Background The medial patellofemoral ligament （MPFL） reconstruction is popular in clinical practice for chronic patellar dislocation; however, the combination with vastus medialis advancement is rare. The aim of thi...Background The medial patellofemoral ligament （MPFL） reconstruction is popular in clinical practice for chronic patellar dislocation; however, the combination with vastus medialis advancement is rare. The aim of this study was to evaluate the clinical outcome of the combination of MPFL reconstruction with vastus medialis advancement.Methods We retrospectively analyzed 69 patients with chronic patellar dislocation between July 2004 and October 2008： twenty eight cases with isolated MPFL reconstruction （group Ⅰ）, forty one cases with the combination of MPFL reconstruction with vastus medialis advancement （group C）. All patients had CT scans available for review with knee flexion at 30 degree, on which the congruence angle, patellar tilt angle and patellar lateral shift were measured. Physical apprehension tests were examined and the redislocation was recorded. In addition, knee function was evaluated using the Kujala score and subjective questionnaires.Results Patients were followed up for a mean of 42 months （12-65 months） without a recurrent dislocation reported.Postoperatively, all indexes on CT scan were within the normal range without a statistical difference between the two groups. Results from the apprehension test showed eight patients in group Ⅰ and three in group Chad patellar lateral shift exceeding 1.5 cm with a hard end point （P 〈0.05）. The Kujala score improved significantly from 51.3±4.5 to 79.9±6.2 in group Ⅰ and from 53.7±5.2 to 83.9±6.5 in group C （P 〉0.05）. However, the subjective questionnaire revealed a significant difference （P 〈0.05）, including 12 excellent, seven good and nine fair in group Ⅰ and 30 excellent, six good and five fair in group C.Conclusion The combination of MPFL reconstruction with vastus medialis advancement is better than isolated reconstruction to improve the subjective effects and decrease the patellar instability rate for chronic patellar dislocation.展开更多
Background： Numerous studies have investigated the influence of osseous factors on patellofemoral joint instability, but research on the influence of dynamic muscle factors in vivo is still in the exploratory stage. ...Background： Numerous studies have investigated the influence of osseous factors on patellofemoral joint instability, but research on the influence of dynamic muscle factors in vivo is still in the exploratory stage. This study aimed to use magnetic resonance imaging （MRI） and diffusion tensor imaging （DTI） to evaluate vastus medialis oblique （VMO） fiber bundles in patients with recurrent patellar dislocation to explore the changes in muscle morphology and function. Methods： This prospective study involved 30 patients （7 males and 23 females; average age, 21.4 ± 3.8 years） clinically diagnosed with recurrent patellar dislocation in Peking University Third Hospital and 30 healthy volunteers matched for age, sex, and body mass index in our medical school between January 2014 and October 2014. None of the patients had a recent history of traumatic patellar dislocation or transient patellar dislocation. All patients underwent conventional MRI and DTI of the knee. The cross-sectional area of the VMO on MRI and the fractional anisotropy （FA）, apparent diffusion coefficient （ADC）, and primary （λ1）, secondary （λ2）, and three-level characteristic （λ3） values on DTI were measured. The independent-samples t-test was used to compare these parameters between the two groups. Results： Compared with the control group, the patient group showed significantly higher FA values （0.39 ± 0.05 vs. 0.33 ± 0.03） and significantly lower ADC （1.51 ± 0.13 vs. 1.58± 0.07）, λ2 （4.96 ±0.13 vs. 5.04 ± 0.07）, and λ3 values （4.44 ± 0.14 vs. 4.58 ± 0.07; t = 5.99, t = -2.58, t = 3.02, and t = -4.88, respectively： all P 〈 0.05）. Cross-sectional VMO area and λ1 values did not differ between the two groups （t = 1.82 and t = 0.22, respectively; both P 〉 0.05）. Conclusions： The functional status of the VMO is closely associated with recurrent patellar dislocation. MRI, especially DTI （FA, ADC, λ2, and ,λ3）, can detect early changes in VMO function and might lhcilitate the noninvasive monitoring of the functional status of the VMO in patients with recurrent patellar dislocation.展开更多
文摘Background The medial patellofemoral ligament （MPFL） reconstruction is popular in clinical practice for chronic patellar dislocation; however, the combination with vastus medialis advancement is rare. The aim of this study was to evaluate the clinical outcome of the combination of MPFL reconstruction with vastus medialis advancement.Methods We retrospectively analyzed 69 patients with chronic patellar dislocation between July 2004 and October 2008： twenty eight cases with isolated MPFL reconstruction （group Ⅰ）, forty one cases with the combination of MPFL reconstruction with vastus medialis advancement （group C）. All patients had CT scans available for review with knee flexion at 30 degree, on which the congruence angle, patellar tilt angle and patellar lateral shift were measured. Physical apprehension tests were examined and the redislocation was recorded. In addition, knee function was evaluated using the Kujala score and subjective questionnaires.Results Patients were followed up for a mean of 42 months （12-65 months） without a recurrent dislocation reported.Postoperatively, all indexes on CT scan were within the normal range without a statistical difference between the two groups. Results from the apprehension test showed eight patients in group Ⅰ and three in group Chad patellar lateral shift exceeding 1.5 cm with a hard end point （P 〈0.05）. The Kujala score improved significantly from 51.3±4.5 to 79.9±6.2 in group Ⅰ and from 53.7±5.2 to 83.9±6.5 in group C （P 〉0.05）. However, the subjective questionnaire revealed a significant difference （P 〈0.05）, including 12 excellent, seven good and nine fair in group Ⅰ and 30 excellent, six good and five fair in group C.Conclusion The combination of MPFL reconstruction with vastus medialis advancement is better than isolated reconstruction to improve the subjective effects and decrease the patellar instability rate for chronic patellar dislocation.
文摘Background： Numerous studies have investigated the influence of osseous factors on patellofemoral joint instability, but research on the influence of dynamic muscle factors in vivo is still in the exploratory stage. This study aimed to use magnetic resonance imaging （MRI） and diffusion tensor imaging （DTI） to evaluate vastus medialis oblique （VMO） fiber bundles in patients with recurrent patellar dislocation to explore the changes in muscle morphology and function. Methods： This prospective study involved 30 patients （7 males and 23 females; average age, 21.4 ± 3.8 years） clinically diagnosed with recurrent patellar dislocation in Peking University Third Hospital and 30 healthy volunteers matched for age, sex, and body mass index in our medical school between January 2014 and October 2014. None of the patients had a recent history of traumatic patellar dislocation or transient patellar dislocation. All patients underwent conventional MRI and DTI of the knee. The cross-sectional area of the VMO on MRI and the fractional anisotropy （FA）, apparent diffusion coefficient （ADC）, and primary （λ1）, secondary （λ2）, and three-level characteristic （λ3） values on DTI were measured. The independent-samples t-test was used to compare these parameters between the two groups. Results： Compared with the control group, the patient group showed significantly higher FA values （0.39 ± 0.05 vs. 0.33 ± 0.03） and significantly lower ADC （1.51 ± 0.13 vs. 1.58± 0.07）, λ2 （4.96 ±0.13 vs. 5.04 ± 0.07）, and λ3 values （4.44 ± 0.14 vs. 4.58 ± 0.07; t = 5.99, t = -2.58, t = 3.02, and t = -4.88, respectively： all P 〈 0.05）. Cross-sectional VMO area and λ1 values did not differ between the two groups （t = 1.82 and t = 0.22, respectively; both P 〉 0.05）. Conclusions： The functional status of the VMO is closely associated with recurrent patellar dislocation. MRI, especially DTI （FA, ADC, λ2, and ,λ3）, can detect early changes in VMO function and might lhcilitate the noninvasive monitoring of the functional status of the VMO in patients with recurrent patellar dislocation.
