■虽然已对天然内侧髌股韧带(MPFL)的生物力学特性进行了充分研究,MPFL重建(MPFLR)的生物力学没有全面的总结。对MPFLR中使用的当前技术的运动学特性和功能行为的准确理解对于恢复自然生物力学和改善结果至关重要。
■为了全面回顾MPFLR变异的生物力学效应,具体确定移植物选择和重建技术的效果。
■系统评价。
■根据PRISMA(系统评价和荟萃分析的首选报告项目)指南进行系统评价。共有32项研究符合纳入标准:(1)使用≥8个人体尸体标本,(2)报告MPFLR的一个组成部分,(3)有多个比较组。
■Gracilis,半腱肌,股四头肌移植物的极限破坏载荷(N)分别为206.2、102.8和190.0至205.0,刚度(N/mm)分别为20.4、8.5和21.4至33.6。单束和双束技术产生的极限破坏载荷(N)分别为171和213,刚度(N/mm)分别为13.9和17.1。与更近侧放置的锚相反,在the骨的中央和上部放置的锚在整个运动范围内产生的长度变化最小。缝线,缝合锚,和跨骨隧道都产生了相似的极限破坏载荷,刚度,和伸长率数据。股骨隧道错位导致接触压力显着增加,髌骨翻译,倾斜,和移植物收紧或松动。低张力移植物(2N)最接近恢复髌股接触压力,翻译,和倾斜。移植物固定角度可变且不一致地改变了接触压力,髌骨平移和倾斜。
■数据表明,将MPFLR股骨隧道放置在Schöttle点对成功至关重要。股骨通道直径应大于移植物直径≥2mm,以限制移植物前进和过度张紧。移植物固定,无论移植物的选择或固定角度,在最小的张力下最佳地进行,并在内侧和上内侧髌骨处进行髌骨固定。然而,较低的固定角度可以减少移植物应变,如果股骨隧道非解剖放置,较高的固定角度可能会加剧anisometry和长度变化。
UNASSIGNED: While the biomechanical properties of the native medial patellofemoral ligament (MPFL) have been well studied, there is no comprehensive summary of the biomechanics of MPFL reconstruction (MPFLR). An accurate understanding of the kinematic properties and functional behavior of current techniques used in MPFLR is imperative to restoring native biomechanics and improving outcomes.
UNASSIGNED: To provide a comprehensive review of the biomechanical effects of variations in MPFLR, specifically to determine the effect of graft choice and reconstruction technique.
UNASSIGNED: Systematic review.
UNASSIGNED: A systematic review was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A total of 32 studies met inclusion criteria: (1) using ≥8 human cadaveric specimens, (2) reporting on a component of MPFLR, and (3) having multiple comparison groups.
UNASSIGNED: Gracilis, semitendinosus, and quadriceps grafts demonstrated an ultimate load to failure (N) of 206.2, 102.8, and 190.0 to 205.0 and stiffness (N/mm) of 20.4, 8.5, and 21.4 to 33.6, respectively. Single-bundle and double-bundle techniques produced an ultimate load to failure (N) of 171 and 213 and stiffness (N/mm) of 13.9 and 17.1, respectively. Anchors placed centrally and superomedially in the patella produced the smallest degree of length changes throughout range of motion in contrast to anchors placed more proximally. Sutures, suture anchors, and transosseous tunnels all produced similar ultimate load to failure, stiffness, and elongation data. Femoral tunnel malpositioning resulted in significant increases in contact pressures, patellar translation, tilt, and graft tightening or loosening. Low tension grafts (2 N) most closely restored the patellofemoral contact pressures, translation, and tilt. Graft fixation angles variably and inconsistently altered contact pressures, and patellar translation and tilt.
UNASSIGNED: Data demonstrated that placement of the MPFLR femoral tunnel at the Schöttle point is critical to success. Femoral tunnel diameter should be ≥2 mm greater than graft diameter to limit graft advancement and overtensioning. Graft fixation, regardless of graft choice or fixation angle, is optimally performed under minimal tension with patellar fixation at the medial and superomedial patella. However, lower fixation angles may reduce graft strain, and higher fixation angles may exacerbate anisometry and length changes if femoral tunnel placement is nonanatomic.