外侧髌骨脱位术后重返运动现状的研究进展
Research Progress on Return to Sport after Lateral Patellar Dislocation Surgery
DOI: 10.12677/acm.2025.1582250, PDF,    科研立项经费支持
作者: 杨荣涛*, 廖超凡:西安医学院研究生院,陕西 西安;张 亮, 郑 江#:西安交通大学附属红会医院运动医学诊疗中心,陕西 西安
关键词: 外侧髌骨脱位内侧髌股韧带重建重返运动骨性手术心理因素Lateral Patellar Dislocation Medial Patellofemoral Ligament Reconstruction Return to Sport Bony Surgery Psychological Factors
摘要: 外侧髌骨脱位(lateral patellar dislocation, LPD)是青少年中常见的膝关节运动损伤,发病率呈逐年上升趋势。内侧髌股韧带重建(medial patellofemoral ligament reconstruction, MPFLR)作为治疗LPD的主流术式可取得良好的临床疗效,显著降低再脱位率,但在患者重返运动(return to sport, RTS)水平方面仍存在争议,尤其当合并复杂骨性手术时表现更差。本文系统综述了不同手术方式(单纯MPFLR及MPFLR联合各类骨性手术)对RTS水平的影响,并探讨了心理因素在RTS中的关键作用,旨在为临床优化治疗策略、制定个体化RTS方案提供参考。
Abstract: Lateral patellar dislocation (LPD) is a common knee sports injury among adolescents, with an increasing incidence year by year. Medial patellofemoral ligament reconstruction (MPFLR), as the mainstream surgical procedure for treating LPD, can achieve good clinical efficacy and significantly reduce the redislocation rate. However, there is still controversy regarding the level of return to sport (RTS) in patients, especially when combined with complex bony surgeries, where the performance is worse. This article systematically reviews the impact of different surgical methods (pure MPFLR and MPFLR combined with various bony surgeries) on the RTS level, and discusses the key role of psychological preparation in RTS, aiming to provide a reference for clinical optimization of treatment strategies and formulation of individualized RTS programs.
文章引用:杨荣涛, 廖超凡, 张亮, 郑江. 外侧髌骨脱位术后重返运动现状的研究进展[J]. 临床医学进展, 2025, 15(8): 420-426. https://doi.org/10.12677/acm.2025.1582250

参考文献

[1] Palmowski, Y., Jung, T., Doering, A., Gwinner, C., Schatka, I. and Bartek, B. (2021) Analysis of Cartilage Injury Patterns and Risk Factors for Knee Joint Damage in Patients with Primary Lateral Patella Dislocations. PLOS ONE, 16, e0258240. [Google Scholar] [CrossRef] [PubMed]
[2] Lyons, J.G., Hudson, T.L. and Krishnamurthy, A.B. (2022) Epidemiology of Patellar Dislocations in the United States from 2001 to 2020: Results of a National Emergency Department Database. The Physician and Sportsmedicine, 52, 26-35. [Google Scholar] [CrossRef] [PubMed]
[3] Ramer, J.D., DuBois, D.L., Duncan, R.J., Bustamante, A.S., Vandell, D.L., Marquez, D.X., et al. (2025) Childhood Predictors of High School Sport Participation and Effects of Participation on Young Adult Activity and Mental Health. Annals of Medicine, 57, Article 2447905. [Google Scholar] [CrossRef] [PubMed]
[4] 陈世益, 李国平, 敖英芳, 等. 功能至上、早期康复与重返运动是骨科运动医学的灵魂[J]. 中国运动医学杂志, 2020, 39(5): 339-340.
[5] Meynard, P., Malatray, M., Sappey-Marinier, E., Magnussen, R.A., Bodiou, V., Lustig, S., et al. (2021) Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Dislocation Allows a Good Rate to Return to Sport. Knee Surgery, Sports Traumatology, Arthroscopy, 30, 1865-1870. [Google Scholar] [CrossRef] [PubMed]
[6] Dennis, E.R., Marmor, W.A., Propp, B.E., Erickson, B.J., Gruber, S., Brady, J.M., et al. (2024) Isolated Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Instability Regardless of Tibial Tubercle-Trochlear Groove Distance and Patellar Height: Minimum 5-Year Outcomes. The American Journal of Sports Medicine, 52, 2196-2204. [Google Scholar] [CrossRef] [PubMed]
[7] Marigi, E.M., Feroe, A.G., Smith, J.H., Stuart, M.J., Hevesi, M., Camp, C.L., et al. (2023) Surgical Stabilization for Recurrent Patellar Instability in Competitive Wrestlers: Outcomes, Reoperations, and Return to Play at 6-Year Mean Follow-Up. The American Journal of Sports Medicine, 51, 2608-2616. [Google Scholar] [CrossRef] [PubMed]
[8] Mengis, N., Zimmermann, F., Schemel, L., Rippke, J.N., Milinkovic, D.D. and Balcarek, P. (2022) Return to Sports and Patients’ Rehabilitation Continuum after Deepening Trochleoplasty and Concomitant Patellar-Stabilizing Procedures: A Case Series of 111 Patients at 2 to 4 Years of Follow-Up. The American Journal of Sports Medicine, 50, 674-680. [Google Scholar] [CrossRef] [PubMed]
[9] Li, Z.I., Garra, S., Eskenazi, J., Montgomery, S.R., Triana, J., Hughes, A.J., et al. (2024) Patients Who Undergo Tibial Tubercle Anteromedialization with Medial Patellofemoral Ligament Reconstruction Demonstrate Similar Rates of Return to Sport Compared to Isolated MPFL Reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy, 32, 371-380. [Google Scholar] [CrossRef] [PubMed]
[10] Hao, K., Niu, Y., Kong, L. and Wang, F. (2023) Medial Patellofemoral Ligament Reconstruction Combined with Derotational Distal Femoral Osteotomy Yields Better Outcomes than Isolated Procedures in Patellar Dislocation with Increased Femoral Anteversion. Knee Surgery, Sports Traumatology, Arthroscopy, 31, 2888-2896. [Google Scholar] [CrossRef] [PubMed]
[11] Olotu, O., Siddiqui, A., Peterson, D., et al. (2021) The Superficial “Swing-Down” Quadriceps Tendon Autograft Is a Viable Option for Medial Patellofemoral Ligament Reconstruction: A Systematic Review. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 37, 3187-3197. [Google Scholar] [CrossRef] [PubMed]
[12] Baer, M.R. and Macalena, J.A. (2017) Medial Patellofemoral Ligament Reconstruction: Patient Selection and Perspectives. Orthopedic Research and Reviews, 9, 83-91. [Google Scholar] [CrossRef] [PubMed]
[13] Huo, Z., Niu, Y., Kang, H., Hao, K., Fan, C., Li, K., et al. (2024) Three Different Patellar Fixation Techniques Yield Similar Clinical and Radiological Outcomes in Recurrent Patellar Dislocation Undergoing Medial Patellofemoral Ligament Reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy, 32, 2848-2858. [Google Scholar] [CrossRef] [PubMed]
[14] Xu, C., Zhao, Y., Ni, Z., Li, K., Kang, H. and Wang, F. (2025) Returning to Pre-Injury Level of Sports before 9 Months after Medial Patellofemoral Ligament Reconstruction Increases the Incidence of Anterior Knee Pain in Young Patients. Knee Surgery, Sports Traumatology, Arthroscopy, 33, 837-845. [Google Scholar] [CrossRef] [PubMed]
[15] Manjunath, A.K., Hurley, E.T., Jazrawi, L.M. and Strauss, E.J. (2021) Return to Play after Medial Patellofemoral Ligament Reconstruction: A Systematic Review. The American Journal of Sports Medicine, 49, 1094-1100. [Google Scholar] [CrossRef] [PubMed]
[16] Ryan, P.C., Ching, I.C., Ierulli, V.K., Pickett, K. and Mulcahey, M.K. (2025) Fear of Reinjury, Psychological Factors, and Sport Played Have Negative Impact on Return to Sport Following Medial Patellofemoral Ligament Reconstruction for Patellar Instability. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 41, 1605-1617. [Google Scholar] [CrossRef] [PubMed]
[17] Žlak, N., Kacin, A., Martinčič, D. and Drobnič, M. (2022) Age, Body Mass Index, Female Gender, and Patellofemoral Cartilage Degeneration Predict Worse Patient Outcome after Patellofemoral Instability Surgery. Knee Surgery, Sports Traumatology, Arthroscopy, 30, 3751-3759. [Google Scholar] [CrossRef] [PubMed]
[18] Wang, Q., Li, K., Xu, C., Ni, Z., Chen, X., Zhang, Y., et al. (2024) Predicting Two-Year Return-to-Sport Failure after Medial Patellofemoral Ligament Reconstruction in Patellar Dislocation Patients with Bone Abnormalities. Journal of Orthopaedic Surgery and Research, 19, Article No. 766. [Google Scholar] [CrossRef] [PubMed]
[19] Platt, B.N., Bowers, L.C., Magnuson, J.A., Marx, S.M., Liu, J.N., Farr, J., et al. (2022) Return to Sport after Medial Patellofemoral Ligament Reconstruction: A Systematic Review and Meta-Analysis. The American Journal of Sports Medicine, 50, 282-291. [Google Scholar] [CrossRef] [PubMed]
[20] Vivekanantha, P., Kahlon, H., Cohen, D., et al. (2023) Isolated Medial Patellofemoral Ligament Reconstruction Results in Similar Postoperative Outcomes as Medial Patellofemoral Ligament Reconstruction and Tibial‐Tubercle Osteotomy: A Systematic Review and Meta‐Analysis. Knee Surgery, Sports Traumatology, Arthroscopy, 31, 2433-2445. [Google Scholar] [CrossRef] [PubMed]
[21] Coda, R.G., Cheema, S.G., Hermanns, C., Kramer, M., Tarakemeh, A., Schroeppel, J.P., et al. (2021) Online Rehabilitation Protocols for Medial Patellofemoral Ligament Reconstruction with and without Tibial Tubercle Osteotomy Are Variable among Institutions. Arthroscopy, Sports Medicine, and Rehabilitation, 3, e305-e313. [Google Scholar] [CrossRef] [PubMed]
[22] Krych, A.J., O’Malley, M.P., Johnson, N.R., Mohan, R., Hewett, T.E., Stuart, M.J., et al. (2018) Functional Testing and Return to Sport Following Stabilization Surgery for Recurrent Lateral Patellar Instability in Competitive Athletes. Knee Surgery, Sports Traumatology, Arthroscopy, 26, 711-718. [Google Scholar] [CrossRef] [PubMed]
[23] Blanke, F., Watermann, K., Haenle, M., Feitenhansl, A., Camathias, C. and Vogt, S. (2020) Isolated Medial Patellofemoral Ligament Reconstruction Can Be an Effective Procedure in Patellofemoral Instability with Risk Factors. The Journal of Knee Surgery, 33, 992-997. [Google Scholar] [CrossRef] [PubMed]
[24] Hinz, M., Rab, P., Brunner, M., Rupp, M., Runer, A., Grüning, L., et al. (2025) Psychological Readiness for Return to Sport Following Distal Femoral Osteotomy in Patients with Recurrent Patellar Instability. BMC Musculoskeletal Disorders, 26, Article No. 310. [Google Scholar] [CrossRef] [PubMed]
[25] Hwang, U.J., Kim, J.S. and Chung, K.S. (2025) Machine Learning Predictions of Subjective Function, Symptoms, and Psychological Readiness at 12 Months after ACL Reconstruction Based on Physical Performance in the Early Rehabilitation Stage: Retrospective Cohort Study. Orthopaedic Journal of Sports Medicine, 13, Article 23259671251319512.
[26] Hurley, E.T., Markus, D.H., Mannino, B.J., Gonzalez-Lomas, G., Alaia, M.J., Campbell, K.A., et al. (2021) Patients Unable to Return to Play Following Medial Patellofemoral Ligament Reconstructions Demonstrate Poor Psychological Readiness. Knee Surgery, Sports Traumatology, Arthroscopy, 29, 3834-3838. [Google Scholar] [CrossRef] [PubMed]
[27] Li, Z.I., Triana, J., Lott, A., Rao, N., Jazrawi, T., Montgomery, S.R., et al. (2023) Patients Who Undergo Bilateral Medial Patellofemoral Ligament Reconstruction Return to Sport at a Similar Rate as Those That Undergo Unilateral Reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy, 31, 4195-4203. [Google Scholar] [CrossRef] [PubMed]
[28] Shankar, D.S., DeClouette, B., Avila, A., Vasavada, K.D., Lan, R., Strauss, E.J., et al. (2024) Medial Quadriceps Tendon Femoral Ligament Reconstruction and Medial Patellofemoral Ligament Reconstruction Have No Significant Differences in Clinical Outcomes for Treatment of Lateral Patellar Instability: A Matched-Cohort Study. Journal of ISAKOS, 9, 502-509. [Google Scholar] [CrossRef] [PubMed]
[29] Straume-Næsheim, T.M., Randsborg, P.H., Mikaelsen, J.R., et al. (2019) Recurrent Lateral Patella Dislocation Affects Knee Function as Much as ACL Deficiency—However Patients Wait Five Times Longer for Treatment. BMC Musculoskeletal Disorders, 20, Article No. 318. [Google Scholar] [CrossRef] [PubMed]
[30] Gennarelli, S.M., Brown, S.M. and Mulcahey, M.K. (2020) Psychosocial Interventions Help Facilitate Recovery Following Musculoskeletal Sports Injuries: A Systematic Review. The Physician and Sportsmedicine, 48, 370-377. [Google Scholar] [CrossRef] [PubMed]