestring J., Herbort M., Schulze M., Kösters C. Medial patellofemoral ligament reconstruction: fixation strength of 5 different techniques for graft fixation at the patella. Arthroscopy. 2013;29(4):766-773. doi: 10.1016/j.arthro.2012.12.004.
  34. Гиршин С.Г., Лазишвили Г.Д., Дубров В.Э. Повреждения и заболевания мышц, сухожилий и связок (клинический опыт и обзор литературы). М. : «Дом Книги», 2013. 494 с.
  35. Королев А.В., Афанасьев А.П., Герасимов Д.О., Рязанцев М.C. Наш опыт лечения пациентов с острым травматическим латеральным вывихом надколенника. Вестник травматологии и ортопедии им. Н.Н. Приорова. 2015;(4):70-73.
  36. Schöttle P.B., Fucentese S.F., Romero J. Clinical and radiological outcome of medial patellofemoral ligament reconstruction with a semitendinosus autograft for patella instability. Knee Surg Sports Traumatol Arthrosc. 2005;13(7):516–521. doi: 10.1007/s00167-005-0659-0.
  37. Zanon G., Marullo M., Benazzo F. Double-bundle medial patellofemoral ligament reconstruction with a single patellar tunnel. Arthrosc Tech. 2013;2(4):e401-e404. doi: 10.1016/j.eats.2013.06.008.
  38. Ahmad C.S., McCarthy M., Gomez J.A., Shubin Stein B.E. The moving patellar apprehension test for lateral patellar instability. Am J Sports Med. 2009;37(4):791-796. doi: 10.1177/0363546508328113.
  39. Nijs J., Van Geel C., Van der auwera C, Van de Velde B. Diagnostic value of five clinical tests in patellofemoral pain syndrome. Man Ther. 2006;11(1):69-77. doi: 10.1016/j.math.2005.04.002.
  40. Жук Е.В. Клиническая диагностика латеральной нестабильности надколенника. Военная медицина. 2015; (4):107-109.
  41. Schoettle P.B., Zanetti M., Seifert B., Pfirrmann C.W., Fucentese S.F., Romero J. The tibial tuberosity–trochlear groove distance; a comparative study between CT and MRI scanning. Knee. 2006;13(1):26-31. doi: 10.1016/j.knee.2005.06.003.
  42. Dejour D., Locatelli E. Patellar instability in adults surgical techniques. In: Surgican techniques in orthopaedics and traumatology, Duparc J. (ed). Paris : Elsevier, 2002. рр. 55-520-A-10.
  43. Tavernier T., Dejour D. [Knee imaging: what is the best modality]. J Radiol. 2001;82(3 Pt 2):387-405. (in French).
  44. Shabshin N., Schweitzer M.E., Morrison W.B., Parker L. MRI criteria for patella alta and baja. Skeletal Radiol. 2004;33(8):445-450. doi: 10.1007/s00256-004-0794-6.
  45. Королев А.В., Магнитская Н.Е., Рязанцев М.С., Пилипсон Ж.Ю., Хасаншин М.М., Ильин Д.О. Взаимосвязь положения костных каналов при артроскопической пластике передней крестообразной связки, интраоперационных пожеланий хирурга и антропометрических данных пациента. Травматология и ортопедия России. 2016;(1):85-95. doi: 10.21823/2311-2905-2016-0-1-85-95.
  46. Keats T.E., Teeslink R., Diamond A.E., Williams J.H. Normal axial relationships of the major joints. Radiology. 1966;87(5):904-907. doi: 10.1148/87.5.904.
  47. Yoshioka Y., Siu D., Cooke T.D. The anatomy and functional axes of the femur. J Bone Jt Surg Am. 1987;69(6): 873-880. doi: 10.2106/00004623-198769060-00012.
  48. Nomura E., Inoue M. Surgical technique and rationale for medial patellofemoral ligament reconstruction for recurrent patellar dislocation. Arthroscopy. 2003;19(5):E47. doi: 10.1053/jars.2003.50167.
  49. Christiansen S.E., Jacobsen B.W., Lund B., Lind M. Reconstruction of the medial patellofemoral ligament with gracilis tendon autograft in transverse patellar drill holes. Arthroscopy. 2008;24(1):82-87. doi: 10.1016/j.arthro.2007.08.005.
  50. Schöttle P.B., Hensler D., Imhoff A.B. Anatomical double-bundle MPFL reconstruction with an aperture fixation. Knee Surg Sports Traumatol Arthrosc. 2010;18(2):147-151. doi: 10.1007/s00167-009-0868-z.
  51. Li J., Li Y., Wei J., Wang J., Gao S., Shen Y. A simple technique for reconstruction of medial patellofemoral ligament with bone-fascia tunnel fixation at the medial margin of the patella: a 6-year-minimum follow-up study. J Orthop Surg. 2014;9:66. doi: 10.1186/s13018-014-0066-7.
  52. Wang H.D., Dong J-T., Gao S.J. Medial patellofemoral ligament reconstruction using a bone groove and a suture anchor at patellar: a safe and firm fixation technique and 3-year follow-up study. J Orthop Surg. 2016;11(1):138. doi: 10.1186/s13018-016-0473-z.
  53. von Engelhardt L.V., Fuchs T., Weskamp P., Jerosch J. Effective patellofemoral joint stabilization and low complication rates using a hardware-free MPFL reconstruction technique with an intra-operative adjustment of the graft tension. Knee Surg Sports Traumatol Arthrosc. 2018 Sep;26(9):2750-2757. doi: 10.1007/s00167-017-4723-3.
  54. Lippacher S., Dreyhaupt J., Williams S.R., Reichel H., Nelitz M. Reconstruction of the medial patellofemoral ligament: clinical outcomes and return to sports. Am J Sports Med. 2014;42(7):1661-1668. doi: 10.1177/0363546514529640.
  55. Feller J.A., Richmond A.K., Wasiak J. Medial patellofemoral ligament reconstruction as an isolated or combined procedure for recurrent patellar instability. Knee Surg Sports Traumatol Arthrosc. 2014;22(10):2470-2476. doi: 10.1007/s00167-014-3132-0.
  56. Krych A.J., O’Malley M.P., Johnson N.R., Mohan R., Hewett T.E., Stuart M.J., Dahm D.L. Functional testing and return to sport following stabilization surgery for recurrent lateral patellar instability in competitive athletes. Knee Surg Sports Traumatol Arthrosc. 2018;26(3):711-718. doi: 10.1007/s00167-016-4409-2.
  57. Berard J.-B., Magnussen R.A., Bonjean G., Ozcan S., Lustig S., Neyret P., Servien E. Femoral tunnel enlargement after medial patellofemoral ligament reconstruction: prevalence, risk factors, and clinical effect. Am J Sports Med. 2014;42(2):297-301.

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