Author:
Zhao Chao,Dong Conglei,Wang Xiaomeng,Kong Lingce,Chang Bo,Wang Fei
Abstract
Abstract
Purpose
To investigate the change of the cross-sectional area (CSA) of vastus medialis oblique (VMO) in patients with recurrent patellar dislocation (RPD) treated by tibial tubercle transfer combined with medial patellofemoral ligament (MPFL) reconstruction by imaging methods, and to guide clinical treatment and rehabilitation.
Methods
From October 2015 to March 2022, 23 patients with RPD who underwent tibial tubercle transfer combined with MPFL reconstruction were retrospectively enrolled. All patients were assessed by CT in the supine position with the knee fully extended and the quadriceps relaxed. The CSA of VMO and the ratio of CSA of VMO to body weight (CSA/BW) were measured at the upper pole of the patella, 5 mm above the upper pole of the patella and 5 mm below the upper pole of patella. The differences of measured parameters were compared before surgery and at follow-up, including CSA of VMO and CSA/BW. Test level α = 0.05.
Results
The tibial tubercle-trochlear groove (TT-TG) distance was significantly reduced at follow-up compared with that before surgery (27.91 ± 1.95 mm vs 12.33 ± 1.07 mm, P < 0.001). The CSA of VMO was significantly increased at follow-up compared with that before surgery at 5 mm below the upper pole of the patella (473.06 ± 106.32 mm2 vs 562.97 ± 157.90 mm2, P < 0.001), at the upper pole of the patella (641.23 ± 188.45 mm2 vs 700.23 ± 177.55 mm2, P = 0.029), and at 5 mm above the upper pole of the patella (788.25 ± 238.62 mm2 vs 849.79 ± 180.84 mm2, P = 0.018). The CSA/BW was significantly increased at follow-up compared with that before surgery at 5 mm below the upper pole of the patella (7.83 ± 2.52 mm2/kg vs 9.22 ± 3.54 mm2/kg, P < 0.001), at the upper pole of the patella (10.48 ± 3.62 mm2/kg vs 11.42 ± 4.14 mm2/kg, P = 0.020), and at 5 mm above the upper pole of the patella (12.86 ± 4.65 mm2/kg vs 13.68 ± 3.86 mm2/kg, P = 0.017).
Conclusion
After tibial tubercle transfer combined with MPFL reconstruction, CSA of VMO increased in patients with RPD, which will help to enhance patellar stability and reduce recurrence.
Funder
National Natural Science Foundation of China
Publisher
Springer Science and Business Media LLC
Subject
Orthopedics and Sports Medicine,Surgery
Reference55 articles.
1. Gravesen KS, Kallemose T, Blønd L, Troelsen A, Barfod KW. High incidence of acute and recurrent patellar dislocations: a retrospective nationwide epidemiological study involving 24.154 primary dislocations. Knee Surg Sports Traumatol Arthrosc Off J ESSKA. 2018;26(4):1204–9.
2. Zaffagnini S, Grassi A, Zocco G, Rosa MA, Signorelli C, Marcheggiani Muccioli GM. The patellofemoral joint: from dysplasia to dislocation. EFORT Open Rev. 2017;2(5):204–14.
3. Balcarek P, Oberthür S, Hopfensitz S, et al. Which patellae are likely to redislocate? Knee Surg Sports Traumatol Arthrosc Off J ESSKA. 2014;22(10):2308–14.
4. Ling DI, Brady JM, Arendt E, et al. Development of a multivariable model based on individual risk factors for recurrent lateral patellar dislocation. J Bone Joint Surg Am. 2021;103(7):586–92.
5. Migliorini F, Pilone M, Eschweiler J, Marsilio E, Hildebrand F, Maffulli N. High rates of damage to the medial patellofemoral ligament, lateral trochlea, and patellar crest after acute patellar dislocation: magnetic resonance imaging analysis. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc. 2022;38:2472–9.