| Objective: The patellar dislocation is a currently common orthopedicclinical disease. It was found that, with most cases, the medial patellofemoralligament (MPFL) was found relaxation，torn，or dysfunction in recent years.Biomechanical and anatomic studies have confirmed that MPFL is the primarysoft tissue inhibiting strength for patellar dislocation and control patellacampaign track ordinary. Therefore, reconstruction of the medialpatellofemoral ligament is the main surgical choice for the treatment ofpatellar dislocation. There is a wide range of ways of reconstructing themedial patellofemoral ligament, but the clinical effects of traditional surgeryare not very ideal. With the anatomic and biomechanical study of the medialpatellofemoral ligament, it will inevitably bring about changes in the clinicaldiagnosis and treatment methods. Double-bundle anatomic reconstruction ofthe medial patellofemoral ligament has become the mainstream of thetreatment of patellar dislocation. The key of anatomical reconstruction is torestore the normal anatomical structures and physiological functions of themedial patellofemoral ligament. The choices of the beginning and endingpoints of the reconstructed MPFL, graft and fixed method are particularlyimportant.This paper compare clinical results of semi-tunnel bone bridgefixed and suture anchors fixed in double-bundle anatomic reconstruction ofthe medial patellofemoral ligament to treat patellar dislocation.Clinicalfollow-up to assess the surgical treatment of the two fixed methodsdouble-bundle anatomic reconstruction of MPFL, and provide effectivereference for the surgery choice of clinical treatment of patellar dislocation.Method: This study reviewed81patients who had undergonedouble-bundle anatomic reconstruction of the medial patellofemoral ligament to treat patellar dislocation from March2006to April2008,29men and52women. Aged from16to26years old, with an average age of20.4years. Thesurgery anatomically reconstructed dual function bundles of the medialpatellofemoral ligament using autogenous semitendinosus-gracilis tendongraft. The midpoint of the highest point of the medial femoral condyle and theadductor tubercle was selected as the femoral insertion point, the patellarinsertion point was in the centre and the upper inner corner of the patellarmedial edge. The femoral end of the graft were fixed by a7×23millimetreabsorbable screw after drilling a3centimetres deep femoral tunnel by a7millimetre diameter reamer. To fix the patella end, the modified semi-tunnelbone bridge fixed was used in45patients and suture anchors fixed was used in36patients. Repeatedly adjusted the tension of the reconstructed ligamentunder arthroscopy and made the tension of superior-oblique bundle andinferior-straight bundle unanimous. The final arthroscopic check adjustedpatella trajectory normal during knee flexion and extension, especially in earlyflexion, it was ensured that the patella can smoothly enter the trochlear.Postoperative rehabilitation accorded to conventional procedures andfunctional exercise. Complications in both groups were recorded. The clinicalevaluation involved physical examination and patellar apprehension sign,patellar stability, Kujala scores and subjective questionnaire scores.Computerized tomography (CT) were evaluated to examine the patellar lateralshift rate (PLSR) and the patella tilt angle (PTA). The spss13.0statisticalsoftware was used to analyse the follow-up data. Paired t-test was used tocompare preoperative and postoperative, independent samples t-test was usedto compare semi-tunnel bone bridge fixed group and suture anchors fixedgroup. The significace level was set at P <0.05.Results: The wound of all the patients healed primarily. None had befound infection, nonunion occurred and deep venous thrombosis. All of thepatients had follow-up of24months and48months. Preoperative date of thepatient, including age, gender, PTA, PLSR and knee Kujala score between thetwo groups were not statistically different (P>0.05). Postoperative physical examinations including patellar tilt test and patellar apprehension sign werenegative. There were no patellar re-dislocation occurred. PLSR and PTA wererestored to the normal range, a statistically significant difference comparedwith preoperative (P<0.05). At24months postoperation, the Kujala scores insemi-tunnel bone bridge fixed group (92.91±3.18) were significantly higherthan preoperative (57.09±2.59)(P<0.05), and the Kujala scores in sutureanchors fixed group (91.72±2.99) were also significantly higher thanpreoperative (56.19±2.78)(P<0.05). There was no significant difference ofKujala scores between semi-tunnel bone bridge fixed group (92.91±3.18) andsuture anchors fixed group (91.72±2.99). At48months postoperation, theKujala scores in semi-tunnel bone bridge fixed group (93.67±1.80) weresignificantly higher than in suture anchors fixed group (92.58±2.09)(P<0.05).So the same to PLSR and PTA. Postoperative subjective questionnaire scoresof24months and48months follow-up suggested that: semi-tunnel bonebridge fixed group scored95.56%and93.33%while suture anchors fixedgroup scored94.44%and88.89%.Conclusions: Both semi-tunnel bone bridge fixed and suture anchorsfixed for double-bundle anatomic reconstruction of the medial patellofemoralligament to treat patellar dislocation can effectively restore the patella stability,improve knee function. There was no difference between each other atshort-term clinical effects, while the semi-tunnel bone bridge fixed fordouble-bundle anatomic reconstruction of the medial patellofemoral ligamentto treat patellar dislocation will be excellent at long-term clinical effects. |
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