EFFECTIVENESS OF KNEE EXTENSOR MECHANISM RECONSTRUCTION FOR RECURRENT PATELLAR SUBLUXATION WITH BONE ANCHOR IN ADOLESCENTS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 LIYanlin , WANGGuoliang , CAIGuofeng , JIADi , JILinsong , HEChuan , ZHENGJiali

Department of Sports Medicine, the First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650032, P. R. China;

Corresponding?author：

LIYanlin, Email: 852387873@qq.com

Keywords：

Recurrent patellar subluxation; Extensor mechanism; Anchor technique; Adolescent

DOI：

10.7507/1002-1892.20150262

Video：

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Objective To explore the effectiveness of knee extensor mechanism reconstruction in the treatment of recurrent patellar subluxation with bone anchor in adolescents. Methods Between January 2010 and December 2013, 20 patients with patellar subluxation were treated by knee extensor mechanism reconstruction with bone anchor. There were 11 males and 9 females, aged from 12 to 17 years (mean, 15.3 years). The left knee was involved in 12 cases and the right knee in 8 cases. The disease duration was 5-10 years (mean, 7 years). All the patients had knee pain and lateral subluxation of the patella. Preoperative Lysholm knee score was 71.4±4.7. All the patients received the MRI examination to exclude menisci or ligaments lesion. CT examination showed the tibial tuberosity trochlear groove spacing ranged from 15 to 20 mm (mean, 17 mm). X-ray film examination indicated that no varus or valgus was observed, and bony structure was normal. Results All the incisions healed at first stage. The patients received follow-up of 12-24 months (mean, 13 months). Knee pain occurred in 2 cases and were cured after symptomatic treatment. The axial X-ray films showed good position of the patella and normal anatomic relationship of the patellofemoral joint. No anchor loosening and pulling out, internal fixation failure, pseudoarthrosis formation, and postoperative recurrent patellar subluxation occurred during follow-up. At 1 year, the Lysholm knee score was significantly improved to 94.2±3.4 (t=22.705, P=0.000). According to Insall criterion, the results were excellent in 9 cases, good in 9 cases, and fair in 2 cases, with an excellent and good rate of 90%. Conclusion The bone anchor for extensor mechanism reconstruction is a convenient and reliable way to treat the recurrent patellar subluxation, with a satisfactory early effectiveness and less complications; however, its long-term effectiveness is required a further follow-up.

Citation： LIYanlin, WANGGuoliang, CAIGuofeng, JIADi, JILinsong, HEChuan, ZHENGJiali. EFFECTIVENESS OF KNEE EXTENSOR MECHANISM RECONSTRUCTION FOR RECURRENT PATELLAR SUBLUXATION WITH BONE ANCHOR IN ADOLESCENTS. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(10): 1204-1207. doi: 10.7507/1002-1892.20150262 Copy

1.	Balcarek P, Oberthür S, Hopfensitz S, et al. Which patellae are likely to redislocate? Knee Surg Sports Traumatol Arthrosc, 2014, 22(10): 2308-2314.
2.	Rhee SJ, Pavlou G, Oakley J, et al. Modern management of patellar instability. Int Orthop, 2012, 36(12):2447-2456.
3.	Kita K, Tanaka Y, Toritsuka Y, et al. Patellofemoral chondral status after medial patellofemoral ligament reconstruction using secondlook arthroscopy in patients with recurrent patellar dislocation. J Orthop Sci, 2014, 19(6):925-932.
4.	趙波, 冉霞, 張銘華, 等. 關節鏡下髕骨內側支持帶緊縮術治療青少年急性髕骨脫位. 中國修復重建外科雜志, 2013, 27(12):1437-1441.
5.	張金平, 李彥林, 金耀峰, 等. 脛骨結節抬高內移術治療髕骨半脫位的臨床分析. 昆明醫學院學報, 2010, 31(9):64-66.
6.	Becher C, Kley K, Lobenhoffer P, et al. Dynamic versus static reconstruction of the medial patellofemoral ligament for recurrent lateral patellar dislocation. Knee Surg Sports Traumatol Arthrosc, 2014, 22(10):2452-2457.
7.	盧世壁, 主譯. 坎貝爾骨科手術學. 9版. 山東:科學技術出版社, 2004:1317-1318.
8.	Biyani R, Elias JJ, Saranathan A, et al. Anatomical factors influencing patellar tracking in the unstable patellofemoral joint. Knee Surg Sports Traumatol Arthrosc, 2014, 22(10):2334-2341.
9.	Niimoto T, Deie M, Adachi N, et al. Quantitative stress radiography of the patella and evaluation of patellar laxity before and after lateral release for recurrent dislocation patella. Knee Surg Sports Traumatol Arthrosc, 2014, 22(10):2408-2413.
10.	Leferbvre R, Leroux A, Poumarat G, et al. Vastus medialis: anatomical and functional considerations and implications based upon human and cadaveric studies. J Manipulative Physiol Ther, 2006, 29(2):139-144.
11.	Lin YF, Lin JJ, Jan MH, et al. Role of the vastus medialis obliquus in repositioning the patella:a dynamic computed tomagraphy study. Am J Sports Med, 2008, 36(4):741-746.
12.	Kim MK, Na SI, Lee JM, et al. Comparison of bioabsorbable suture anchor fixation on the tibial side for anterior cruciate ligament reconstruction using free soft tissue graft:experimental laboratory study on porcine bone. Yonsei Med J, 2014, 55(3):760-765.
13.	Petri M, Dratzidis A, Brand S, et al. Suture anchor repair yields better biomechanical properties than transosseous sutures in ruptured quadriceps tendons. Knee Surg Sports Traumatol Arthrosc, 2015, 23(4):1039-1045.
14.	魚紅進, 劉興國, 宋明輝, 等. 髕骨習慣性脫位的手術治療. 中國傷殘醫學, 2013, 21(7):10-11.
15.	Balcarek P, Oberthür S, Frosch S, et al. Vastus medialis obliquus muscle morphology in primary and recurrent lateral patellar instability. Biomed Res Int, 2014, 2014:326586.
16.	胥少汀, 葛寶豐, 徐印坎. 實用骨科學. 4版. 北京:人民軍醫出版社, 2012:2258.
17.	Lee CH, Wu CC, Pan RY, et al. Medial retinacular flap advancement and arthroscopic lateral release for symptomatic chronic patellar lateral subluxation with tilting. Knee Surg Sports Traumatol Arthrosc, 2014, 22(10):2499-2504.
18.	Wang S, Ji G, Yang X, et al. Femoral trochlear groove development after patellar subluxation and early reduction in growing rabbits. Knee Surg Sports Traumatol Arthrosc, 2014.[Epub ahead of print].

1. Balcarek P, Oberthür S, Hopfensitz S, et al. Which patellae are likely to redislocate? Knee Surg Sports Traumatol Arthrosc, 2014, 22(10): 2308-2314.
2. Rhee SJ, Pavlou G, Oakley J, et al. Modern management of patellar instability. Int Orthop, 2012, 36(12):2447-2456.
3. Kita K, Tanaka Y, Toritsuka Y, et al. Patellofemoral chondral status after medial patellofemoral ligament reconstruction using secondlook arthroscopy in patients with recurrent patellar dislocation. J Orthop Sci, 2014, 19(6):925-932.
4. 趙波, 冉霞, 張銘華, 等. 關節鏡下髕骨內側支持帶緊縮術治療青少年急性髕骨脫位. 中國修復重建外科雜志, 2013, 27(12):1437-1441.
5. 張金平, 李彥林, 金耀峰, 等. 脛骨結節抬高內移術治療髕骨半脫位的臨床分析. 昆明醫學院學報, 2010, 31(9):64-66.
6. Becher C, Kley K, Lobenhoffer P, et al. Dynamic versus static reconstruction of the medial patellofemoral ligament for recurrent lateral patellar dislocation. Knee Surg Sports Traumatol Arthrosc, 2014, 22(10):2452-2457.
7. 盧世壁, 主譯. 坎貝爾骨科手術學. 9版. 山東:科學技術出版社, 2004:1317-1318.
8. Biyani R, Elias JJ, Saranathan A, et al. Anatomical factors influencing patellar tracking in the unstable patellofemoral joint. Knee Surg Sports Traumatol Arthrosc, 2014, 22(10):2334-2341.
9. Niimoto T, Deie M, Adachi N, et al. Quantitative stress radiography of the patella and evaluation of patellar laxity before and after lateral release for recurrent dislocation patella. Knee Surg Sports Traumatol Arthrosc, 2014, 22(10):2408-2413.
10. Leferbvre R, Leroux A, Poumarat G, et al. Vastus medialis: anatomical and functional considerations and implications based upon human and cadaveric studies. J Manipulative Physiol Ther, 2006, 29(2):139-144.
11. Lin YF, Lin JJ, Jan MH, et al. Role of the vastus medialis obliquus in repositioning the patella:a dynamic computed tomagraphy study. Am J Sports Med, 2008, 36(4):741-746.
12. Kim MK, Na SI, Lee JM, et al. Comparison of bioabsorbable suture anchor fixation on the tibial side for anterior cruciate ligament reconstruction using free soft tissue graft:experimental laboratory study on porcine bone. Yonsei Med J, 2014, 55(3):760-765.
13. Petri M, Dratzidis A, Brand S, et al. Suture anchor repair yields better biomechanical properties than transosseous sutures in ruptured quadriceps tendons. Knee Surg Sports Traumatol Arthrosc, 2015, 23(4):1039-1045.
14. 魚紅進, 劉興國, 宋明輝, 等. 髕骨習慣性脫位的手術治療. 中國傷殘醫學, 2013, 21(7):10-11.
15. Balcarek P, Oberthür S, Frosch S, et al. Vastus medialis obliquus muscle morphology in primary and recurrent lateral patellar instability. Biomed Res Int, 2014, 2014:326586.
16. 胥少汀, 葛寶豐, 徐印坎. 實用骨科學. 4版. 北京:人民軍醫出版社, 2012:2258.
17. Lee CH, Wu CC, Pan RY, et al. Medial retinacular flap advancement and arthroscopic lateral release for symptomatic chronic patellar lateral subluxation with tilting. Knee Surg Sports Traumatol Arthrosc, 2014, 22(10):2499-2504.
18. Wang S, Ji G, Yang X, et al. Femoral trochlear groove development after patellar subluxation and early reduction in growing rabbits. Knee Surg Sports Traumatol Arthrosc, 2014.[Epub ahead of print].

Chinese Journal of Reparative and Reconstructive Surgery

EFFECTIVENESS OF KNEE EXTENSOR MECHANISM RECONSTRUCTION FOR RECURRENT PATELLAR SUBLUXATION WITH BONE ANCHOR IN ADOLESCENTS

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