The Comparative Analysis Of Small Incision Under The Arthroscopy-assisted And Open Surgery Reconstruction Of Medial Patellar Ligament For Patellar Dislocation

Objective To investigate the operation method which was more predominant and moreworthy of advocating through comparative analysis of the clinical treatment effect ofpatellar dislocations treated by the method of arthroscopic-assisted small incisionreconstruction of medial patellofemoral ligament and of open surgery reconstruction ofmedial patellofemoral ligament.Method60hospitalization cases with traumatic dislocation of patellar were collectedfrom January2012to July2013in the Second Hospital of Tangshan. The60cases weredivided into two group according to different operation methods: the group witharthroscopic-assisted small incision reconstruction of medial patellofemoral ligament(group A) and the group with open surgery reconstruction of medial patellofemoralligament (group B). Arthroscopic operating system made by American StrykerCorporation and Smith&Nephew plc was used in group A. There were30cases with30patellar dislocations in Group A, in which there were11males and19females,14leftknees and16right knees, aged from14to36with average age of24.1.14cases receivedthe treatment for the first time, and the other16cases received the treatment for relapseafter conservative treatment. There were30cases with30patellar dislocations in GroupB, in which there were23males and7females,21left knees and9right knees. The casesin group B were aged from21to46with average age of34.4, in which14cases receivedthe treatment for the first time, and the other16cases received the treatment for relapseafter conservative treatment. All cases received follow-up visit. The knee functions wereevaluated according to Lysholm knee score scale and Kujala score. All data wereanalysed through SPSS13.0. Pared-samples T test was performed in pain, function, theactive anteflexion and flexor muscle strength. P value less than0.05was consideredstatistically significant, was considered significantly statistical significance. Theinspection level was defined as α=0.05.Result All the patients were followed up15.5months on average (range,12-20months). The average time of recovery normal exercise intensity was4.5months (range,3-6months). About group A, The Lysholm knee scores increased from69.4±3.9pre-operation to93.3±3.1post-operation follow-up (P﹤0.05), and the Kujala score increasedfrom63.4±4.4pre-operation to94.46±3.6post-operation follow-up (P﹤0.05). Therewere statistically significant differences. About group B， The Lysholm knee scoresincreased from66.7±1.4pre-operation to92.17±5.3post-operation follow-up(P﹤0.05),and the Kujala score increased from63.9±2.8pre-operation to95.57±2.6post-operationfollow-up (P﹤0.05). There were statistically significant differences. But there was no statistical significance between A and B in Lysholm knee score and in Kujala score (P﹥0.05). That is to say that knee joint function scores were the same pre-operation and post-operation follow-up between group A and B. The excellent and good rates of knee jointfunction post-operation in the two group were the same about93%(P﹥0.05).Comparative results in lateral patellofemoral angles and patellar lateral displacement: ingroup A, the lateral patellofemoral angles increased from2.7±2.3°pre-operation to8.1±3.3°(P﹤0.5); the patellar lateral displacement decreased from0.9±0.6cm to-1.3±1.1cm (P﹤0.05). The differences between pre-operation and post-operation hadstatistical significance. In group B, the lateral patellofemoral angles increased from2.1±1.8°pre-operation to9.05±4.3°(P﹤0.05); the patellar lateral displacementdecreased from1.2±0.8cm to-1.7±0.6cm (P﹤0.05). The differences between pre-operation and post-operation had statistical significance too. That is to say that，whether in group A or group B, lateral patellofemoral angles and patellar lateraldisplacement had been rectify with statistical significance pre-operation than pre-operation, while there was no significant difference between group A and B（P﹥0.05）.Conclusion There are no statistically significant differences in functional recovery,complications and redislocation between the treatment methods of dislocation of patellar,arthroscopic-assisted small incision reconstruction of medial patellofemoral ligament andopen surgery reconstruction of medial patellofemoral ligament, but the former has muchmore superiority.1Before medial patellofemoral ligament reconstruction, arthroscope canbe used to directly and dynamically observe patellofemoral congruence and patellar track,which is conducive to diagnosing and typing the patellar instability.2According to thediagnosis and type to choose the rational surgical method and to predict the successpossibility of the operation.3lysis of vastus lateralis contracture and adhesion can beperformed through small incision.4It can be identified if it is combining injury and lesioninside the knee, for example, meniscus tear, injuries of ligament, plica synovialis,synovitis, osteochondritis dis-secans and intracapsular corpus liberum, etc. and deal withthose at the same time.5This treatment has slight injure, light disturbance of the knee-joint and less postoperation pain and stress damage, and early rehabilitative treatment.