髌骨不稳的软组织固定
简介
这篇综述讨论髌骨不稳中MPFL重建的股骨侧软组织固定（将移植物环绕大收肌腱）。唯一直接比较软组织固定与螺钉固定的RCT显示，两组Kujala评分分别为89和88，再脱位率均为0%，手术并发症无显著差异；在骨骼未成熟患者中，该技术可避免骺板损伤，摘要称已在专门儿童系列中得到验证，但未列出具体结局数据。综述同时介绍合并MPFL与MPTL重建的技术，并汇总作者34…
英文摘要
Patellar instability is a common and potentially disabling condition in young active patients. The medial patellofemoral ligament (MPFL) is the primary passive restraint to lateral patellar translation at 0 to 30 degrees of flexion, and its reconstruction has become the cornerstone of surgical management for recurrent patellofemoral dislocation. The medial patellotibial ligament (MPTL), a secondary stabiliser whose contribution increases markedly at higher flexion angles, has attracted renewed interest as an adjunct to MPFL reconstruction. Femoral fixation of the graft has traditionally relied on interference screws or suture anchors; however, soft tissue fixation, looping the graft around the adductor magnus (AM) tendon, avoids the risks of tunnel malposition, hardware-related complications, and physis violation, while yielding equivalent clinical outcomes in adult populations. The only published randomised controlled trial directly comparing soft tissue and screw femoral fixation for MPFL reconstruction demonstrated no significant difference in Kujala score (89 vs. 88), redislocation rate (0% vs. 0%), or surgical morbidity, supporting the equivalence of the 2 approaches. In skeletally immature patients, soft tissue femoral fixation eliminates the risk of injury to the growth plate, and has been validated in dedicated paediatric series. This review summarises the anatomic and biomechanical basis for soft tissue fixation, describes the surgical technique for combined MPFL and MPTL reconstruction using an ipsilateral gracilis autograft, presents clinical outcomes from our series of 34 patients and a PRISMA systematic review of 197 operated knees, and discusses graft selection, prognostic factors, paediatric considerations, complications, and future directions.