RANDOMIZED PROSPECTIVE STUDY ON TRAUMATIC PATELLAR DISLOCATION: CONSERVATIVE TREATMENT VERSUS RECONSTRUCTION OF THE MEDIAL PATELLOFEMORAL LIGAMENT USING THE PATELLAR TENDON, WITH A MINIMUM OF TWO YEARS OF FOLLOW-UP

The aim of the study was to evaluate the results of the medial patellofemoral ligament reconstruction with a medial strip of patellar tendon autograft after a minimum 2-year followup. Ten patients (10 knees) were operated on by one surgeon, according to the modified technique, described by Camanho, without any bone plug at free graft end. The mean age of the patients was 27.2 years (ranging from 18 to 42 years). The mean follow-up period was 3 years and 7 months. All patients were reviewed prospectively. At the last follow-up visit, all the patients demonstrated a significant improvement in terms of patellofemoral joint stability, all aspects of the KOOS questionnaire, and Kujala et al.’s score (59.7 points preoperatively and 84.4 points at the last followup). No patient revealed recurrent dislocation. The SF-36 score revealed a significant improvement in bodily pain, general health, physical role functioning, social role functioning, and physical functioning domains. The described MPFL reconstruction with the use of the medial 1/3rd of patella tendon is an effective procedure that gives satisfactorily patellofemoral joint functions, improves the quality of life, and provides much pain relief. It is relatively simple, surgically not extensive, and economically cost-effective procedure.

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Clinical Outcomes After Medial Patellofemoral Ligament Reconstruction With Suture Fixation of the Gracilis Tendon via Transosseous Tunnels

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119900373 ◽

2020 ◽

Vol 8 (2) ◽

pp. 232596711990037

Author(s):

Hangzhou Zhang ◽

Mao Ye ◽

Qingwei Liang

Keyword(s):

Patellar Dislocation ◽

Medial Patellofemoral Ligament ◽

Case Series ◽

Mpfl Reconstruction ◽

Suture Fixation ◽

Recurrent Patellar Dislocation ◽

Patellar Tilt ◽

Transosseous Suture ◽

Patellar Tilt Angle

Background: Several fixation methods have been introduced in medial patellofemoral ligament (MPFL) reconstruction. However, the optimal management of patients with recurrent patellar dislocation remains controversial. Purpose: To present a case series with a minimum 2-year follow-up of 29 patients with recurrent patellar dislocation who underwent a new transosseous suture fixation technique for MPFL reconstruction. Study Design: Case series; Level of evidence, 4. Methods: From January 2014 through February 2016, a total of 29 patients with recurrent patellar dislocation for which the MPFL was reconstructed with transosseous suture patellar fixation were studied. All patients were available for follow-up (mean, 37.52 months; range, 26-48 months). The patellar attachment was fixed by transosseous patellar sutures. The International Knee Documentation Committee (IKDC) subjective knee score, Kujala score, Tegner score, range of motion, congruence angle, patellar tilt angle, and complications were assessed both pre- and postoperatively. Results: No recurrent dislocation was observed in any of the 29 patients for a minimum of 2 years. All outcome scores improved significantly from preoperatively to postoperatively: the average IKDC subjective knee evaluation score from 53 to 87, Kujala from 54 to 90, Lysholm from 50 to 89, and Tegner from 3 to 5 ( P < .001 for all). The congruence angle significantly decreased from 22° preoperatively to –3° postoperatively, and the patellar tilt angle (Merchant) decreased from 23° preoperatively to 5° postoperatively ( P < .001 for both). In total, 25 patients (25/29; 86.21%) were completely pain-free when performing activities of daily living at the last follow-up, and 27 patients (93.1%) rated themselves as very satisfied or satisfied with the results. Conclusion: In patients with chronic recurrent patellar dislocation, transosseous patellar suture fixation for MPFL reconstruction can significantly improve patellar stability and achieve good results at short-term follow-up.

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Extensive Lateral Release and Medial Patellofemoral Ligament Reconstruction in 25 Years of Chronic Fixed Lateral Patellar Dislocation: A 5-Year Follow-Up Case Report

Case Reports in Orthopedics ◽

10.1155/2019/9542398 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7

Author(s):

Andri M. T. Lubis ◽

Petrus Aprianto ◽

Yudistira P. Siregar

Keyword(s):

Patellar Dislocation ◽

Ligament Reconstruction ◽

Medial Patellofemoral Ligament ◽

Daily Activities ◽

Lateral Release ◽

Medial Patellofemoral Ligament Reconstruction ◽

Lateral Dislocation ◽

Lateral Patellar Dislocation ◽

The Right

Lateral dislocation of the patella is not uncommon and may impede daily activities as this causes compressive dysfunction and instabilities. Most cases of patellar lateral dislocation are due to damage to the medial patellofemoral ligament (MPFL), either rupture of detachment of the patella or femoral attachment. MPFL reconstruction alone was considered adequate for the treatment of this condition. We present a case of a 49-year-old male with chronic posttraumatic lateral patellar dislocation of the right knee of 25 years, which we treated with extensive lateral release and right medial patellofemoral ligament reconstruction with 5-year follow-up data.

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Surgical treatment of medial patellofemoral ligament injuries achieves better outcomes than conservative management in patients with primary patellar dislocation: a meta-analysis

Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine ◽

10.1136/jisakos-2017-000152 ◽

2017 ◽

Vol 3 (2) ◽

pp. 98-104 ◽

Cited By ~ 3

Author(s):

Amre Hussein ◽

Asser A Sallam ◽

Mohamed A Imam ◽

Martyn Snow

Keyword(s):

Conservative Treatment ◽

Surgical Management ◽

Conservative Management ◽

Patellar Dislocation ◽

Medial Patellofemoral Ligament ◽

Meta Analysis ◽

Treated Group ◽

Current Evidence ◽

Conservative Group ◽

Kujala Score

ImportanceLateral patellar dislocation is a commonly encountered disorder that affects mainly young and active adults and is associated with potential long-term morbidity. Primary traumatic dislocations can result in injury to the medial patellofemoral ligament (MPFL). There is controversy in literature about the superiority of early surgical intervention over conservative treatment of MPFL injuries.ObjectiveThe aim of this project was to undertake a meta-analysis to evaluate the clinical outcomes of the surgical management of MPFL injuries compared with conservative treatment in patients with primary patellar dislocation.Evidence reviewA systematic review of the English literature combining electronic databases Allied and Complementary Medicine (AMED), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase and MEDLINE ((Ovid) and PubMed) and the reference lists of the final studies was performed during the last week of June 2017 using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Four eligible randomised controlled trials comparing MPFL repair/reconstruction to conservative management met our inclusion criteria. They were identified and critically appraised, and the results were quantitatively evaluated giving data of a total of 171 patients. They were divided into two groups: surgically treated group (92 patients) and conservatively treated group (79 patients). The performed surgical procedures included: reconstruction and repair of the MPFL. The conservative management group included mainly physiotherapy. The outcomes evaluated were the rate of recurrent dislocation of the patella and the Kujala score.FindingsOur analysis showed high statistical significance favouring the surgical management in reducing the redislocation rate (6.74%) in comparison with the conservative group (28.5%) (P<0.001). The surgical group also demonstrated significantly higher Kujala score (70.8) compared with the conservative group (59.8) (P<0.001).Conclusions and relevanceContrary to the available current evidence in the literature, we report that the surgical management of MPFL injuries in patients with primary patellar dislocation results in a significantly reduced rate of redislocation when compared with non-operative management.Level of evidenceMeta-analysis, therapeutic type II.

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The Effect of Patellar Orientation on the Stiffness of the Porcine Femur-Medial Patellofemoral Ligament-Patella Complex

ASME 2011 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2011-53545 ◽

2011 ◽

Author(s):

Kwang E. Kim ◽

Shanlin Hsu ◽

Matthew B. Fisher ◽

Savio L-Y. Woo

Keyword(s):

Patellar Dislocation ◽

Medial Patellofemoral Ligament ◽

Primary Repair ◽

Biomechanical Properties ◽

The Us ◽

Follow Up Studies ◽

Graft Tissue ◽

Redislocation Rate ◽

Selection Of

Patellar dislocation has an incidence of 5.8 per 100,000 per year in the US, and this number increases by five-fold for adolescents 1. Conservative management has been the preferred treatment, but recent follow-up studies have revealed a high redislocation rate. Similar outcomes were also found following primary repair of the medial patellofemoral ligament (MPFL) 2. As a result, replacement with soft tissue autografts has gained attention for recurrent patellar dislocations in recent years 2, 3. As such, the selection of an appropriate graft tissue will need the knowledge of the biomechanical properties of the FMPC, particularly its stiffness for the performance of the graft.

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Medial patellofemoral ligament reconstruction combined with biplanar supracondylar femoral derotation osteotomy in recurrent patellar dislocation with increased femoral internal torsion and genu valgum: a retrospective pilot study

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04816-2 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Xiangtian Deng ◽

Lingzhi Li ◽

Peng Zhou ◽

Fuyuan Deng ◽

Yuan Li ◽

...

Keyword(s):

Clinical Outcomes ◽

Patellar Dislocation ◽

Medial Patellofemoral Ligament ◽

Mechanical Axis ◽

Genu Valgum ◽

Mpfl Reconstruction ◽

Ct Scans ◽

Recurrent Patellar Dislocation ◽

Derotation Osteotomy

Abstract Background The purpose of this study was to evaluate the clinical and radiographic outcomes after medial patellofemoral ligament (MPFL) reconstruction combined with supracondylar biplanar femoral derotation osteotomy (FDO) in recurrent patellar dislocation (RPD) with increased femoral anteversion angle (FAA) and genu valgum. Methods Between January 2017 to December 2020, a total of 13 consecutive patients (13 knees, 4 males and 9 females, mean age 18.7 (range, 15–29 years) with RPD with increased FAA (FAA > 25°) and genu valgum (mechanical axis deformity of ≥5°) who underwent supracondylar biplanar FDO using a Tomofix-locking plate combined with MPFL reconstruction in our institution were included. Preoperative full-leg standing radiographs, lateral views, and hip-knee-ankle computed tomography (CT) scans were used to evaluate the mechanical lateral distal femoral angle (mLDFA), anatomical femorotibial angle (aFTA), mechanical axis, patellar height, tibial tubercle-trochlear groove (TT-TG) distance, and torsional angle of the tibial and femoral in the axial plane. Patient reported outcomes were evaluated using the International Knee Documentation Committee (IKDC) score, Kujala score, Lysholm score, visual analog scale (VAS), and Tegner score preoperatively and postoperatively. Postoperative CT scans were used to evaluate the changes of FAA and TT-TG, and full-leg standing radiographs was used to evaluate the changes of mLDFA, aFTA, and mechanical axis. Results A total of 13 patients (13 knees) were included with an average follow-up period of 26.7 months (range 24–33). No cases developed wound infection, soft tissue irritation, and recurrent patellar dislocation during the follow-up period after surgery. Bone healing at the osteotomy site was achieved in all cases, and all patients regained full extension and flexion. Clinical outcomes (VAS, Kujala, IKDC, Lysholom, and Tegner scores) improved significantly at the final follow-up after surgery (p < 0.05). The mean mLDFA, aFTA, mechanical axis, and TT-TG distance showed statistically significant improvement following the combined surgery (p < 0.05), while the CDI did not change significantly after surgery (p>0.05). Conclusion MPFL reconstruction combined with supracondylar biplanar FDO showed satisfactory clinical outcomes and radiographic results in the short-term follow-up period.

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CONSERVATIVE TREATMENT OF FRACTURES OF THE PROXIMAL PHALANX: AN OPTION EVEN FOR UNSTABLE FRACTURE PATTERNS

Hand Surgery ◽

10.1142/s0218810413500287 ◽

2013 ◽

Vol 18 (02) ◽

pp. 229-234 ◽

Cited By ~ 10

Author(s):

Michael Held ◽

Pieter Jordaan ◽

Maritz Laubscher ◽

Martin Singer ◽

Michael Solomons

Keyword(s):

Conservative Treatment ◽

Prospective Study ◽

Range Of Motion ◽

Conservative Management ◽

Proximal Phalanx ◽

Unstable Fracture ◽

Non Union ◽

Fracture Patterns ◽

Phalangeal Fractures

Purpose: The purpose of the study was to assess the efficacy of the conservative management of proximal phalangeal fractures in a dorsal plaster slab. Methods: Twenty-three consecutive patients with extra-articular proximal phalangeal fractures were included in this prospective study. Fourteen patients (62%) presented with fractures considered unstable. The fractures were reduced and the position was held with a dorsal plaster slab for three weeks. The patients were followed up for an average of seven weeks (range 2 to 45) after the injury. Range of motion of the finger and radiological evidence of union, non-union or malunion was documented after removal of the plaster. Results: Ninety-one percent of fractures maintained an acceptable reduction. All cases measured less than 15° of angulation. On average 1,1 mm of shortening was measured. In two (9%) cases the reduction was not accepted on follow up assessment and the fractures were managed surgically. Conclusion: Most extra-articular proximal phalanx fractures can be managed conservatively with acceptable results.

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Isolated Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Dislocation

The American Journal of Sports Medicine ◽

10.1177/0363546509333482 ◽

2009 ◽

Vol 37 (9) ◽

pp. 1735-1742 ◽

Cited By ~ 107

Author(s):

Mario Ronga ◽

Francesco Oliva ◽

Umile Giuseppe Longo ◽

Vittorino Testa ◽

Giovanni Capasso ◽

...

Keyword(s):

Patellar Dislocation ◽

Ligament Reconstruction ◽

Medial Patellofemoral Ligament ◽

Case Series ◽

Predisposing Factors ◽

Medial Patellofemoral Ligament Reconstruction ◽

Recurrent Patellar Dislocation ◽

Level Of Evidence ◽

The Mean

Background Several medial patellofemoral ligament reconstruction procedures have been proposed to manage recurrent patellar dislocation. Hypothesis Reconstruction of the medial patellofemoral ligament using a hamstring graft with a 2 transverse patellar tunnels technique is an effective treatment for recurrent patellar dislocation in patients without any evident predisposing factors. Study Design Case series; Level of evidence, 4. Methods Twenty-eight patients with chronic patellar instability without any anatomic predisposing factors, experiencing recurrent unilateral patellar dislocation, were included in the study. Evaluation included the modified Cincinnati and the Kujala scores, anthropometry, plain radiography, and isokinetic dynamometry. Results The average follow-up was 3.1 years (range, 2.5-4 years). The mean modified Cincinnati score increased from 52 preoperatively to 89 (P = .001). The mean Kujala scores increased from 45 preoperatively to 83 (P = .03). The muscle volume of the thigh of the operated limb increased with time, but remained less well developed than the nonoperated limb (P = .04). The mean Insall-Salvati index was 1.1 (range, 0.9-1.2) preoperatively and remained within normal range (1.1 [range, 0.9 to 1.2]) (P = .07), at latest follow-up. Significant isokinetic strength differences were found between the operated and the contralateral limbs (.05 < P < .006), even at the latest follow-up. Three patients experienced a new patellar dislocation. Conclusion Medial patellofemoral ligament reconstruction using hamstring tendon passed through a double patellar transverse bony tunnel technique is a safe, reliable management option for recurrent patellar dislocation in patients without any predisposing anatomic factors.

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