Medial patellofemoral ligament reconstruction with allograft versus autograft tissue results in similar recurrent dislocation risk and patient-reported outcomes

Objectives: Medial patellofemoral ligament (MPFL) reconstruction has become an increasingly popular means to regain stability in the setting of recurrent lateral patellar dislocation, with nearly twice the number of medical centers performing reconstruction of the MPFL and outcomes reported on nearly double the number of patients in recent years. While recent studies have demonstrated improved patient reported outcome measures and a high rate of return to sports, limited literature has explored its effectiveness as an isolated intervention in the context of trochlear dysplasia. The purpose of this study was to determine the efficacy of isolated MPFL reconstruction in treating patellar instability in the setting of trochlear dysplasia. Methods: This was a retrospective review of consecutive patients who underwent unilateral or bilateral medial patellofemoral ligament reconstruction for patellofemoral instability. No osteotomies were included. All patients with minimum 2 year follow up were included. Pre- and postoperative assessment included ligamentous laxity, patellar crepitus, tilt, translation, and apprehension, and radiographic features including tibial tubercle-trochlear groove (TT-TG) ratio, Dejour classification, and Caton Deschamps ratio. Final follow up consisted of patient reported outcome measures including the Kujala score, International Knee Documentation Committee (IKDC) score, Lysholm score, and visual analog scale (VAS). Results: 105 MPFL reconstructions were included. Average age at surgery was 23.8 years (SD 9.7, range 12.1 - 57.0) with an average BMI of 23.4 (SD 4.7, range 16.3-43.6) and an average of 4.4 (SD 6.8) dislocation events prior to surgery. Average follow up was 44 months (range 24-111). 76% of patients were female. Average preoperative TT-TG ratio was 13.5 (SD 3.9, range 3.2-22) and Caton Deschamps ratio was 1.2 (SD 0.2, range 0.9-1.6); 74.5% of patients had Dejour C or D trochlear grooves. Kujala score improved from 54.5 (SD 3.8) preoperatively to 87.2 (SD 2.1) at 2 year follow up (p < 0.0001), Lysholm improved from 57.7 (SD 3.6) to 86.4 (SD 2.0) (p < 0.0001), IKDC improved from 52.1 (SD 3.8) to 79.5 (SD 2.6) (p < 0.0001), and VAS pain score improved from 2.9 (SD 0.3) to 1.7 (SD 0.3) (p<0.017). 78.9% of patients were able to return to sports at 1 year, with 69% returning to the same or higher level of play. At minimum 2-year follow up, only 5 patients reported either a postoperative dislocation or subluxation event. Conclusion: This study is the largest single series to report on the effectiveness of isolated MPFL reconstructions in a cohort of patients with a high incidence of trochlear dysplasia. In patients with normal TT-TG ratios, isolated medial patellofemoral ligament reconstruction provides safe and effective treatment for patellofemoral instability, despite the presence of Dejour class C or D trochlear grooves. Most patients are able to return to sports by 1 year postoperatively at the same or higher level of play.

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Medial patellofemoral ligament reconstruction for recurrent dislocation of the patella: A preliminary report

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/0749-8063(92)90064-i ◽

1992 ◽

Vol 8 (3) ◽

pp. 335-340 ◽

Cited By ~ 165

Author(s):

Joa˜o L. Ellera Gomes

Keyword(s):

Preliminary Report ◽

Ligament Reconstruction ◽

Medial Patellofemoral Ligament ◽

Recurrent Dislocation ◽

Medial Patellofemoral Ligament Reconstruction ◽

Dislocation Of The Patella

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Outcomes following Medial Patellofemoral Ligament Reconstruction with Allograft (177)

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00296 ◽

2021 ◽

Vol 9 (10_suppl5) ◽

pp. 2325967121S0029

Author(s):

Danielle Markus ◽

Eoghan Hurley ◽

Edward Shontz ◽

Kirk Campbell ◽

Laith Jazrawi ◽

...

Keyword(s):

Ligament Reconstruction ◽

Medial Patellofemoral Ligament ◽

Medial Patellofemoral Ligament Reconstruction ◽

Recurrent Instability ◽

Vas Score ◽

Kujala Score ◽

Patient Reported ◽

The Mean ◽

Low Rate

Objectives: Medial patellofemoral ligament reconstruction (MPFLR) using allograft tissue has several potential benefits including the absence of donor site morbidity, ability to predict graft parameters, and decreased operative time. The purpose of this study was to evaluate the outcomes of patients following MPFLR with allograft. Our hypothesis was that there would be a low rate of recurrent instability, and excellent clinical outcomes reported. Methods: A retrospective review of athletes who underwent MPFL Reconstruction, with a minimum of 12-month follow-up was performed. Recurrent instability (including re-dislocation and subluxation), Visual Analogue Scale (VAS) score, Kujala score, satisfaction, and whether they would undergo the same surgery again, were evaluated. Results: Overall, follow up was attained for 131 patients with 141 knees (73.4%). The mean patient age of 25.0 years, 67.4% females, and mean time to follow-up was 46.8 months (12-111). At final follow up, the mean VAS score was 1.4 ± 2.0, the mean Kujala score was 84.8 ± 15.6, the mean satisfaction score was 84% ± 26.0, and 117 (83.0%) would undergo the same procedure again if required. There was 17 (12.0%) patients that had recurrent instability, with 2 being re-dislocations (1.4%). A further procedure was performed in 14 patients (9.9%). There were no intra-operative complications in our series. Conclusions: There was a low rate of recurrent instability following MPFLR with allograft, with excellent patient reported outcomes, and a low complication rate.

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Medial patellofemoral ligament reconstruction with gracilis autograft for recurrent patellar instability: a case report

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20183279 ◽

2018 ◽

Vol 6 (8) ◽

pp. 2831

Author(s):

Komang Mahendra Laksana ◽

I. G. N. Wien Aryana

Keyword(s):

Patellar Instability ◽

Ligament Reconstruction ◽

Medial Patellofemoral Ligament ◽

Cartilage Damage ◽

Recurrent Dislocation ◽

Womac Score ◽

Joint Surface ◽

Medial Patellofemoral Ligament Reconstruction ◽

Chronic Instability ◽

Recurrent Patellar Instability

The medial patellofemoral ligament (MPFL) is the primary passive restraint in pathologic lateral translation of the patella. Recurrent patellar instability is common, and multiple procedures have been described for its treatment. Chronic instability of the patellofemoral joint and recurrent dislocation may lead to progressive cartilage damage and severe arthritis if not treated adequately. A 17-years-old female presented with a one-year history of knee pain in his left knee. The apprehension test is positive; there is pain and muscle defensive contraction of lateral patellar dislocation with 20°-30° of knee flexion. MRI revealed flattened trochlear joint surface proximally and the concavity is less pronounced distally. The inclination angle is less than 11 degrees and trochlear facet asymmetry can be seen on axial view. Patient undergone medial patellofemoral ligament reconstruction with gracilis autograft and six months postoperatively, the patient was followed up using WOMAC score and showed good result. WOMAC score was 96.2% indicating no significant pain, joint stiffness, or any difficulty on physical activity. After the operation, the patient is able to perform regular daily activities without any complaints. This study has shown that treatment of recurrent patellar instability with medial patellofemoral ligament reconstruction using gracilis autograft resulted in satisfactory functional outcome based on WOMAC score.

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COMPARISON OF CLINICAL OUTCOMES BETWEEN INDIVIDUALS WITH MEDIAL PATELLOFEMORAL LIGAMENT RECONSTRUCTION AND ANTERIOR CRUCIATE LIGAMENT

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00157 ◽

2020 ◽

Vol 8 (4_suppl3) ◽

pp. 2325967120S0015

Author(s):

Michael Shingles ◽

Chastity Chov ◽

Colleen Rogers ◽

Caroline Lisee ◽

Thomas Birchmeier ◽

...

Keyword(s):

Ligament Reconstruction ◽

Medial Patellofemoral Ligament ◽

Clinical Success ◽

Young Patients ◽

Knee Extension ◽

Quadriceps Strength ◽

Medial Patellofemoral Ligament Reconstruction ◽

Knee Extension Strength ◽

Patient Reported ◽

Isometric Knee Extension

Background: Return to sport is a commonly utilized outcome to denote clinical success for patients who have recently undergone medial patellofemoral ligament reconstruction (MPFLR) and ACL reconstruction (ACLR). However, there is a lack of clarity whether persistent functional and patient-reported deficits are consistent among young patients who have undergone these surgical procedures. Purpose: To compare patient-reported function, psychological readiness for sport, and functional symmetry between age and sex-matched individuals with recent MPFLR or ACLR. Methods: Fifteen participants with a history of MFPLR (sex= 8 women/7 men, age= 16.6±2.7 years, BMI= 23.2±4.1 kg/m2, months since surgery= 5.3±1.5) and 15 participants with ACLR (sex= 8 women/7 men, age= 17.1±2.8 years, BMI= 23.8±3.5 kg/m2, months since surgery= 5.9±0.8) enrolled in this cross-sectional research study. Participants were enrolled at the time of their final scheduled clinical visit. All participants completed the Tegner Activity Scale, the International Knee Documentation Committee (IKDC) subjective knee evaluation form, and the ACL-RSI scale. Participants then completed knee extension-flexion isokinetic strength testing at 60°/s, isometric knee extension strength assessment at 90° of knee flexion, and a battery of single-leg hopping tasks including the single hop, triple hop, crossover hop, and single leg vertical jump from which limb symmetry indices (LSI) were calculated. Group comparisons for patient-reported outcomes, strength LSI, and single-leg hop LSI were made using independent samples t-tests and the odds of meeting ≥90% LSI, ≥90 IKDC score, or ≥64 ACL-RSI score were compared between groups using odds ratios and 95% confidence intervals. Results: Participants with MPFLR reported worse ACL-RSI scores (MPFL= 50.3±23.0, ACLR= 77.3±18.7, p= 0.001) and displayed worse isometric knee extension strength symmetry (MPFL= 70.5±13.4%, ACLR= 86.3±16.3%, p= 0.01) and crossover hop symmetry (MPFL= 88.6±12.0%, healthy= 98.4±9.1%, p= 0.04) when compared to participants with ACLR. The odds of a participant with ACLR achieving adequate symmetry were 1.50 (CI95%: 1.05, 2.15) times greater for isometric quadriceps strength and 5.33 times greater (1.03, 27.76) for crossover hop performance when compared to a participant with MPFLR. The odds of reporting ACL-RSI score ≥64 were 7.56 (1.50, 38.15) greater among participants with ACLR as compared to those with MPFLR. Conclusion: Patients with MPFL reconstruction experience worse persistent patient-reported and functional deficits during the terminal phases of rehabilitation as compared to individuals with ACLR. Specific focus on clinical focus on improving psychological readiness for sport and quadriceps strength may facilitate improved outcomes upon medical clearance for unrestricted activity among patients with MPFLR.

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