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

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
• 2 Nomura E, Horiuchi Y, Kihara M. Medial patellofemoral ligament restraint in lateral patellar translation and reconstruction. Knee 2000; 7 (02) 121-127
• 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
• 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
• 5 Amis AA. Current concepts on anatomy and biomechanics of patellar stability. Sports Med Arthrosc Rev 2007; 15 (02) 48-56
• 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
• 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
• 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
• 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
• 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
• 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
• 12 Dejour D, Reynaud P, Lecoultre B. Douleurs et instabilité rotulienne. Essai de classification. Med Hyg (Geneve) 1998; 56: 1466-1471
• 13 Schock EJ, Burks RT. Medial patellofemoral ligament reconstruction using a hamstring graft. Oper Tech Sports Med 2001; 9 (03) 169-175
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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)
• 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
• 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
• 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
• 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
• 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