Medial Patellofemoral Ligament Reconstruction in Traumatic Patellar Dislocation without Patellar Fixation

2019 ◽  
Vol 33 (10) ◽  
pp. 998-1003
Author(s):  
Samir Abdulrazik Ibrahim ◽  
Emad Mureed Shohdy ◽  
Sami Abdulghaffar Ramadan ◽  
Abdulrahman Khalid Almisfer ◽  
Wael Shoabe Abdulsattar ◽  
...  
Keyword(s):  
Patellar Dislocation ◽  
International Knee Documentation Committee ◽  
Clinical Results ◽  
Mpfl Reconstruction ◽  
Traumatic Rupture ◽  
Spontaneous Reduction ◽  
Kujala Score ◽  
History Of ◽  
Recurrent Patellar Instability

AbstractAcute traumatic patellar dislocation is a common injury, and spontaneous reduction may occur at the time of injury or may be reduced at the field of the accident by someone. It may be associated with osteochondral fractures and rupture of medial patellar stabilizers leading to recurrent patellar instability. The aim of this prospective study was to evaluate the outcomes of medial patellofemoral (PF) ligament (MPFL) reconstruction in recurrent traumatic patellar dislocation. Forty-five patients presented with PF instability as a result of traumatic rupture MPFL with normal patellar tracking underwent MPFL reconstruction without patellar fixation hardware through two parallel transpatellar tunnels and one screw in femoral tunnel. All patients were evaluated clinically preoperatively and at a minimum follow-up of 24 months, and International Knee Documentation Committee (IKDC) and Kujala scores were used to assess the clinical results. All patients were available for evaluation at a minimum of 24 months (up to 36 months). The mean age of these patients at the time of surgery was 22.82 years (range: 18–34 years). All patients gave history of trauma of their knees. Mean IKDC scale showed significant improvement as it rose from 47.17 preoperatively to 77.94 postoperatively, and mean Kujala score rose from 53.88 preoperatively to 86.24 postoperatively (p < 0.001). No recurrence of dislocation was recorded. Only three patients had mild atrophy of thigh and one patient had some difficulty in jumping. Reconstruction of MPFL by this method provides good clinical result in the treatment of PF instability by using autologous graft (semitendinosus and gracilis). Less hardware were used with less complications.

scholarly journals Early Results of Patients With Recurrent Patellar Instability Treated With MPFL Reconstruction

2017 ◽  
Vol 5 (2_suppl2) ◽  
pp. 2325967117S0004
Author(s):  
Ömer Naci Ergin ◽  
Mehmet Ekinci ◽  
Fuat Bilgili ◽  
Yücel Bilgin ◽  
Mehmet Aşık
Keyword(s):  
Patellar Dislocation ◽  
Patellar Instability ◽  
Mpfl Reconstruction ◽  
Activity Score ◽  
Vas Score ◽  
Early Results ◽  
Kujala Score ◽  
Patient Reported ◽  
Recurrent Patellar Instability

Introduction: MPFL reconstruction is an evidence-based and successful technique in treating patients with recurrent patellar instability without alignment problems or who have not yet undergone skeletal maturity for distal realignment surgery. Aim: The aim of this study is to report early results of patients who underwent MPFL reconstruction Method: 21 patients with lateral patellar instability who were treated with MPFL reconstruction using hamstring autogrefts in our clinic between 2012 and 2013 were evaluated. Mean age was 18.8 (8-32). Average age of first patellar dislocation was 13 (5-18). Patients’ history of complaints, pre and postoperative knee ROMs, patellofemoral pain scales, and patellofemoral instabilities were evaluated. These evaluations were done using Kujala score, İKDC (International Knee Documentation Committee) score, KOS(Knee Outcome Survey Activities Of Daily Living Score) score, Tegner activity score and VAS score. Results: 86% of our patient reported getting better with the surgery. The mean follow up was 25,2 months.Median Kujala score rose from 71 preop to 96 postop(p<0.05) and median İKDC score rose from 72 to 95(p<0.05). VAS score decreased from 3.4 to 1.2. KOS score was on average 83. Tegner activity score of our patients which was 2.57 preoperatively increased to 4.71. Only one patient had a decreased range of flexion (10 degrees on terminal flexion) and only one patient had persisting recurrent patellar dislocation (%4). The failure to treat this patient was attributed to his concurrent patologies consisting of patella alta, trochlear dysplasia and patellofemoral malalignment. Conclusion: MPFL reconstruction with hamstring autograft for treating patellar instability seems to be an effective surgical option according to early results. For late term results further follow-up is needed.

Clinical Outcomes and Predictive Factors for Failure With Isolated MPFL Reconstruction for Recurrent Patellar Instability: A Series of 211 Reconstructions With a Minimum Follow-up of 3 Years

2019 ◽  
Vol 47 (6) ◽  
pp. 1323-1330 ◽  
Author(s):  
Elliot Sappey-Marinier ◽  
Bertrand Sonnery-Cottet ◽  
Padhraig O’Loughlin ◽  
Herve Ouanezar ◽  
Levi Reina Fernandes ◽  
...  
Keyword(s):  
Patellar Instability ◽  
Trochlear Dysplasia ◽  
Patella Alta ◽  
Mpfl Reconstruction ◽  
Tibial Tubercle ◽  
Trochlear Groove ◽  
Kujala Score ◽  
The Mean ◽  
Recurrent Patellar Instability

Background: Reconstruction of the medial patellofemoral ligament (MPFL) is widely acknowledged as an integral part of the current therapeutic armamentarium for recurrent patellar instability. The procedure is often performed with concomitant bony procedures, such as distalization of the tibial tuberosity or trochleoplasty in the case of patella alta or high-grade trochlear dysplasia, respectively. At the present time, few studies have evaluated the clinical effectiveness of MPFL reconstruction as an isolated intervention. Purpose: To report the clinical outcomes of isolated MPFL reconstruction in cases of patellar instability and to identify predictive factors for failure. Study Design: Case series; Level of evidence, 4. Methods: A retrospective analysis of prospectively collected data was performed, including all patients who had undergone isolated MPFL reconstruction between January 2008 and January 2014. Preoperative assessment included the Kujala score, assessment of patellar tracking (“J-sign”), and radiographic features, such as trochlear dysplasia according to Dejour classification, patellar height with the Caton-Deschamps index (CDI), tibial tubercle–trochlear groove distance, and patellar tilt. The Kujala score was assessed postoperatively. Failure was defined by a postoperative patellar dislocation or surgical revision for recurrent patellar instability. Results: A total of 239 MPFL reconstructions were included; 28 patients (11.7%) were uncontactable and considered lost to follow-up. Thus, 211 reconstructions were analyzed with a mean follow-up of 5.8 years (range, 3-9.3 years). The mean age at surgery was 20.6 years (range, 12-48 years), and 55% of patients were male. Twenty-seven percent of patients had a preoperative positive J-sign, and 93% of patients had trochlear dysplasia (A, 47%; B, 25%; C, 15%; D, 6%). The mean CDI was 1.2 (range, 1.0-1.7); mean tibial tubercle–trochlear groove distance, 15 mm (range, 5-30 mm); and mean patellar tilt, 23° (range, 9°-47°). The mean Kujala score improved from 56.1 preoperatively to 88.8 ( P < .001). Ten failures were reported that required surgical revision for recurrent patellar instability (4.7%). Uni- and multivariate analyses highlighted 2 preoperative risk factors for failure: patella alta (CDI ≥1.3; odds ratio, 4.9; P = .02) and preoperative positive J-sign (odds ratio, 3.9; P = .04). Conclusion: In cases of recurrent patellar instability, isolated MPFL reconstruction would appear to be a safe and efficient surgical procedure with a low failure rate. Preoperative failure risk factors identified in this study were patella alta with a CDI ≥1.3 and a preoperative positive J-sign.

Arthroscopic Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Dislocation: Short-term Clinical Results

2020 ◽  
Author(s):  
Yong Huang ◽  
Yuan Yang ◽  
Mingjin Zhong ◽  
Fan Su ◽  
Jian Xu ◽  
...  
Keyword(s):  
Patellar Dislocation ◽  
Medial Patellofemoral Ligament ◽  
Recurrent Dislocation ◽  
Clinical Results ◽  
Recurrent Patellar Dislocation ◽  
Patellar Tilt ◽  
Kujala Score ◽  
The Mean ◽  
Tegner Score

Abstract The present study aimed to introduce a novel technique to reconstruct medial patellofemoral ligament (MPFL) via arthroscopy for recurrent patellar dislocation. A retrospective review of a prospectively collected registry was undertaken. A total of 34 patients (35 knees) who underwent arthroscopic reconstruction of MPFL from December 2017 to August 2019 were identified. Kujala score, Tegner score, Lyscholm score, patellar tilt, and congruence angle were recorded preoperatively and postoperatively. The occurrences of patient satisfaction, complications, and recurrent dislocation were recorded. The cohort consisted of both genders equally, and the mean age was 21.0±7.8 years, the mean body mass index was 22.5±3.5, and the mean follow-up time was 21.8±5.6 months. The patellar tiltdecreased from 46.4±19.3° to 12.5±16.9° (P < 0.001), the congruence angle decreased from 46.4±19.3° to 12.5±16.9° (P < 0.001), Kujala score improved from 55.1±4 to 88.7±4.4 (P < 0.001); Tegner score improved from 1.3±0.4 to 3.7±1.1 (P < 0.001), and Lyscholm score improved from 55.5±3.9 to 89.1±4.8 (P < 0.001). Among them, 30 (88.2%) patients fully recovered to normal pain-free daily life, 24 patients (70.6%) returned to sports, 32 patients were satisfied with surgery, and no redislocations were encountered. MPFL reconstruction via arthroscopy improves the knee joint function in patients with recurrent patellar dislocation and is a safe and effective surgical treatment for recurrent patellar dislocation.

scholarly journals Medial Patellofemoral Ligament Reconstruction

2017 ◽  
Vol 5 (1_suppl) ◽  
pp. 2325967117S0003
Author(s):  
Jose Antonio Palacios ◽  
Carlos Yacuzzi ◽  
Jose I. Oñativia ◽  
Juan Pablo Zicaro ◽  
Matias Costa-Paz
Keyword(s):  
Surgical Techniques ◽  
Return To Sport ◽  
Clinical Results ◽  
Mpfl Reconstruction ◽  
Score Improvement ◽  
Kujala Score ◽  
Semitendinosus Graft ◽  
Distal Realignment ◽  
Patellofemoral Dislocation

Objectives: Recurrent patellofemoral dislocation is usually a multifactorial pathology. Different surgical techniques have been described according to the etiology of dislocation. In absence of a severe malalignment or an anatomical patellofemoral dysplasia, reconstruction of Medial Patello-femoral Ligament (MPFL) can restore the normal tracking of the patella, avoiding lateral excursion. The purpose of this study was to evaluate clinical results and complications in patients who underwent a MPFL reconstruction. Methods: We retrospectively evaluated 19 patients who underwent an anatomic MPFL reconstruction using autologous semitendinosus graft between 2007 and 2012. Exclusion criteria were patients with less than three years of follow-up and those with an associated procedure such as distal realignment or trochleoplasty. Clinical outcomes were measured using Kujala score and return to sport rate. We registered the postoperative complications and recurrence rate. Results: Nine patients were men and 10 women with a mean age of 25 years. Average follow-up was 5.8 years. Nine patients (47.4%) returned to their previous sport level, 8 (42.1%) changed to another sport or decreased their level and 2 (10.5%) were unable to practice any sports at all. Kujala score improvement was from 62.8 preoperative to 88.8 postoperative. One patient decreased the Kujala score. Eighty-nine percent of patients were satisfied with their outcome. One patient had a patellar fracture and four developed an arthrofibrosis and required mobilization under anesthesia. No recurrences were registered. Conclusion: Isolated MPFL reconstruction for recurrent patellofemoral dislocation is an effective alternative in absence of severe malalignment or anatomical dysplasia. Although no recurrences where registered at minimum 3-year follow-up, almost half of the patients were not able to return to their previous sport level.

scholarly journals Medial Patellofemoral Ligament Reconstruction in Skeletally Immature Patients

2014 ◽  
Vol 2 (11_suppl3) ◽  
pp. 2325967114S0015
Author(s):  
Hüseyin Serhat Yercan ◽  
Gürler Kale ◽  
Serkan Erkan ◽  
Taçkın Özalp ◽  
Güvenir Okcu
Keyword(s):  
Medial Patellofemoral Ligament ◽  
Patellofemoral Instability ◽  
Clinical Results ◽  
Mpfl Reconstruction ◽  
Skeletally Immature ◽  
Open Physis ◽  
Kujala Score ◽  
Patellar Shift ◽  
Study Participants

Objectives: To evaluate the clinical outcome after medial patellofemoral ligament (MPFL) reconstruction for patellofemoral instability in skeletally immature patients. Methods: Study participants were 8 patients ( median age, 10 years; range, 5-14 and one male , others female) who had suffered from persistent patellofemoral instability. Our technique preserves femoral and patellar insertion anatomy of MPFL using a free semitendinosus autograft, together with tenodesis to the adductor magnus tendon thus sparing the open physis of distal femur and the patellar attachment of MPFL. The clinical results were evaluated preoperatively and the final follow-up period using the Kujala patellofemoral score. Patellar shift, tilt and height were measured preoperatively and on the latest follow-up on plain radiographs. Results: At average 42 months follow-up ( range, 16 to 56), %80 of patients were satisfied with the treatment. Redislocation or instability symptoms occurred in two patients. No apprehension signs or redislocations were seen in the remanining six patients. A significant improvement (p&#x2039;0.05) in Kujala score (from 36 to 77) was found. Patellar shift & tilt decreased to anatomic values in six patients but patella alta persisted. Conclusion: The result of this study show that MPFL reconstruction with our technique seems to be an effective treatment for recurrent and habitual patellofemoral dislocation in skeletally immature patients; leading to significant increases in stability and functionality.

scholarly journals Modified technique for medial patellofemoral ligament reconstruction – Its outcome with 2-year follow-up

2021 ◽  
Vol 2 ◽  
pp. 26-33
Author(s):  
Vatsal Khetan ◽  
Bhushan Sabnis ◽  
Sajeer Usman ◽  
Anant Joshi
Keyword(s):  
Functional Outcome ◽  
Surgical Procedure ◽  
Patellar Instability ◽  
Subjective Assessment ◽  
Mpfl Reconstruction ◽  
Modified Technique ◽  
Excellent Outcome ◽  
Kujala Score ◽  
Recurrent Patellar Instability

Objectives: The purpose of this study was to present our modified technique for MPFL reconstruction. We also present its functional outcome, complications, and patients’ satisfaction from the procedure. Materials and Method: This study is a retrospective analysis of prospectively collected data during the period of July 2015 and March 2019. Forty cases in patients with recurrent symptomatic patellar instability without a patellar fracture and who underwent isolated MPFL reconstruction were included in the study. Kujala scoring was done to assess the functional outcome at follow-up. Post-operative dislocation and apprehension were recorded in each case along with any complication. Patients were asked to complete a subjective questionnaire postoperatively during follow-up, to assess their satisfaction with the surgical procedure. Results: Pre-operative Kujala score was 45.85 which improved to 92.72 postoperatively at the time follow-up. The improvement in Kujala score was found to be highly significant (P < 0.01). Subjective assessment of the procedure: 72.5% of the patients had an excellent outcome. About 15% of the patients had a good outcome whereas 10% had a fair outcome. Only one patient had a poor outcome. Conclusion: In properly selected patients with recurrent patellar instability, isolated MPFL reconstruction appears to be a safe and efficient surgical procedure for the stabilization of patella, with a low failure rate. Consistent good results with early rehabilitation can be obtained using suture anchors to fix the implant on patella and using the described technique.

scholarly journals The Results of Recurrent Patellar Dislocation Treatment With MPFL Reconstruction in Adolescents With a Minimum Three-year Follow-up: A Prospective Study

2021 ◽  
Author(s):  
Krzysztof Małecki ◽  
Paweł Flont ◽  
Jacek Beczkowski ◽  
Wojciech Stelmach ◽  
Kryspin Ryszard Niedzielski
Keyword(s):  
Prospective Study ◽  
Patellar Dislocation ◽  
Pain Scale ◽  
Mpfl Reconstruction ◽  
Recurrent Patellar Dislocation ◽  
Patellar Tilt ◽  
Imaging Results ◽  
Kujala Score ◽  
Patellar Shift

Abstract PurposeThe aim of this prospective study is to perform a clinical and radiological assessment of the results of surgical treatment in a homogenous group of adolescents with recurrent patellar dislocation (RPD), using medial patellofemoral ligament (MPFL) reconstruction as the basic technique. MethodsTwenty-two patients reported to the follow-up examination after at least three years, including four patients who underwent bilateral surgery (26 knees). The mean age at the time of the surgery was 15.4 years. The subjects were asked to complete the Lysholm-Tegner Knee Scale and the Kujala Anterior Knee Pain Scale before surgery and after follow-up. Based on the imaging results, the Caton-Deschamps Index (CDI), congruence angle (CA), patellofemoral angle (PFA) and Wiberg classification of the patella shape were assessed. ResultsTwo incidents of patellar redislocation was noted. Both the Lysholm-Tegner and Kujala Scale scores significantly improved after follow-up (p<0.001). CDI did not change significantly (p=0.681). The values of both PFA and CA significantly decreased after surgery (p<0.001). An incorrect congruence angle (patellar shift) was present in 22 knees pre-op and ten post-op (p=0.002). Increased patellofemoral angle (patellar tilt) was present in 21 knees pre-op and seven post-op (p<0.001). A statistically significant correlation was demonstrated between PFA and both Lyscholm-Tegner and Kujala score (in both p<0.001, r=-0.5). A slight, but significant, correlation was found between CA and Kujala score (p=0.008, r= -0.036). ConclusionSurgical treatment causes a considerable improvement in the functional assessment of patients, as well as anatomical conditions within the patellofemoral joint.ClinicalTrials.gov record No PMMHRI-BCO.34/2019ClinicalTrials.gov Identifier: NCT03983213https://clinicaltrials.gov/ct2/show/NCT03983213Registered 06/12/2019 - Retrospectively registered

Effect of Isolated Medial Patellofemoral Ligament Reconstruction in Patellofemoral Instability Regardless of Predisposing Factors

2020 ◽  
Author(s):  
Jae Ik Lee ◽  
Mohd Shahrul Azuan Jaffar ◽  
Han Gyeol Choi ◽  
Tae Woo Kim ◽  
Yong Seuk Lee
Keyword(s):  
Medial Patellofemoral Ligament ◽  
Trochlear Dysplasia ◽  
Case Series ◽  
Patellofemoral Instability ◽  
International Knee Documentation Committee ◽  
Predisposing Factors ◽  
Mpfl Reconstruction ◽  
Patellar Tilt ◽  
Case Series Study

AbstractThe purpose of this study was to evaluate the outcomes of isolated medial patellofemoral ligament (MPFL) reconstruction, regardless of the presence of predisposing factors. A total of 21 knees that underwent isolated MPFL reconstruction from March 2014 to August 2017 were included in this retrospective series. Radiographs of the series of the knee at flexion angles of 20, 40, and 60 degrees were acquired. The patellar position was evaluated using the patellar tilt angle, sulcus angle, congruence angle (CA), and Caton-Deschamps and Blackburne-Peel ratios. To evaluate the clinical outcome, the preoperative and postoperative International Knee Documentation Committee (IKDC) and Lysholm knee scoring scales were analyzed. To evaluate the postoperative outcomes based on the predisposing factors, the results were separately analyzed for each group. Regarding radiologic outcomes, 20-degree CA was significantly reduced from 10.37 ± 5.96° preoperatively to −0.94 ± 4.11° postoperatively (p = 0.001). In addition, regardless of the predisposing factors, delta values of pre- and postoperation of 20-degree CA were not significantly different in both groups. The IKDC score improved from 53.71 (range: 18–74) preoperatively to 94.71 (range: 86–100) at the last follow-up (p = 0.004), and the Lysholm score improved from 54.28 (range: 10–81) preoperatively to 94.14 (range: 86–100) at the last follow-up (p = 0.010). Isolated MPFL reconstruction provides a safe and effective treatment for patellofemoral instability, even in the presence of mild predisposing factors, such as trochlear dysplasia, increased patella height, increased TT–TG distance, or valgus alignment. This is a Level 4, case series study.

scholarly journals Tunnel-enlargement after MPFL reconstruction with a free gracilis graft does correlation with proximal tunnel malposition

2017 ◽  
Vol 5 (4_suppl4) ◽  
pp. 2325967117S0014
Author(s):  
Efe Turgay ◽  
Almut Höger ◽  
Jens Figiel ◽  
Philip Roessler ◽  
Karl-Friedrich Schüttler ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Femoral Tunnel ◽  
Cartilage Damage ◽  
Clinical Results ◽  
Mpfl Reconstruction ◽  
Tunnel Enlargement ◽  
Tunnel Position ◽  
Femoral Tunnel Position ◽  
Femoral Tunnel Enlargement

Aims and Objectives: In current literature only one study investigates femoral tunnel enlargement after medial patello-femoral ligament (MPFL) reconstruction. Aim of the present study was to investigate the occurrence of femoral tunnel enlargement after MPFL reconstruction and a possible correlation to femoral tunnel position as well as clinical outcome. Materials and Methods: Patients with a minimum follow-up of at least 24 months after MPFL reconstruction with a free gracilis graft and without concomitant procedures were identified by reviewing patient files. Patients meeting the inclusion criteria were contacted and invited to participate in the study. After informed consent a clinical examination as well as magnetic resonance imaging (MRI) were performed. Tegner activity scale, Kujala score as well as the IKDC were evaluated. On MR images tunnel position in frontal and saggital planes, tunnel diameter as well as possible confounders such as cartilage damage were assessed. Results: 31 consecutive Patients (23 female, 8 male) were identified and took part in this ongoing investigation. Mean follow-up was 4.1 years. A femoral tunnel enlargement was noted in 12 patients. In 9 of these 12 patients the femoral tunnel was positioned too proximal. In the 19 patients that showed no tunnel enlargement only 6 tunnels were placed too proximal. Clinical results did not differ significantly between patient groups with or without tunnel enlargement regarding range of motion of the knee joint, Tegner, Kujala or IKDC score. Conclusion: Proximal malposition of the femoral tunnel was significantly more often in patients with femoral tunnel enlargement implying a biomechanical reason for tunnel enlargement after MPFL reconstruction. An impact on clinical outcome could not be perceived.

scholarly journals Results of a novel surgical technique for iridodialysis repair using segments

2021 ◽  
Author(s):  
Ugur Unsal ◽  
Huri Sabur ◽  
Mehmet Soyler
Keyword(s):  
Surgical Technique ◽  
Minimally Invasive ◽  
Clinical Results ◽  
Study Data ◽  
Invasive Technique ◽  
Minimally Invasive Surgical ◽  
Corrected Distance Visual Acuity ◽  
History Of ◽  
Surgical Manipulation

Abstract Purpose: To describe a novel surgical technique for iridodialysis repair using iris retractor segments and report its clinical results.Methods: 53 eyes of 53 patients who underwent surgery for iridodialysis repair were enrolled in this retrospective study. Data recorded from patient files consisted of age, sex, history of trauma, surgical indications and type of surgery, preoperative and postoperative corrected distance visual acuity (CDVA), intraocular pressure (IOP), complications, and follow-up time. The novel, minimally invasive surgical technique was explicitly described in detail.Results: Mean follow-up time was 34.4 (range 12-84) months. The subjects were 29 (54.7%) men and 26 (45.3%) women, and the mean age was 56.6±14.0 years. Iridodialysis repair performed using one segment in 37 (69.8%) eyes, two segments in 15 (28.3%) eyes, and three segments in 1 (1.9%) eye. Pupilloplasty was performed in 17 eyes due to wide pupil diameter. The iridodialysis repair was combined with lens removal in 48 eyes, and anterior vitrectomy was performed in 10 eyes. CDVA significantly improved after surgery (p<0.001). Post-traumatic IOP rise was the most common complication, and six patients needed medical therapy for glaucoma control.Conclusion: Iridodialysis repair using iris retractor segment is a minimally invasive technique and found to be safe and effective, providing less surgical manipulation and surgical time than other techniques.

Sign in / Sign up

Export Citation Format

Share Document