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CC BY-NC-ND 4.0 · Revista Chilena de Ortopedia y Traumatología 2021; 62(02): e104-e112
DOI: 10.1055/s-0041-1735603
Artículo Original | Original Article

Reconstrucción del ligamento patelofemoral medial mediante suturas transóseas patelares: estudio transversal de 34 pacientes

Article in several languages: español | English
Andrés Pakuts 
1   Clínica Red Salud Elqui, La Serena, Chile
2   Centro Médico Ossis, La Serena, Chile
,
Luis Fernando Martin 
3   Residente Traumatología y Ortopedia, Facultad de Medicina Clínica Alemana de Santiago-Universidad del Desarrollo, Santiago, Chile
,
Christophe Riquoir 
4   Interno, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
,
Alex Schadenberg 
4   Interno, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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Resumen

Introducción La inestabilidad rotuliana recurrente puede conducir a malos resultados funcionales y daño articular progresivo a largo plazo, y con frecuencia se aborda mediante la reconstrucción del ligamento patelofemoral medial (RLPFM), con múltiples técnicas que suelen diferir en el método de fijación de la rótula.

Objetivo Evaluar los resultados de RLPFM utilizando una técnica novedosa de fijación rotuliana mediante suturas transóseas. El objetivo principal es determinar las tasas de reluxación y los resultados funcionales incluyendo retorno deportivo. Los objetivos secundarios incluyen la evaluación de las complicaciones y de otras variables relacionadas, y la comparación entre los resultados de RLPFM aislada y asociada a una osteotomía de la tuberosidad tibial.

Métodos Estudio transversal de 34 pacientes sometidos a RLPFM desde 2013 hasta 2019 con un seguimiento mínimo de 12 meses. La reconstrucción fue realizada por el mismo primer cirujano con autoinjerto de gracilis de doble banda en todos los casos. La fijación del injerto en la cara medial de la rótula se realizó utilizando dos puntos de fijación transóseos independientes con suturas de alta resistencia, y la fijación femoral anatómica, con un tornillo interferencial mediante referencias anatómicas y radiológicas. Hubo 27 pacientes con RLPFM aislada, y 7 con osteotomía de la tuberosidad tibial asociada.

Resultados La edad media fue de 22,8 años (desviación estándar [DE]: 9,1). El 50% eran hombres. El seguimiento desde la cirugía hasta el cuestionario fue de 30,4 meses (rango: 12 a 72 meses). La puntuación media de Kujala en el seguimiento fue de 89,4 (DE: 12,8; mediana: 93,5; rango: 51 a 100). No hubo casos de reluxación. No se identificaron otras complicaciones durante el seguimiento. El 81% de los pacientes regresó a los deportes, y el 47% regresó a su nivel previo de participación. No se encontraron diferencias significativas al comparar RLPFM aislada con grupos de osteotomía asociada.

Conclusión La RLPFM mediante sutura transósea para fijación en la rótula mostró que la estabilidad rotuliana fue restaurada en el corto y mediano plazo. Esta técnica es segura, tiene excelentes resultados funcionales, y evita posibles complicaciones de los túneles rotulianos o morbilidad asociada al uso de implantes.

Palabras clave

ligamento patelofemoral medial - reconstrucción - inestabilidad rotuliana


Publication History

Received: 17 May 2020

Accepted: 22 March 2021

Article published online:
30 September 2021

© 2021. Sociedad Chilena de Ortopedia y Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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