Management of Injuries to the Medial Patellofemoral Ligament: A Review

2017 ◽  
Vol 31 (05) ◽  
pp. 439-447 ◽  
Author(s):  
Jaydev Mistry ◽  
Kevin Bonner ◽  
Chukwuweike Gwam ◽  
Melbin Thomas ◽  
Jennifer Etcheson ◽  
...  
Keyword(s):  
Effective Treatment ◽  
Patellar Dislocation ◽  
Medial Patellofemoral Ligament ◽  
Surgical Techniques ◽  
Mpfl Reconstruction ◽  
Normal Anatomy ◽  
Lateral Subluxation ◽  
Subluxation Of The Patella ◽  
Patellar Stabilization ◽  
Graft Selection

AbstractThe medial patellofemoral ligament (MPFL) is thought to be the most important medial structure providing restraint to lateral subluxation of the patella. After an initial patellar dislocation, the MPFL is frequently injured and can usually be treated with conservative measures. However, these patients often suffer from recurrent dislocations, which thereby necessitate operative intervention. In the setting of normal anatomy and kinematics, isolated reconstruction of the MPFL is an effective treatment for preventing recurrent dislocations. Various surgical techniques have been described, with differences in fixation and graft selection. The treatment of MPFL injuries should aim to provide patellar stabilization and restore normal kinematics throughout the joint. This review will discuss the following: (1) anatomy of the MPFL, (2) presentation and assessment of MPFL injuries, (3) management of patients with MPFL injuries, and (4) complications following MPFL reconstruction.

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

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.

scholarly journals Acute patellofemoral instability in children and adolescents

Joints ◽  
2016 ◽  
Vol 04 (01) ◽  
pp. 047-051 ◽  
Author(s):  
Pierluigi Antinolfi ◽  
Matteo Bartoli ◽  
Giacomo Placella ◽  
Andrea Speziali ◽  
Valerio Pace ◽  
...  
Keyword(s):  
Children And Adolescents ◽  
Medial Patellofemoral Ligament ◽  
Patellofemoral Instability ◽  
Rehabilitation Program ◽  
Mpfl Reconstruction ◽  
Anatomical Reconstruction ◽  
Targeted Interventions ◽  
Physeal Sparing ◽  
Patellar Stabilization ◽  
Bone Abnormalities

Patellofemoral problems are considered to be among the most frequent causes of knee pain in children and adolescents. Correcting bone abnormalities through specific and targeted interventions is mandatory in skeletally immature patients. Medial patellofemoral ligament (MPFL) reconstruction is the preferred procedure, but there are several important precautionary considerations that the surgeon must take into account. it must always be remembered that MPFL rupture is the result, not the cause, of an altered extensor mechanism; therefore, patellar stabilization with MPFL reconstruction is only the first step to be accomplished in the management of an MPFL rupture. If other anatomical alterations are encountered, alternative/additional surgical procedures should be considered. If MPFL rupture occurs without associated anatomical or functional knee alterations, an ap propriate rehabilitation program after MPFL reconstruction should be sufficient to achieve a good outcome.In conclusion, an acute patellar dislocation should be managed conservatively unless there is evidence of osteochondral damage or medial retinaculum lesions. Osseous procedures are contraindicated in children, while MPFL anatomical reconstruction with “physeal sparing” is the primary surgical option.

scholarly journals Medial patellofemoral ligament reconstruction using autologous hamstring graft for recurrent patellar dislocation: a clinical and functional outcome evaluation

2021 ◽  
Vol 7 (4) ◽  
pp. 854
Author(s):  
Sanjib Ghosh ◽  
Ayon Das ◽  
Mahak Baid ◽  
Arijit Das
Keyword(s):  
Patellar Dislocation ◽  
Medial Patellofemoral Ligament ◽  
Patellofemoral Instability ◽  
Outcome Evaluation ◽  
Mpfl Reconstruction ◽  
Anatomical Reconstruction ◽  
Complication Rates ◽  
Hamstring Graft ◽  
Recurrent Patellar Dislocation ◽  
Kujala Score

<p>Patellofemoral instability is a painful and often recurring disorder with many negative long-term consequences. Surgical treatment for patellar dislocation has evolved from the initial medial reefing to the present-day anatomical reconstruction of medial patellofemoral ligament (MPFL) which is thought to be the most appropriate treatment. MPFL reconstruction successfully addresses patellofemoral instability by restoring the deficient most important static primary soft tissue restraint. This prospective case series was conducted at a Tertiary care Govt. Hospital in Kolkata between January 2019 to August 2020 on 15 patients who underwent MPFL reconstruction for recurrent patellar dislocation. All patients were followed up at an interval of 2 weeks, 6 weeks, 3 months and 6 months. Kujala score was used to assess the functional outcomes of the patients. Out of 15 patients, 13 (86.7%) showed good to excellent results whereas 2 (13.3%) had Fair outcome and none of the patients demonstrated Poor surgical result. The mean Kujala score improved from 49.6 pre-operatively to 92.7 post-operatively. By the end of 6 months follow-up, 13 (86.7%) patients achieved almost full range of motion. Majority (80%) of patients did not have any complications. Only 2 patients had a post-operative recurrence (13.3%). Reconstruction of MPFL using autologous hamstring graft showed excellent results over the short term with a low re-dislocation rate and acceptable complication rates. It greatly helps in preventing further episodes of patellar subluxations or dislocations and in improving quality of life.</p>

scholarly journals 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

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.

Medial Patellofemoral Ligament Reconstruction for Adolescents With Acute First-Time Patellar Dislocation With an Associated Loose Body

2021 ◽  
pp. 036354652110135
Author(s):  
Pradyuma Gurusamy ◽  
Jason M. Pedowitz ◽  
Alyssa N. Carroll ◽  
Kristina Johnson ◽  
Henry G. Chambers ◽  
...  
Keyword(s):  
Patient Reported Outcomes ◽  
Patellar Dislocation ◽  
Medial Patellofemoral Ligament ◽  
Case Series ◽  
Loose Body ◽  
Mpfl Reconstruction ◽  
Return To Sports ◽  
Recurrent Instability ◽  
Patient Reported ◽  
First Time

Background: The management of adolescents with acute first-time patellar dislocation with an associated loose body remains a debated topic. The rate of recurrent dislocation in these patients may be up to 61% if the medial patellofemoral ligament (MPFL) is repaired or not addressed surgically. To our knowledge, a prospective evaluation of MPFL reconstruction for adolescents with acute first-time patellar dislocation with an associated chondral or osteochondral loose body has not been previously performed. Purpose/Hypothesis: The purpose of this study was to analyze patients with a first-time patellar dislocation who required surgery for a loose body, comparing those who underwent MPFL repair or no treatment with those who underwent MPFL reconstruction during the index procedure. The hypothesis was that performing MPFL reconstruction would reduce the rate of recurrent instability and improve patient-reported outcomes compared with MPFL repair or no treatment. A secondary objective was to report outcomes of those patients who underwent reconstruction versus those who did not. Study Design: Case series; Level of evidence, 4. Methods: This was a prospective analysis of adolescents treated with MPFL reconstruction for acute first-time patellar dislocation with associated loose bodies between 2015 and 2017 at a single pediatric level 1 trauma center with minimum 2-year follow-up. Retrospective analysis was previously performed for a similar cohort of adolescents treated with MPFL repair or no treatment. Patient characteristic data, radiographic measurements, and surgical variables were compared. Primary outcome measures included recurrent subluxation or dislocation and the need for further stabilization procedures. Secondary outcomes included Kujala score, Single Assessment Numeric Evaluation score, patient satisfaction, and ability to return to sport. Results: A total of 76 patients were included, 30 in the MPFL reconstruction cohort and 46 in the MPFL repair or no-treatment cohort. The only difference noted in patient characteristic, radiographic, or surgical variables was a smaller Insall-Salvati ratio in the reconstruction group (1.29 vs 1.42; P = .011). Compared with MPFL repair or no treatment, MPFL reconstruction was associated with less recurrent instability (10.0% vs 58.7%; P < .001), fewer secondary procedures (6.7% vs 47.8%; P < .001), and more frequent return to sports (66.7% vs 39.1%; P = .003). No differences in patient-reported outcomes were noted. Conclusion: Performing concomitant MPFL reconstruction in adolescents with first-time patellar dislocation and an intra-articular loose body results in a 5-fold reduction in recurrent instability, reduces the need for subsequent surgery, and improves patients’ ability to return to sports compared with repairing or not treating the MPFL.

scholarly journals Efficacy Study of Medial Patellofemoral Ligament Single-bundle Reconstruction with Anterior Half of the Peroneus Longus Tendon Autograft for Treatment of Recurrent Patellar Dislocation

2020 ◽  
Author(s):  
Junjun Zha ◽  
Tianwei Zhang ◽  
E Cai ◽  
Ju Tang
Keyword(s):  
Patellar Dislocation ◽  
Medial Patellofemoral Ligament ◽  
Mpfl Reconstruction ◽  
Lateral Release ◽  
Recurrent Patellar Dislocation ◽  
Peroneus Longus Tendon ◽  
Longus Tendon ◽  
Peroneus Longus ◽  
Anterior Half ◽  
Tendon Autograft

Abstract Background To report the clinical outcomes of a longitudinal patellar tunnel technique in reconstruction of the medial patellofemoral ligament(MPFL) with anterior half of the peroneus longus tendon autograft treatment of recurrent patellar dislocation.Methods From May 2010 to January 2019, we performed MPFL reconstruction with anterior half of the peroneus longus tendon autograft by using a longitudinal patellar tunnel technique on 48 knees in 45 patients(26 female, 19 male) with the median age was 24 (17 ~ 44) years old with recurrent patellar dislocation. We made one 4. 5 mm channel from the medial upper edge of the patella to the surface (medial half) of the patella so that to introduce autograft into the medial femoral channel. The autograft was fixed with absorbable screws with the knee bent at 30°. CT and X-rays were used to assess the correction of the tibia tuberosity- trochlear groove (TT-TG) distance, patellar tilt angle, Caton-Deschamps index, femoral anteversion angle, tibial extorsion angle, and the presence or absence of knee valgus. Subjective scores, such as Kujala score and Lysholm score, were used to evaluate knee function preoperatively and postoperatively.Results No recurrence of patellar dislocation occurred in these patients during an average of 25 ± 7.6 months (range, 6 to 54 months) of follow-up. Preoperative TT-TG distance, patellar tilt angles, and Caton-Deschamps index was (18.9 ± 5.7)mm(10.2mm ~ 32.4 mm),31.5°±13.7° (20.3°~58.4°),1.1 ± 0.2 (1.0 ~ 1.5), respectively, which were corrected by (10.8 ± 4.3) mm (4.5 mm ~ 17.1 mm), 10.7°±2.6° (5.6°~15.3°), and 1.07 ± 0.06 (1.02 ~ 1.15) postoperatively(P < 0.05). 28 knees were treated with lateral release + MPFL reconstruction; 11 knees were treated with lateral release + tibial tubercle ingression + MPFL reconstruction; 9 knees were treated with lateral release + tibial tubercle ingression and depression + MPFL reconstruction. At the last follow-up, Lysholm score was (89.7 ± 2.3), which significantly improved (P < 0.05) compared with the pre-operational score of (54.4 ± 5.9); Kujala score was (91.5 ± 4.4) points, which significantly improved (P < 0.05) compared with the pre-operational score of (60.6 ± 5.8).Conclusion One patellar tunnels in reconstruction of the medial patellofemoral ligament (MPFL) with anterior half of the peroneus longus tendon autograft is a safe, effective, and economic method for recurrent patellar dislocation.

scholarly journals 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 study

2021 ◽  
Author(s):  
Xiangtian Deng ◽  
Lingzhi Li ◽  
Peng Zhou ◽  
Yuan Li ◽  
Yanwei He ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Patellar Dislocation ◽  
Medial Patellofemoral Ligament ◽  
Genu Valgum ◽  
Mpfl Reconstruction ◽  
Ct Scans ◽  
Recurrent Patellar Dislocation ◽  
Derotation Osteotomy ◽  
The Mean

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 and genu valgum 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), 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. Results A total of 13 patients (13 knees) were included with an average follow-up period of 14.7 months (range 12–26). No cases of patients developed wound infection, soft tissue irritation, and recurrent 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, ICDC, Lysholom, and Tegner scores) improved significantly at the final follow-up after surgery (p < 0.05). The mean mLDFA changed significantly from 82.72°±3.27° to 88.63°±2.35°. The mean TT-TG distance significantly decreased from 19.63 ± 3.21 mm to 13.29 ± 2.78 mm, while the CDI did not change significantly after surgery (p༞0.05). The mean FAA significantly decreased from 32.77°±3.78° to 19.08°±3.14°, while the tibial torsion 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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