Combination of the medial patellofemoral ligament reconstruction with the quasi-anatomic technique, tibial tuberosity osteotomy, lateral retinaculum release and mosaicplasty produces satisfactory results for patients with patello-femoral instability. 2-Year follow-up.

Autor: Pacheco-Garcia LM; Laboratory of Biomechanics, Articular Physiology and Experimental Orthopedic Surgery, Department of Physiology, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico., Martín-Domínguez LA; Departamento de Cirugia, Facultad de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; ICATKnee, ICATME, Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, Barcelona, Spain., Perelli S; ICATKnee, ICATME, Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Orthopedic Surgery and Traumatology, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain., Monllau JC; ICATKnee, ICATME, Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Orthopedic Surgery and Traumatology, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain., Simón-Sánchez FJ; ICATKnee, ICATME, Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, Barcelona, Spain., Gutiérrez-de la O J; Department of Traumatology, Medical Services of the Universidad Autónoma de Nuevo León, Monterrey, Mexico; Department of Human Anatomy, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico., Messa LAM; Unidad de Rodilla, Hospital Universitari d'Igualada, Catalunya, Spain., Espregueira-Mendes J; FIFA Medical Centre of Excellence, Clínica do Dragão, Espregueira-Mendes Sports Centre, Porto, Portugal; School of Medicine, Minho University, Braga, Portugal., Martínez-Guajardo KV; Laboratory of Biomechanics, Articular Physiology and Experimental Orthopedic Surgery, Department of Physiology, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico., Morales-Avalos R; Laboratory of Biomechanics, Articular Physiology and Experimental Orthopedic Surgery, Department of Physiology, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico; Department of Traumatology, Medical Services of the Universidad Autónoma de Nuevo León, Monterrey, Mexico. Electronic address: rodolfo.moralesav@uanl.edu.mx.
Jazyk: angličtina
Zdroj: The Knee [Knee] 2024 Dec; Vol. 51, pp. 44-57. Date of Electronic Publication: 2024 Sep 05.
DOI: 10.1016/j.knee.2024.08.011
Abstrakt: Introduction: This study aimed to evaluate the effectiveness and safety of a combined surgical approach for treating complex patellofemoral instability. This approach combines four procedures: medial patellofemoral ligament (MPFL) reconstruction with the quasi-anatomic technique, lateral retinaculum release, anteromedialization and distalization of tibial tuberosity and patellar/femoral mosaicplasty.
Material and Methods: Between August and November 2021, we enrolled 27 patients in the study (21 females, 6 males, average age 28.6 years). All with patella alta, recurrent patellar instability, severe cartilage focal damage, and increased tibial tubercle-trochlear groove distance. All underwent the combined procedure during this period. We assessed their pain and functional scores before surgery and at 6, 12, and 24 months after surgery using standardized scoring systems.
Results: Patients initially reported significant pain and functional limitations. However, at 24 months, their pain scores significantly reduced, averaging 1.5 compared to 8.2 pre-surgery. Similarly, their functional scores substantially improved, with Lysholm, Tegner, Kujala, BPII scores reaching 87.44, 8.44, 90.03, 86.07 compared to 56.4, 3.7, 42.48, 23 pre-surgery, respectively. Importantly, no cases of recurrent instability occurred, and 96.3% of patients reported complete satisfaction.
Conclusions: This combined surgical approach has a high rate of success for patients with patella alta, recurrent lateral patellar instability, severe focal chondral lesions, and increased TT-TG distance. Moreover, 26 out of 27 patients (96.3%) reported total satisfaction. Therefore, we conclude that although this procedure combination is not simple, it is a safe, reproducible, and alleviates pain at 24 months postoperatively, and significantly improves functional scores.
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2024 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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