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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >SPONTANEOUS CORRECTION OF EXTERNAL TIBIOFEMORAL ROTATION AND TIBIAL TUBEROSITY-TROCHLEAR GROOVE DISTANCE OCCURS AFTER MEDIAL PATELLOFEMORAL LIGAMENT RECONSTRUCTION IN FIXED OR OBLIGATORY DISLOCATORS
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SPONTANEOUS CORRECTION OF EXTERNAL TIBIOFEMORAL ROTATION AND TIBIAL TUBEROSITY-TROCHLEAR GROOVE DISTANCE OCCURS AFTER MEDIAL PATELLOFEMORAL LIGAMENT RECONSTRUCTION IN FIXED OR OBLIGATORY DISLOCATORS

机译：外部胫骨旋转和胫骨节结节 - Trochlear槽槽距离固定或强制脱臼的内侧髌韧带重建后发生自发校正

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Background: Tibial tubercle to trochlear groove distance (TT-TG) and external tibiofemoral rotation (TFR) through the knee joint have been identified potential contributing factors to patellar instability. In patients with a fixed or obligatory lateral patella dislocation (FOD), the normal force vector of the extensor mechanism is altered, so instead of a direct axial pull to cause extension, it exerts a lateralizing and external rotatory force on the tibia via the tibial tubercle. Hypothesis/Purpose: The purpose of this study is to investigate postoperative changes in TT-TG and TFR after medial patellofemoral ligament reconstruction (MPFLR) in two clinical cohorts: standard traumatic patellar instability (SPI) patients and FOD patients. We hypothesized that by surgically relocating the patella in the trochlea, and re-establishing medial sided soft tissue tension, the increased medializing force vector on the patella may exert enough force to alter resting rotation of the tibia in relation to the femur in the FOD group. Methods: A retrospective study was performed from April 2009 to February 2019. FOD and SPI patients under 18 years with available magnetic resonance imaging (MRI) of the knee before and after MPFLR were eligible. All FOD patients in the time frame were analyzed and SPI patients were randomly selected. Exclusion criteria were outside institution MRI, concomitant alignment procedures done at the time of MPFLR, and prior MPFLR or tibial tubercle osteotomy. TT-TG and TFR (using the posterior femoral and tibial condylar lines) were measured blindly on initial axial MRI. Statistical analysis using a paired sample t -test was performed with significance set at p&0.05. Results: A total of 30 patients were included, 14 in the FOD group and 16 in the SPI group. The mean age at time of surgery was 13.9 years (range 10-17 years), 53% of the cohort was female, and the mean time from surgery to follow-up MRI was 2.0 years. Demographics by group are shown in Table 1. TT-TG and TFR were not significantly different preoperatively versus postoperatively in the SPI group (Table 2). In the FOD group, both TT-TG (17.7 vs 13.7, P= .019) and TFR (8.6 vs 3.1, P= .025) decreased significantly on postoperative MRI. Conclusion: The postoperative decrease in TT-TG and TFR in the FOD group suggests that MPFLR in fixed or obligatory dislocators can improve the external rotation deformity through the level of the joint, and thus may help normalize the forces acting through the extensor mechanism.
机译：背景：通过膝关节的胫骨结节到Trochlear沟槽距离（TT-TG）和外部胫骨旋转（TFR）已经确定了髌骨不稳定性的潜在贡献因素。在固定或义务髌骨位错（FOD）的患者中，改变了伸肌机构的法向载体，因此而不是直接轴向拉动引起延伸，它通过胫骨施加胫骨上的侧向化和外部旋转力结节。假设/目的：本研究的目的是调查两种临床队列中内侧髌韧带韧带重建（MPFLR）后TT-TG和TFR的术后变化：标准创伤髌骨不稳定（SPI）患者和FOD患者。我们假设通过手术迁移Trochlea中的髌骨，并重新建立内侧侧面的软组织张力，髌骨上的增加的媒体力量载体可能会施加足够的力，以改变胫骨的休息旋转与FOD组中的股骨相关。方法：从2009年4月到2019年2月进行了回顾性研究。在MPFLR之前和之后，膝关节的可用磁共振成像（MRI）的FOD和SPI患者在持续的情况下持续了FOD和SPI患者。分析了时帧中的所有FOD患者，随机选择SPI患者。排除标准是外部机构MRI，在MPFLR时伴随着对准程序，以及先前的MPFLR或胫骨节结节骨质术。 TT-TG和TFR（使用后臂和胫骨髁系）在初始轴向MRI上盲目测量。使用配对样品T -Test进行统计分析，具有在P＆amp的意义上设定; LT; 0.05。结果：共有30名患者，FOD组14例，SPI组16例。手术时的平均年龄是13.9岁（范围10-17岁），53％的队列是女性，并且手术到随访MRI的平均时间为2.0年。按组的人口统计显示在表1中。TT-TG和TFR在SPI组中术后没有显着不同（表2）。在FOD组中，TT-TG（17.7 Vs 13.7，P = .019）和TFR（8.6 Vs 3.1，P = .025）在术后MRI显着下降。结论：FOD组TT-TG和TFR的术后减少表明，固定或强制脱臼的MPFLR可以通过接头的水平来改善外部旋转畸形，因此可以有助于使作用通过延伸机构的力归一化。

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