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CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2019; 54(02): 178-182
DOI: 10.1016/j.rbo.2017.10.004
Original Article | Artigo Original
Sociedade Brasileira de Ortopedia e Traumatologia. Published by Thieme Revnter Publicações Ltda Rio de Janeiro, Brazil

Avaliação funcional da reconstrução do ligamento patelofemoral medial em atletas[*]

Artikel in mehreren Sprachen: português | English
Emerson Garms
1   Universidade Federal de São Paulo, Centro de Traumatologia do Esporte (CETE), São Paulo, SP, Brasil
,
Rogerio Teixeira de Carvalho
1   Universidade Federal de São Paulo, Centro de Traumatologia do Esporte (CETE), São Paulo, SP, Brasil
,
César Janovsky
1   Universidade Federal de São Paulo, Centro de Traumatologia do Esporte (CETE), São Paulo, SP, Brasil
,
Alexandre Pedro Nicolini
1   Universidade Federal de São Paulo, Centro de Traumatologia do Esporte (CETE), São Paulo, SP, Brasil
,
Rafael Salmeron Salviani
1   Universidade Federal de São Paulo, Centro de Traumatologia do Esporte (CETE), São Paulo, SP, Brasil
,
Andre Cicone Liggieri
1   Universidade Federal de São Paulo, Centro de Traumatologia do Esporte (CETE), São Paulo, SP, Brasil
› Institutsangaben
Weitere Informationen

Publikationsverlauf

21. August 2017

19. Oktober 2017

Publikationsdatum:
10. Mai 2019 (online)

   Lizenzen und Reprints

Resumo

Objetivo Avaliar os resultados clínicos e funcionais da reconstrução anatômica do ligamento patelofemoral medial com tendões flexores em atletas.

Métodos Estudo tipo série de casos, prospectivo, que analisou a reconstrução do ligamento patelofemoral medial em 32 pacientes (34 joelhos). A avaliação funcional foi feita pelos escores Lysholm e Kujala nos períodos pré e pós-operatórios e os fatores de risco envolvidos foram avaliados.

Resultados Dos 32 pacientes analisados, todos obtiveram melhoria dos escores funcionais comparativamente ao período pré-operatório. Pacientes com menos de cinco episódios de luxação prévios obtiveram melhores resultados funcionais. O valor médio de Lysholm no pré-operatório foi de 62,8 e no pós-operatório de 94,3, quanto ao escore de Kujala a média pré-operatório foi de 63,0 e pós-operatória de 94,0.

Conclusão A reconstrução do ligamento patelofemoral medial com enxerto de tendão flexor do joelho em atletas propiciou melhoria dos escores clínicos e funcionais nos pacientes com instabilidade patelofemoral. A perfuração óssea da patela e o posicionamento do túnel femoral devem ocorrer de forma judiciosa.

Palavras-chave

instabilidade articular - ligamentos articulares - luxação patelar - articulação patelofemoral - atletas

* Trabalho desenvolvido no Centro de Traumatologia do Esporte (CETE), Universidade Federal de São Paulo, São Paulo, SP, Brasil. Publicado originalmente por Elsevier Ltda.


 

  • References

  • 1 Amis AA, Firer P, Mountney J, Senavongse W, Thomas NP. Anatomy and biomechanics of the medial patellofemoral ligament. Knee 2003; 10 (03) 215-220
    CrossrefPubMedGoogle Scholar
  • 2 Nomura E, Horiuchi Y, Kihara M. Medial patellofemoral ligament restraint in lateral patellar translation and reconstruction. Knee 2000; 7 (02) 121-127
    CrossrefPubMedGoogle Scholar
  • 3 Higuchi T, Arai Y, Takamiya H, Miyamoto T, Tokunaga D, Kubo T. An analysis of the medial patellofemoral ligament length change pattern using open-MRI. Knee Surg Sports Traumatol Arthrosc 2010; 18 (11) 1470-1475
    CrossrefPubMedGoogle Scholar
  • 4 Steensen RN, Dopirak RM, McDonald III WG. The anatomy and isometry of the medial patellofemoral ligament: implications for reconstruction. Am J Sports Med 2004; 32 (06) 1509-1513
    CrossrefPubMedGoogle Scholar
  • 5 Amis AA. Current concepts on anatomy and biomechanics of patellar stability. Sports Med Arthrosc Rev 2007; 15 (02) 48-56
    CrossrefPubMedGoogle Scholar
  • 6 Mitchell J, Magnussen RA, Collins CL, Currie DW, Best TM, Comstock RD. , et al. Epidemiology of patellofemoral instability injuries among high school athletes in the United States. Am J Sports Med 2015; 43 (07) 1676-1682
    CrossrefPubMedGoogle Scholar
  • 7 Swenson DM, Collins CL, Best TM, Flanigan DC, Fields SK, Comstock RD. Epidemiology of knee injuries among U.S. high school athletes, 2005/2006-2010/2011. Med Sci Sports Exerc 2013; 45 (03) 462-469
    CrossrefPubMedGoogle Scholar
  • 8 Fithian DC, Paxton EW, Stone ML, Silva P, Davis DK, Elias DA. , et al. Epidemiology and natural history of acute patellar dislocation. Am J Sports Med 2004; 32 (05) 1114-1121
    CrossrefPubMedGoogle Scholar
  • 9 Lippacher S, Dreyhaupt J, Williams SR, Reichel H, Nelitz M. Reconstruction of the medial patellofemoral ligament: clinical outcomes and return to sports. Am J Sports Med 2014; 42 (07) 1661-1668
    CrossrefPubMedGoogle Scholar
  • 10 Yeung M, Leblanc MC, Ayeni OR, Khan M, Hiemstra LA, Kerslake S. , et al. Indications for medial patellofemoral ligament reconstruction: a systematic review. J Knee Surg 2016; 29 (07) 543-554
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 11 Mackay ND, Smith NA, Parsons N, Spalding T, Thompson P, Sprowson AP. Medial patellofemoral ligament reconstruction for patellar dislocation: a systematic review. Orthop J Sports Med 2014; 2 (08) 2325967114544021
    CrossrefPubMedGoogle Scholar
  • 12 Dejour D, Reynaud P, Lecoultre B. Douleurs et instabilité rotulienne. Essai de classification. Med Hyg (Geneve) 1998; 56: 1466-1471
    Google Scholar
  • 13 Schock EJ, Burks RT. Medial patellofemoral ligament reconstruction using a hamstring graft. Oper Tech Sports Med 2001; 9 (03) 169-175
    CrossrefGoogle Scholar
  • 14 Schöttle PB, Romero J, Schmeling A, Weiler A. Technical note: anatomical reconstruction of the medial patellofemoral ligament using a free gracilis autograft. Arch Orthop Trauma Surg 2008; 128 (05) 479-484
    CrossrefPubMedGoogle Scholar
  • 15 Gonçaives MB, Júnior LH, Soares LF, Gonçaives TJ, Dos Santos RL, Pereira ML. Reconstrução do ligamento patelofemoral medial para tratamento da luxação recidivante da patela. Rev Bras Ortop 2015; 46 (02) 160-164
    Google Scholar
  • 16 Lind M, Jakobsen BW, Lund B, Christiansen SE. Reconstruction of the medial patellofemoral ligament for treatment of patellar instability. Acta Orthop 2008; 79 (03) 354-360
    CrossrefPubMedGoogle Scholar
  • 17 Yiding-Xia HA, Zhang K, Liu Y. Effects of femoral tunnel position on knee function after medial patellofemoral ligament reconstruction. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2015; 29 (08) 951-954
    PubMedGoogle Scholar
  • 18 Elias JJ, Cosgarea AJ. Technical errors during medial patellofemoral ligament reconstruction could overload medial patellofemoral cartilage: a computational analysis. Am J Sports Med 2006; 34 (09) 1478-1485
    CrossrefPubMedGoogle Scholar
  • 19 Ziegler CG, Fulkerson JP, Edgar C. Radiographic reference points are inaccurate with and without a true lateral radiograph: the importance of anatomy in medial patellofemoral ligament reconstruction. Am J Sports Med 2016; 44 (01) 133-142
    CrossrefPubMedGoogle Scholar
  • 20 Arliani GG, Silva AV, Ueda LR, Astur DC, Yazigi Júnior JA, Cohen M. Reconstruction of the medial patellofemoral ligament in cases of acute traumatic dislocation of the patella: current perspectives and trends in Brazil. Rev Bras Ortop 2014; 49 (05) 499-506
    Google Scholar
  • 21 Parikh SN, Wall EJ. Patellar fracture after medial patellofemoral ligament surgery: a report of five cases. J Bone Joint Surg Am 2011; 93 (17) e97 , (1–8)
    CrossrefPubMedGoogle Scholar
  • 22 Song SY, Kim IS, Chang HG, Shin JH, Kim HJ, Seo YJ. Anatomic medial patellofemoral ligament reconstruction using patellar suture anchor fixation for recurrent patellar instability. Knee Surg Sports Traumatol Arthrosc 2014; 22 (10) 2431-2437
    CrossrefPubMedGoogle Scholar
  • 23 Mountney J, Senavongse W, Amis AA, Thomas NP. Tensile strength of the medial patellofemoral ligament before and after repair or reconstruction. J Bone Joint Surg Br 2005; 87 (01) 36-40
    PubMedGoogle Scholar
  • 24 Efe T, Seibold J, Geßlein M, Schüttler K, Schmitt J, Schofer MD. , et al. Non-anatomic proximal realignment for recurrent patellar dislocation does not sufficiently prevent redislocation. Open Orthop J 2012; 6: 114-117
    CrossrefPubMedGoogle Scholar
  • 25 Weinberger JM, Fabricant PD, Taylor SA, Mei JY, Jones KJ. Influence of graft source and configuration on revision rate and patient-reported outcomes after MPFL reconstruction: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2017; 25 (08) 2511-2519
    CrossrefPubMedGoogle Scholar
  • 26 Placella G, Speziali A, Sebastiani E, Morello S, Tei MM, Cerulli G. Biomechanical evaluation of medial patello-femoral ligament reconstruction: comparison between a double-bundle converging tunnels technique versus a single-bundle technique. Musculoskelet Surg 2016; 100 (02) 103-107
    CrossrefPubMedGoogle Scholar