Inestabilidad rotular: Reconstrución y reparación de los principales tejidos…

Fithian, Donald C. MD 1; Gupta, Neeraj MD 2

Abstract:

Over the past 10 years, interest in the passive restraints of the patellofemoral joint and their contributions to patellar stability has resulted in the description of a variety of techniques for reconstruction of the medial retinacular ligaments. The most important stabilizer of the patella in normal knees is the trochlear groove. However, when the groove is deficient, as it is in many patients with patellofemoral instability, the retinacular ligaments take on a greater role. Furthermore, regardless of the quality of the trochlea, if the patella is dislocating then the medial ligaments must be abnormally lax. In either case, to control excessive mobility of the patella, the medial ligamentous tethers must be restored to competency. Stabilization of the patella should always include a repair or reconstruction of the medial patellofemoral ligament (MPFL) to restore passive patellar mobility to within normal limits. MPFL reconstruction is considered a more durable technique than medial retinacular repair for preventing recurrent patellar instability. It is indicated for any patient with at least 2 documented patellar dislocations and a physical examination indicating excessive lateral patellar mobility. When tensioning MPFL graft, the surgeon should ensure that it is lax throughout the range of motion if the patella is centered within the femoral groove and should only become tight when the patella is displaced laterally from its centered position. Early range of motion is important after MPFL reconstruction to overcome postoperative stiffness due to scarring near the femoral attachment site. With these precautions, MPFL reconstruction is a reliable technique for restoration of patellar stability.