内侧髌胫韧带的应用解剖、生物力学及重建的研究进展

目的 总结内侧髌胫韧带（MPTL）的应用解剖及生物力学、重建技术及其临床疗效研究进展。方法 在中国知网、PubMed、Web of Science数据库中,检索2022年5月之前公开发表的关于MPTL解剖、生物力学及重建技术研究文献47篇;通过对上述文章的参考文献进行筛选,补充检索21篇。按照本研究纳入和排除标准,最终纳入47篇文献（中文文献5篇、英文文献42篇）进行分析和总结。结果 MPTL位于膝关节内侧支持带第二层,起自髌骨内侧下端。沿内下方走行,止于胫骨前内侧近端。MPTL内侧总约束力约为5%,并且主要在膝关节屈曲30°~90°的倾斜和旋转中发挥作用。此外,初次髌骨脱位常伴有内侧髌股韧带（MPFL）和MPTL的联合损伤。MPTL参与的重建方式主要分为单纯MPTL重建和MPFL联合MPTL重建,前者临床研究疗效良好,但单纯重建MPTL无法恢复内侧支持带原有的生物力学结构,故不推荐在临床中应用。在多项MPFL联合MPTL重建临床研究中,患者术后功能Lysholm评分、Kujala评分和国际膝关节文献委员会（IKDC）评分,以及髌骨高度、胫骨结节-滑车沟、髌骨外移度等影像学指标均得到有效改善,但MPFL联合MPTL重建手术适应证仍未达成共识。结论 对MPTL的应用解剖和生物力学研究进一步证实了MPTL在维持髌股关节稳定性中的重要作用,因此,MPFL与MPTL联合重建能恢复内侧支持带的解剖和生物力学。为了满足临床需要,尚需要进一步研究以论证该手术的适应证。

Research progress on anatomy,biomechanics, and reconstruction of the medial patellotibial ligament

Objective This study aimed to summarize the advances in anatomy, biomechanics, reconstruction technique, and clinical outcome of medial patellotibial ligament (MPTL). Methods A computer-based online search in the databases of CNKI, PubMed, and Web of Science was performed to identify articles on the anatomy, biomechanics, and reconstruction of medial patellotibial ligament, and the articles were published before May 2022. A total of 47 articles were retrieved, through screening the references of the above articles, and 21 articles were supplemented. Based on the inclusion and exclusion criteria of this study, a total of 47 articles were finally included (5 articles in Chinese and 42 articles in English) for analysis and summary. Results MPTL was located in the second layer of the medial retinaculum of the knee joint starting from the medial lower end of the patella. It runs along the inner lower part and ends at the anteromedial proximal end of the tibia. The medial binding force of MPTL is about 5%, and it mainly plays a role in the tilt and rotation of knee flexion of 30°-90°. In addition, primary patellar dislocation is often accompanied by combined injury of the medial patellofemoral ligament (MPFL) and MPTL. At present, the reconstruction methods involved in treating MPTL are mainly divided into MPTL reconstruction alone and MPFL combined with MPTL reconstruction. The former has a good clinical outcome, however, the MPTL reconstruction alone does not restore the original biomechanical structure of the medial retinaculum, hence, it is not recommended for clinical application. In several clinical studies of MPFL combined with MPTL reconstruction, the postoperative functional scores (Lysholm, Kujala, and International Knee Documentation Committee IKDC]), and imaging indicators (patella height, tibial tuberosity-trochlear groove, patella lateral displacement, etc.) have been effectively improved. However, there is no consensus on the surgical indications of MPFL combined with MPTL reconstruction. Conclusions The current study on the anatomy and biomechanics of MPTL has further confirmed the importance of MPTL in maintaining the stability of the patellofemoral joint. Therefore, MPFL combined with MPTL reconstruction can restore the anatomy and biomechanics of the original medial retinaculum. However, it is necessary to further study and demonstrate the indications of this operation to meet the clinical needs.