Inestabilidad femoropatelar. Controversia y evidencia

Palabras clave: Articulación femoropatelar, luxación de rótula, ligamento patelofemoral medial

Resumen

La inestabilidad rotuliana se debe a una alteración del mecanismo extensor de la rodilla, que involucra a diferentes estructuras anatómicas. La anamnesis, la exploración física y las pruebas complementarias son cruciales para determinar el manejo adecuado.  Una las estructuras anatómicas más importantes es el ligamento patelofemoral medial (LPFM), siendo su reconstrucción la técnica quirúrgica más empleada para resolver el problema de la inestabilidad. Existen diversas formas de realizar la reconstrucción del LPFM y se pueden añadir otros gestos quirúrgicos según las alteraciones anatómicas del paciente.   

Citas

Chotel F, Bérard J, Raux S. Patellar instability in children and adolescents. Orthop Traumatol Surg Res. 2014 Feb;100(1 Suppl): S125-37. doi: 10.1016/j.otsr.2013.06.014. Epub 2014 Jan 10. Review. https://pubmed.ncbi.nlm.nih.gov/24412258/

Thompson P, Metcalfe AJ. Current concepts in the surgical management of patellar instability. Knee. 2019 Nov 28. pii: S0968-0160(19)30261-3. doi:10.1016/j.knee.2019.11.007. https://pubmed.ncbi.nlm.nih.gov/31787447/

Osborne JD, Luczak SB, Acker WB, Bicos J. Patellofemoral Joint Contact Pressures: Current Concepts and Use in Patellar Instability Studies. Orthopedics. 2019 Mar 1;42(2): e172-e179. doi: 10.3928/01477447-20190118-05. Epub 2019 Jan 31. Review. https://pubmed.ncbi.nlm.nih.gov/30668882/

Amis AA, Oguz C, Bull AM, Senavongse W, Dejour D. The effect of trochleoplasty on patellar stability and kinematics: a biomechanical study in vitro. J Bone Joint Surg Br. 2008 Jul;90(7):864-9. doi: 10.1302/0301-620X.90B7.20447. PMID: 18591593. https://pubmed.ncbi.nlm.nih.gov/18591593/

Li CH, Ricketts D, Wang XS, Yu TB, Qi C, Zhu YL. An anatomical study of the origin, structure and insertion of the medial patellofemoral ligament. Folia Morphol (Warsz). 2018;77(2):356-361. doi: 10.5603/FM.a2018.0028. Epub 2018 Mar23. https://pubmed.ncbi.nlm.nih.gov/29569702/

Alaia MJ, Cohn RM, Strauss EJ. Patellar instability. Bull Hosp Jt Dis (2013). 2014;72(1):6-17. PMID: 25150323. https://pubmed.ncbi.nlm.nih.gov/25150323/

Parikh SN, Lykissas MG, Gkiatas I. Predicting Risk of Recurrent Patellar Dislocation. Curr Rev Musculoskelet Med. 2018 Jun;11(2):253-260. doi: 10.1007/s12178-018-9480-5. Review. https://pubmed.ncbi.nlm.nih.gov/29736871/

Dejour H,Walch G, Neyret P, Adeleine P. [Dysplasia of the femoral trochlea]. Rev Chir Orthop Reparatrice Appar Mot. 1990;76(1):45–54. https://pubmed.ncbi.nlm.nih.gov/2140459/

Igoumenou VG, Dimopoulos L, Mavrogenis AF. Patellar Height Assessment Methods: An Update. JBJS Rev. 2019 Jan;7(1):e4. doi: 10.2106/JBJS.RVW.18.00038. PMID: 30624307. https://pubmed.ncbi.nlm.nih.gov/30624307/

Biedert RM, Albrecht S. The patellotrochlear index: a new index for assessing patellar height. Knee Surg Sports Traumatol Arthrosc. 2006 Aug;14(8):707-12. doi: 10.1007/s00167-005-0015-4. Epub 2006 Feb 23. PMID: 16496126. https://pubmed.ncbi.nlm.nih.gov/16496126/

Wiberg G. Roentgenographic and anatomic studies on the femoropatellar joint. Acta Orthop Scand. 1941;12:319–410. doi: 10.3109/17453674108988814. https://www.tandfonline.com/doi/pdf/10.3109/17453674108988818

Purohit N, Hancock N, Saifuddin A. Surgical management of patellofemoral instability. I. Imaging considerations. Skeletal Radiol. 2019 Jun;48(6):859-869. doi: 10.1007/s00256-018-3123-1. Epub 2018 Dec 12. Review. PubMed PMID: 30542758. https://pubmed.ncbi.nlm.nih.gov/30542758/

Dixit S, Deu RS. Nonoperative Treatment of Patellar Instability. Sports Med Arthrosc Rev. 2017 Jun;25(2):72-77. doi: 10.1097/JSA.0000000000000149. https://pubmed.ncbi.nlm.nih.gov/28459749/

The Evolution of Patellofemoral Instability Surgery During the Past 25 Years. Sports Med Arthrosc Rev. 2018 Dec;26(4):157-159. doi: 10.1097/JSA.0000000000000221. Review. PubMed PMID: 30395057. https://pubmed.ncbi.nlm.nih.gov/30395057/

Obermeyer C, Hoffmann DB, Wachowski MM. [Patellar dislocation in children and adolescents : Current developments in diagnostics and treatment]. Orthopade. 2019 Oct;48(10):868-876. doi: 10.1007/s00132-019-03754-1. Review. German. PubMed PMID: 31101964. https://pubmed.ncbi.nlm.nih.gov/31101964/

Redler LH, Wright ML. Surgical Management of Patellofemoral Instability in the Skeletally Immature Patient. J Am Acad Orthop Surg. 2018 Oct 1;26(19):e405-e415. doi: 10.5435/JAAOS-D-17-00255. Review. https://pubmed.ncbi.nlm.nih.gov/30134308/

Keyes S, Price M, Green DW, Parikh SN. Special Considerations for Pediatric Patellar Instability. Am J Orthop (Belle Mead NJ). 2018 Mar;47(3). doi:10.12788/ajo.2018.0017. PubMed PMID: 29611848. https://pubmed.ncbi.nlm.nih.gov/29611848/

Parikh SN, Redman C, Gopinathan NR. Simultaneous treatment for patellar instability and genu valgum in skeletally immature patients: a preliminary study. J Pediatr Orthop B. 2019 Mar;28(2):132-138. doi: 10.1097/BPB.0000000000000546. PubMed PMID: 30199415. https://pubmed.ncbi.nlm.nih.gov/30199415/

Nwachukwu BU, So C, Schairer WW, Green DW, Dodwell ER. Surgical versus conservative management of acute patellar dislocation in children and adolescents: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2016Mar;24(3):760-7. doi: 10.1007/s00167-015-3948-2. Epub 2015 Dec 24. Review. PubMed PMID: 26704809. https://pubmed.ncbi.nlm.nih.gov/26704809/

Farr J. Editorial Commentary: What Is the Optimal Management of First and Recurrent Patellar Instability? Patellofemoral Instability Management Continues to Evolve. Arthroscopy. 2018 Nov;34(11):3094-3097. doi:10.1016/j.arthro.2018.08.046. PubMed PMID: 30392692. https://pubmed.ncbi.nlm.nih.gov/30392692/

McNeilan RJ, Everhart JS, Mescher PK, Abouljoud M, Magnussen RA, Flanigan DC.Graft Choice in Isolated Medial Patellofemoral Ligament Reconstruction: A Systematic Review With Meta-analysis of Rates of Recurrent Instability and Patient-Reported Outcomes for Autograft, Allograft, and Synthetic Options. Arthroscopy. 2018 Apr;34(4):1340-1354. doi: 10.1016/j.arthro.2017.11.027. Epub 2018 Feb 1. https://pubmed.ncbi.nlm.nih.gov/29366741/

Matuszewski Ł, Tramś M, Ciszewski A, Wilczyński M, Tramś E, Jakubowski P, Matuszewska A, John K. Medial patellofemoral ligament reconstruction in children: A comparative randomized short-term study of fascia lata allograft and gracilis tendon autograft reconstruction. Medicine (Baltimore). 2018 Dec;97(50):e13605. doi: 10.1097/MD.0000000000013605. PubMed PMID: 30558034. https://pubmed.ncbi.nlm.nih.gov/30558034/

Spang RC, Tepolt FA, Paschos NK, Redler LH, Davis EA, Kocher MS. Combined Reconstruction of the Medial Patellofemoral Ligament (MPFL) and Medial Quadriceps Tendon-Femoral Ligament (MQTFL) for Patellar Instability in Children and Adolescents: Surgical Technique and Outcomes. J Pediatr Orthop. 2019 Jan;39(1):e54-e61. doi: 10.1097/BPO.0000000000001259. PubMed PMID: 30300273. https://pubmed.ncbi.nlm.nih.gov/30300273/

Hetsroni I, Mann G, Dolev E, Nyska M. Combined reconstruction of the medial patellofemoral and medial patellotibial ligaments: outcomes and prognostic factors. Knee Surg Sports Traumatol Arthrosc. 2019 Feb;27(2):507-515. doi:10.1007/s00167-018-5145-6. Epub 2018 Sep20. https://pubmed.ncbi.nlm.nih.gov/30238237/

Leal-Blanquet J, Alentorn-Geli E, Torres-Claramunt R, Monllau JC. Partial quadriceps tendon transfer for revision medial patellofemoral ligament reconstruction: A new surgical technique. Acta Orthop Traumatol Turc. 2017 May;51(3):258-261. doi: 10.1016/j.aott.2017.03.004. Epub 2017 Apr 28. PubMed PMID: 28457794; PubMed Central PMCID: PMC6197314. https://pubmed.ncbi.nlm.nih.gov/28457794/

Lee DY, Park YJ, Song SY, Hwang SC, Park JS, Kang DG. Which Technique Is Better for Treating Patellar Dislocation? A Systematic Review and Meta-analysis. Arthroscopy. 2018 Nov;34(11):3082-3093.e1. doi: 10.1016/j.arthro.2018.06.052. Epub 2018 Oct 6. https://pubmed.ncbi.nlm.nih.gov/30301628/

Zhang L, Li Z. Long-Term Clinical Results of Double Bundle Reconstruction of the Medial Patellofemoral Ligament for Patellar Instability. J Knee Surg. 2019 Feb;32(2):153-159. doi: 10.1055/s-0038-1636913. Epub 2018 Mar 7. PubMed PMID:29514373. https://pubmed.ncbi.nlm.nih.gov/29514373/

Kang H, Zheng R, Dai Y, Lu J, Wang F.Single- and double-bundle medial patellofemoral ligament reconstruction procedures result in similar recurrent dislocation rates and improvements in knee function: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2019 Mar; 27(3):827-836. doi: 10.1007/s00167-018-5112-2. Epub 2018 Aug22. https://pubmed.ncbi.nlm.nih.gov/30136103/

Bonazza NA, Lewis GS, Lukosius EZ, Roush EP, Black KP, Dhawan A. Effect of Transosseous Tunnels on Patella Fracture Risk After Medial Patellofemoral Ligament Reconstruction: A Cadaveric Study. Arthroscopy. 2018 Feb;34(2):513-518. doi: 10.1016/j.arthro.2017.08.267. PubMed PMID: 29100765. https://pubmed.ncbi.nlm.nih.gov/29100765/

Schöttle PB, Schmeling A, Rosenstiel N, Weiler A. Radiographic landmarks for femoral tunnel placement in medial patellofemoral ligament reconstruction. Am J Sports Med. 2007 May;35(5):801-4. doi: 10.1177/0363546506296415. Epub 2007 Jan 31. PMID: 17267773. https://pubmed.ncbi.nlm.nih.gov/17267773/

Zhang X, Xie G, Zhang C, Fang Z, Zhao J, Huangfu X. Comparation and evaluation of the accuracy of the sulcus localization method to establish the medial patellofemoral ligament femoral tunnel: a cadaveric and clinical study. BMC Musculoskelet Disord. 2019 Feb 7;20(1):53. doi: 10.1186/s12891-019-2439-x. PubMed PMID: 30732597. https://pubmed.ncbi.nlm.nih.gov/30732597/

Koenen P, Shafizadeh S, Pfeiffer TR, Wafaisade A, Bouillon B, Kanakamedala AC, Jaecker V. Intraoperative fluoroscopy during MPFL reconstruction improves the accuracy of the femoral tunnel position. Knee Surg Sports Traumatol Arthrosc. 2018 Dec;26(12):3547-3552. doi: 10.1007/s00167-018-4983-6. Epub 2018 May 11. https://pubmed.ncbi.nlm.nih.gov/29752499/

Burrus MT, Werner BC, Cancienne JM, Diduch DR. Correct Positioning of the Medial Patellofemoral Ligament: Troubleshooting in the Operating Room. Am J Orthop (Belle Mead NJ). 2017 Mar/Apr;46(2):76-81. Review. PubMed PMID: 28437491. https://pubmed.ncbi.nlm.nih.gov/28437491/

Schüttler KF, Hoeger A, Heyse TJ, Figiel J, Timmesfeld N, Stein T, Ziring E, Efe T. Femoral tunnel widening is associated with tunnel malposition but not with clinical failure after medial patellofemoral ligament reconstruction with a free gracilis tendon graft. Arch Orthop Trauma Surg. 2018 Jul;138(7):979-984. doi:10.1007/s00402-018-2923-z. Epub 2018 Apr 2. PubMed PMID: 29611007. https://pubmed.ncbi.nlm.nih.gov/29611007/

Sim JA, Lim JK, Lee BH. Anatomic double-bundle medial patellofemoral ligament reconstruction with aperture fixation using an adjustable-length loop device: a 2-year follow-up study. BMC Musculoskelet Disord. 2018 Sep 25;19(1):346. doi: 10.1186/s12891-018-2261-x. PubMed PMID: 30253770; PubMed Central PMCID: PMC6156865. https://pubmed.ncbi.nlm.nih.gov/30253770/

Gao Z, Li Y, Wang G, Cai G. [Influencing factors of medial patellofemoral ligament reconstruction for patellar dislocation]. Zhongguo Xiu Fu Chong Jian WaiK e Za Zhi. 2018 Aug 15;32(8):1047-1051. doi: 10.7507/1002-1892.201710049. Review. Chinese. https://pubmed.ncbi.nlm.nih.gov/30238733/

Zuo YX, Ma ZP. [Reconstruction of medial patellofemoral ligament with Tightrope button fixation on the femoral side for the treatment of traumatic patellar dislocation]. Zhongguo Gu Shang. 2017 Nov 25;30(11):1039-1042. doi: 10.3969/j.issn.1003-0034.2017.11.014. https://pubmed.ncbi.nlm.nih.gov/29457397/

Lorbach O, Zumbansen N, Kieb M, Efe T, Pizanis A, Kohn D, Haupert A. Medial Patellofm oral Ligament Reconstruction: Impact of Knee Flexion Angle During Graft Fixation on Dynamic Patellofemoral Contact Pressure-A Biomechanical Study. Arthroscopy. 2018 Apr;34(4):1072-1082. doi: 10.1016/j.arthro.2017.09.047. Epub 2018 Jan 2. https://pubmed.ncbi.nlm.nih.gov/29305291/

Gobbi RG, Demange MK, de Ávila LFR, Araújo Filho JAB, Moreno RA, Gutierrez MA, de Sá Rebelo M, Tírico LEP, Pécora JR, Camanho GL. Patellar tracking after isolated medial patellofemoral ligament reconstruction: dynamic evaluation using computed tomography. Knee Surg Sports Traumatol Arthrosc. 2017Oct;25(10):3197-3205. doi: 10.1007/s00167-016-4284-x. Epub 2016 Aug 20. https://pubmed.ncbi.nlm.nih.gov/27544273/

Magnussen RA. Patella Alta Sees You, Do You See It? Am J Orthop (Belle Mead NJ). 2017 Sep/Oct;46(5):229-231. https://pubmed.ncbi.nlm.nih.gov/29099881/

Neri T, Parker DA, Beach A, Gensac C, Boyer B, Farizon F, Philippot R. Medial patellofemoral ligament reconstruction with or without tibial tubercle transfer is an effective treatment for patellofemoral instability. Knee Surg Sports Traumatol Arthrosc. 2019 Mar;27(3):805-813. doi: 10.1007/s00167-018-5102-4. Epub 8. https://pubmed.ncbi.nlm.nih.gov/30167754/

Frings J, Krause M, Wohlmuth P, Akoto R, Frosch KH. Influence of patient-related factors on clinical outcome of tibial tubercle transfer combined with medial patellofemoral ligament reconstruction. Knee. 2018 Dec;25(6):1157-1164. doi: 10.1016/j.knee.2018.07.018. Epub 2018 Aug 14. PubMedPMID : 30115592. https://pubmed.ncbi.nlm.nih.gov/30115592/

Grimm NL, Lazarides AL, Amendola A. Tibial Tubercle Osteotomies: a Review of a Treatment for Recurrent Patellar Instability. Curr Rev Musculoskelet Med. 2018 Jun;11(2):266-271. doi: 10.1007/s12178-018-9482-3. Review. PubMed PMID: 29721692. https://pubmed.ncbi.nlm.nih.gov/29721692/

D’Amore T, Tanaka MJ, Cosgarea AJ. When and How Far to Move the Tibial Tuberosity in Patients With Patellar Instability. Sports Med Arthrosc Rev. 2017 Jun;25(2):78-84. doi: 10.1097/JSA.0000000000000146. PMID: 28459750. https://pubmed.ncbi.nlm.nih.gov/28459750/

Kaiser P, Schmoelz W, Schöttle PB, Heinrichs C, Zwierzina M, Attal R. Isolated medial patellofemoral ligament reconstruction for patella instability is insufficient for higher degrees of internal femoral torsion. Knee Surg Sports Traumatol Arthrosc. 2019 Mar;27(3):758-765. doi: 10.1007/s00167-018-5065-5. Epub 2018 Jul 30. PubMed PMID: 30062643 https://pubmed.ncbi.nlm.nih.gov/30062643/

Frings J, Krause M, Akoto R, Wohlmuth P, Frosch KH. Combined distal femoral osteotomy (DFO) in genu valgum leads to reliable patellar stabilization and an improvement in knee function. Knee Surg Sports Traumatol Arthrosc. 2018 Dec;26(12):3572-3581. doi: 10.1007/s00167-018-5000-9. Epub 2018 Jun 4. PubMed PMID: 29869201. https://pubmed.ncbi.nlm.nih.gov/29869201/

Carstensen SE, Menzer HM, Diduch DR. Patellar Instability: When is Trochleoplasty Necessary? Sports Med Arthrosc Rev. 2017 Jun;25(2):92-99. doi: 10.1097/JSA.0000000000000150. Review. https://pubmed.ncbi.nlm.nih.gov/28459752/

Carstensen SE, Feeley SM, Burrus MT, Deasey M, Rush J, Diduch DR. Sulcus Deepening Trochleoplasty and Medial Patellofemoral Ligament Reconstruction for Patellofemoral Instability: A 2-Year Study. Arthroscopy. 2020 Aug;36(8):2237-2245. doi: 10.1016/j.arthro.2020.04.017. Epub 2020 Apr 28. PMID: 32353622. https://pubmed.ncbi.nlm.nih.gov/32353622/

Otsuki S, Okamoto Y, Murakami T, Nakagawa K, Okuno N, Wakama H, Neo M. Patellofemoral reconstruction for patellar instability with patella alta in middle-aged patients: Clinical outcomes. Orthop Traumatol Surg Res. 2018 Apr;104(2):217-221. doi: 10.1016/j.otsr.2018.01.003. Epub 2018 Feb 2. PubMed PMID: 29410197. https://pubmed.ncbi.nlm.nih.gov/29410197/

Liu C, Duan G, Niu Y, Cao P, Fu K, Niu J, Wang F. Lateral retinaculum plasty instead of lateral retinacular release with concomitant medial patellofemoral ligament reconstruction can achieve better results for patellar dislocation. Knee Surg Sports Traumatol Arthrosc. 2018 Oct;26(10):2899-2905. doi:10.1007/s00167-017-4798-x. Epub 2017 Nov 14. PubMed PMID: 29138916. https://pubmed.ncbi.nlm.nih.gov/29138916/

Hilber F, Pfeifer C, Memmel C, Zellner J, Angele P, Nerlich M, Kerschbaum M, Popp D, Baumann F, Krutsch W. Early functional rehabilitation after patellar dislocation-What procedures are daily routine in orthopedic surgery? Injury. 2019 Mar;50(3):752-757. doi: 10.1016/j.injury.2018.10.020. Epub 2019 Jan 17. PubMed PMID: 30717889. https://pubmed.ncbi.nlm.nih.gov/30717889/

Lightsey HM, Wright ML, Trofa DP, Popkin CA, Ahmad CS, Redler LH. Rehabilitation variability following medial patellofemoral ligament reconstruction. Phys Sportsmed. 2018 Nov;46(4):441-448. doi: 10.1080/00913847.2018.1487240. Epub 2018 Jul 2. PubMed PMID: 29888637. https://pubmed.ncbi.nlm.nih.gov/29888637/

Shah JN, Howard JS, Flanigan DC, Brophy RH, Carey JL, Lattermann C. A systematic review of complications and failures associated with medial patellofemoral ligament reconstruction for recurrent patellar dislocation. Am J Sports Med. 2012 Aug;40(8):1916-23. doi: 10.1177/0363546512442330. Epub 2012 Jun 7. PMID: 22679297; PMCID: PMC3615712. https://pubmed.ncbi.nlm.nih.gov/22679297/

Gravesen KS, Kallemose T, Blønd L, Troelsen A, Barfod KW. Persistent morbidity after Medial Patellofemoral Ligament Reconstruction - A registry study with an eight-year follow-up on a nationwide cohort from 1996 to 2014. Knee. 2019 Jan;26(1):20-25. doi: 10.1016/j.knee.2018.10.013. Epub 2018 Nov 28. PubMed PMID: 30502935. https://pubmed.ncbi.nlm.nih.gov/30502935/

Publicado
2021-05-13
Número
Vol. 38 Núm. 1 (2021)
Sección
Artículos de Revisión
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