Objective To describe a surgical technique using suture tape for reconstruction of the medial patellofemoral ligament (MPFL). This technique restores the stability of the reconstructed ligament and has excellent postoperative outcomes. Method This is a retrospective analysis. From January 2016 to June 2018, 17 patients underwent MPFL reconstruction using high‐strength suture (FiberTape; Arthrex) augmentation, with at least 12 months of follow up. There were 11 female and 6 male patients. The mean age at the time of MPFL reconstruction was 22.1 years (range 13–34 years). Clinical outcomes included pain level, knee range of motion, passive patellar hypermobility, and maltracking at follow‐up. The lateral patellofemoral angles, congruence angles, and patellar tilt angles were measured in a skyline view by CT at 30° of knee flexion at 12 months. Functional outcomes were assessed using the Lysholm knee scoring scale, the SF‐12 score, the Tegner score, and the Crosby and Insall grading system at yearly follow‐up. Result No patients were lost at the last follow up. One patient had recurrence of patellar dislocation and none of the others had serious complications. The success rate of MPFL repair for preventing recurrent dislocations was 94.1% (16 of 17 knees). Fifteen knees had full range of motion of more than 130°. At follow‐up, 2 knees were judged to have mild hypermobility and none had severe hypermobility or maltracking. Using the Crosby and Insall grading system, 12 knees (70.6%) were graded as excellent, 4 knees (23.5%) as good, 1 knee (5.9%) as fair to poor, and none as worse at the last follow‐up assessment. In all patients, the Lysholm knee score (55.12 ± 13.52 vs 79.88 ± 7.50, P < 0.01), the SF‐12 score (47 ± 9.53 vs 65.24 ± 12.82, P < 0.01), and the Tegner score (2.76 ± 1.39 vs 6.53 ± 1.70, P < 0.01) had improved at their 12‐month follow up. Compared with preoperative radiological findings, there was a significant improvement in lateral patellofemoral angle (−10.24 ± 7.10 vs 6 ± 5.43, P < 0.01), patellar tilt angle (26.53 ± 7.23 vs 9.88 ± 4.24, P < 0.01), and congruence angle (29.59 ± 11.95 vs −8.65 ± 4.86, P < 0.01). Conclusion The use of FiberTape in MPFL reconstruction can improve the stability of the knee following surgery and has good midterm clinical results and low complication rates.
Objective Although many studies have compared the measured resection (MR) technique to the gap balancing (GB) technique, few studies have investigated the hybrid technique. In this study, we compared imaging and clinical outcomes of the MR, GB, and hybrid techniques in primary total knee arthroplasty (TKA). Methods From January 2016 to January 2019, we conducted a retrospective study on 90 patients who underwent unilateral primary TKA; 30 received the MR technique, 30 received the GB technique, and 30 received the hybrid technique. Radiological outcomes, including joint line level, mechanical alignment of the lower limb, positions of the femoral and tibial components, and rotation of the femoral component, and clinical outcomes, including the visual analog scale score for pain, the Knee Society Score, and the range of motion, were assessed among the three groups. One‐way analysis of variance and Dunnett's test were performed for normally distributed data. Kruskal–Wallis H test and Dunn–Bonferroni test were conducted for non‐normally distributed data. Results No significant difference in the mechanical alignment (p = 0.151) and the positions of the tibial and femoral components (p = 0.230 for α angle, p = 0.517 for β angle, p = 0.686 for femoral flexion angle, and p = 0.918 for tibial slope angle) was found among the three groups. No significant difference in the elevation of the joint line between the MR and the hybrid groups was found (2.1 ± 0.3 mm vs 2.1 ± 0.1 mm, p = 0.627), but the GB group (2.8 ± 0.2 mm) differed significantly from the other two groups (p < 0.001). Although rotation of the femoral component in the GB group was larger than that of the MR and hybrid groups, the difference was not significant (1.8° ± 0.2° vs 1.7° ± 0.3° vs. 1.7° ± 0.2°, p = 0.101). The clinical outcomes were not significantly different (p > 0.05), although the results in the hybrid group were slightly higher. Conclusion The hybrid technique helped to restore the mechanical alignment of the lower limb and realize optimal positions of the femoral and tibial components without significant differences relative to the MR and GB techniques. The hybrid technique was more helpful for maintaining the original height of the joint line, which was similar to the MR technique. Additionally, although the improvement in the clinical outcomes in the hybrid group was slightly higher, it was not significantly different among the three groups.
Background The aim of this study is to determine whether distalization of the tibial tubercle is necessary for patients with recurrent patellar dislocation accompanied by patella alta and increased TT-TG. Methods In this retrospective study, all 70 patients (70 knees) with recurrent patellar dislocation accompanied by TT–TG distance ≥20 mm and patella alta (CD-I ≥ 1.4) were surgically treated using MPFLR combined with medialization of the tibial tubercle or medialization and distalization of the tibial tubercle in the Third Hospital of Hebei Medical University between 2017 and 2019. 33 patients(33 knees) received MPFLR combined with medialization of the tibial tubercle (MPFLR + TTm group), 37 patients(37 knees) received MPFLR combined with medialization and distalization of the tibial tubercle (MPFLR + TTm-d group). Evaluation indicators included knee injury and osteoarthritis prognostic score (KOOS) and Kujala score evaluation, congruence angle (CA), patellar tilt angle (PTA), TT-TG distance, Blackburne-Peel index (BP-I), Caton-Deschamps index (CD-I). Results A total of 70 knees (70 patients) with a mean follow-up time of 32 ± 6 months were evaluated in the present study. The postoperative, the PTA, CA, CD-I, BP-I, and TT-TG distance significantly improved in the two groups (P < 0.05), and there was no statistical difference between the two groups (>0.05). The KOOS and Kujala scores of the two groups at the last follow-up were significantly higher than the preoperative scores (P < 0.05), and there was no statistical difference between the two groups (P>0.05). No complications were noted in either group. Conclusion For patients with recurrent patellar dislocation accompanied by increased TT-TG distance and patella alta, distalization is not needed and medialization is sufficient even in the presence of patella alta.
Background Proper lower limb alignment and soft tissue balance are significant indicators to measure the success of total knee arthroplasty (TKA). Previous studies have confirmed that soft tissue relaxation around the knee after TKA will change over time; however, the relationship between lower limb alignment and soft tissue balance after TKA is still unclear. We studied (1) whether the change of soft tissue balance around the knee with time after PS TKA would affect the alignment of the lower limbs; (2) Whether the accuracy of lower limb alignment during PS TKA affects postoperative soft tissue remodeling. Methods In this study, 100 patients were recruited after PS TKA. Among them, 50 patients with a hip knee ankle (HKA) angle of ≤ ± 3 ° were set as the neutral group, and 50 patients with HKA angle of >± 3 ° were set as the deviation group. The imaging results measured the hip knee ankle (HKA) angle before the operation as well as the HKA, varus, and valgus angles at 1, 3, 6, 12, and 24 months after TKA. Clinical assessment included range of motion (ROM), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Knee Society Score (KSS). Results Eight people were excluded in the experiment. The study enrolled 47 patients in the neutral group and 45 patients in the deviant group follow up for 2 years . During the follow-up, the HKA angles were 1.64 °, 1.66 °, 1.69 °, 1.67 °, and 1.64 ° in the neutral group and 4.35 °, 4.38 °, 4.40 °, 4.42 °, and 4.42 ° in the deviation group. There was no statistical significance in the changes of HKA angle in the follow-up of the two groups (P > 0.05). The mean varus angles of the patients in the neutral group were 5.77 °, 4.17 °, 4.06 °, 4.06 °, and 4.09 °, while the mean varus angles of the patients in the deviation group were 5.68 °, 4.20 °, 4.18 °, 4.09 ° and 4.05 °, with no significant difference between the groups (P > 0.05). The mean valgus angles of the patients in the neutral group and deviation group were 2.47 ° and 2.45 ° (P = 0.841), 3.45 ° and 2.88 ° (P < 0.001), 3.63 ° and 3.07 ° (P < 0.001), 3.60 ° and 3.06 ° (P < 0.001), 3.63 ° and 3.10 ° (P < 0.001). ROM, WOMAC and KSS of the two groups were significantly improved after operation, and there was no difference between the two groups. Conclusion This study shows that whether the alignment is accurate or not in the early stage after TKA, the relaxation of the medial and lateral soft tissues of the knee joint change; however, this change will not significantly affect the alignment of the lower limbs. Postoperative residual varus deformity will limit medial soft tissue remodeling. Level of evidence III.
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