Die femorale Tunnelerweiterung nach MPFL Plastik mittels Gracilissehne und ihr Einfluss auf das klinische Outcome
Einleitung: Die Patellaluxation und die damit verbundene Ruptur des medialen patellofemoralen Ligamentes (MPFL) gehören zu einem der häufigsten orthopädischen Krankheitsbilder. Der Ersatz des MPFL hat sich in den letzten Jahren zur wichtigsten Therapieoption entwickelt. Der Einfluss einer femoralen...
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| Format: | Doctoral Thesis |
| Language: | German |
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Philipps-Universität Marburg
2020
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| Online Access: | PDF Full Text |
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Introduction: Patellar dislocation and associated rupture of the medial patellofemoral ligament (MPFL) are among the most common orthopedic disorders. The replacement of the MPFL using a free tendon graft has become the most important therapeutic option in recent years. The influence of femoral tunnel widening on the clinical outcome has not been sufficiently investigated. Therefore, the aim of the present study is to investigate the incidence and influence of a femoral tunnel widening after an isolated MPFL replacement. Additionally, the influence of a femoral tunnel malposition on the development of a tunnel enlargement and the associated clinical outcome were investigated. Methods: Inclusion criteria were isolated rupture of the medial patellofemoral ligament, a free gracilis tendon graft reconstruction and follow-up of at least 1.5 years. Patients with injuries such as flake fractures or cartilage damage were excluded. In the study, 51 patients were followed up. The mean age of follow-up patients was 22.6 ± 8.5 years and the time between surgery and follow-up was 3.01 ± 1.37 years. The clinical examination included testing flexion, extension and the stability of the knee joint and testing the patella stability. The clinical outcome was objectified using the Te-gner Activity Index, the Kujala Score and the International Knee Documentation Score (IKDC). The results were correlated with the results of MRI images. Results: 51 knees of 49 patients were included in the study. The mean age of follow-up patients was 22.6 ± 8.5 years and the time between surgery and follow-up was 3.01 ± 1.37 years. 23 patients in this group showed a tunnel enlargement and 20 were placed too proximal. 13 of the 28 patients without tunnel enlargement had a too proximal tunnel position (p = 0.0033). Patients with tunnel enlargement showed a significantly better Kujala score (83.6 ± 11.7 vs. 74.9 ± 16.2, p = 0.032) and IKDC score (79.7 ± 6.9 vs. 70.7 ± 18, 6, p = 0.024) compared to group without femoral tunnel enlargement. Discussion: The results showed a significant correlation between an overly proximal tunnel and a tunnel widening. The tunnel widening showed no negative impact on the clinical outcome. Patients with tunnel widening achieved better results in the Kujala and IKDC scores than those without tunnel widening.