scholarly journals MPFL Reconstruction with TTT Versus TTT Alone for Recurrent Patella Instability

2016 ◽  
Vol 4 (2_suppl) ◽  
pp. 2325967116S0001
Author(s):  
Peter Annear ◽  
Iswadi Damasena ◽  
Murray Blythe ◽  
David Wysocki
Keyword(s):  
Mpfl Reconstruction ◽  
Patella Instability

scholarly journals Comparison of MPFL Repair Versus MPFL Reconstruction for Refractory Patella Instability in Patients Under 18 Years Old

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0018
Author(s):  
Seth L. Sherman ◽  
Derek W. Geeslin ◽  
Daniel W. Hogan ◽  
John W. Welsh ◽  
Joseph M. Rund ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Primary Repair ◽  
Mpfl Reconstruction ◽  
Patella Instability ◽  
Subjective Outcome ◽  
Recurrent Instability ◽  
Patient Reported ◽  
Outcome Scores ◽  
Reconstruction Group

Background: The medial patellofemoral ligament (MPFL) is the primary soft-tissue restraint against lateral patellar displacement. Surgery to address MPFL incompetence is the current gold standard for recurrent patellofemoral instability. In the young patient, controversy remains regarding the role of MPFL repair in the setting of recurrent patella instability. Hypothesis/Purpose: Our purpose was to investigate subjective outcomes and complication profile of consecutive cohorts under age 18 undergoing MPFL repair or MPFL reconstruction. Our hypothesis was that the MPFL reconstruction group would have higher subjective outcome scores and a lower complication profile. Methods: Following IRB approval, a retrospective review of prospectively collected data identified a consecutive cohort of patients undergoing soft tissue stabilization for recurrent patella instability. Surgery was performed by a single sports fellowship trained surgeon between 2011-2019. MPFL repair was performed on patients prior to November 2015 and MPFL reconstruction with allograft from December 2015 to present. Patients undergoing concomitant bony realignment procedures were included. Patient reported outcomes (PROs) were collected including PROMIS, KOOS, IKDC, Marx, Tegner, and SANE scores. Complications requiring re-operation (i.e., infection, stiffness, recurrent instability) were recorded. Results were analyzed statistically. Results: The cohort was comprised of 43 patients (53 knees), with 15 males (34.9%), and 28 females (65.1%). The MPFL-Repair cohort had 22 patients (24 knees) and the MPFL-Reconstruction had 25 patients (29 knees). The average age of the MPFL-Repair cohort was 14.82 (range 10.5-17.8) and the average age of the MPFL-Reconstruction group was 15.59 (13.0-17.7). At final follow-up (minimum 6 months), there were no statistically significant differences between cohorts for KOOS Pain (p=0.4126), KOOS symptoms (p=0.7990), KOOS ADL (p=0.4398), KOOS Sport Rec (p=0.3357), KOOS QOL (p=0.8707), Global Physical Health (p=0.9736), Global Mental Health (p=0.1724), Physical Function (p=0.8077), Pain Interference (p=0.9740), Mobility T-Score (p=0.0634), Marx activity score (p=0.0844), Tegner Score (p=0.0752), IKDC (p=0.2646), and SANE score (p=0.0811). Regarding complications requiring re-operation, there was 1 knee in the MPFL-Reconstruction group (3.4%) that required further surgery (1 for fracture) and 9 knees in the MPFL-Iso cohort (37.5%) that required re-operation (1 for fracture, 8 for recurrent instability). The difference in complication rate was statistically significant (p=0.0012). Conclusion: In patients under 18 years old undergoing surgery for refractory patella instability, both MPFL allograft reconstruction and MPFL primary repair demonstrated no difference in subjective outcome scores at midterm follow-up. MPFL primary repair had significantly increased rate of complication requiring re-operation, particularly recurrent patella instability requiring revision to MPFL reconstruction. Tables/Figures: [Table: see text][Table: see text][Table: see text]

scholarly journals Dynamic Medial Patellofemoral Ligament Reconstruction in Patellar Instability: A Surgical Technique

2021 ◽  
Vol 1 (6) ◽  
pp. 263502542110235
Author(s):  
Anna Bartsch ◽  
Sebastian Müller ◽  
Christian Egloff
Keyword(s):  
Surgical Technique ◽  
Patellar Instability ◽  
Medial Patellofemoral Ligament ◽  
Functional Results ◽  
Recurrent Dislocation ◽  
Interference Screw ◽  
Gracilis Muscle ◽  
Mpfl Reconstruction ◽  
Patella Dislocation ◽  
Patella Instability

Background: Patella instability with recurrent dislocations is a result of various pathologies, for example, patella alta, trochlea dysplasia or medial patellofemoral ligament (MPFL) rupture. The recurrent dislocation rate of conservatively treated chronic patellar instability is high; therefore, it is recommended to manage it surgically. This video presents a new operative approach to stabilize the patella in a dynamic MPFL reconstruction, which addresses the most common complications occurring in static reconstructions: malpositioning and overtensioning the graft. Indications: Surgical indications for the new dynamic procedure mirror the indications for static MPFL reconstruction. This is MPFL insufficiency (patella instability in the first 30° of knee flexion), which is most frequently seen in recurrent lateral patella dislocations. Moreover in very rare cases of first patella dislocation with a patellar instability severity score equal or higher than 4. Technique Description: The dynamic MPFL reconstruction consists of 3 steps: First, detaching and mobilizing the gracilis muscle at its anatomical insertion. Second, redirecting the freed gracilis muscle to its new patellar insertion. Third, reinserting the gracilis muscle at the patella. Results: The dynamic MPFL reconstruction has the advantage of lesser risk of overtensioning and malpositioning the graft. The insertion point of the MPFL surrogate is easier to locate, and the patella is dynamically stabilized through reflectory gracilis muscle contraction. Compared with the static reconstruction, only one instead of 3 holes have to be drilled and only 1 interference screw has to be placed, thus shortening the surgery time. From a theoretical biomechanical perspective, the dynamic tensioning is superior to the static procedure. The few accomplished studies published so far by Becher et al and Ostermeier et al show good or better functional results (Kujala, Lysholm, Tegner scores) with the dynamic MPFL reconstruction, yet higher evidence studies need to be performed. Conclusion: Dynamic MPFL reconstruction appears to be a simpler and more effective surgical technique for MPFL reconstruction. Because of its novelty, high evidence studies assessing long-term therapeutical outcomes are still lacking and need to be conducted in order to compare it conclusively with the static procedure.

scholarly journals Medial Patellofemoral Ligament Reconstruction Following Total Knee Arthroplasty: A Case Report

2016 ◽  
Vol 02 (01) ◽  
pp. e1-e3
Author(s):  
Vishal Mehta ◽  
David Morawski
Keyword(s):  
Total Knee Arthroplasty ◽  
Case Report ◽  
Knee Arthroplasty ◽  
Ligament Reconstruction ◽  
Medial Patellofemoral Ligament ◽  
Difficult Problem ◽  
Mpfl Reconstruction ◽  
Patella Instability ◽  
Total Knee ◽  
Component Revision

Patella instability is a rare but serious complication seen following total knee arthroplasty. The typical cause of patella instability in this setting is malpositioned components. While the mainstay of treatment is recognizing and correcting any malpositioning of the components, continued instability can remain and be a difficult problem to treat. Medial patellofemoral ligament (MPFL) reconstruction can be a helpful adjunct for the surgeon when faced with cases of continued instability. In this case report, we describe the successful use of MPFL reconstruction in conjunction with component revision for the treatment of postarthroplasty patella instability.

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 Interference Screw Versus Suture Anchors for Femoral Fixation in Medial Patellofemoral Ligament Reconstruction: A Biomechanical Study

2021 ◽  
Vol 9 (3) ◽  
pp. 232596712198928
Author(s):  
Heath P. Gould ◽  
Nicholas R. Delaney ◽  
Brent G. Parks ◽  
Roshan T. Melvani ◽  
Richard Y. Hinton
Keyword(s):  
Medial Patellofemoral Ligament ◽  
Interference Screw ◽  
Biomechanical Study ◽  
Graft Fixation ◽  
Mpfl Reconstruction ◽  
Suture Anchors ◽  
Femoral Fixation ◽  
Significant Difference ◽  
Load To Failure ◽  
The Mean

Background: Femoral-sided graft fixation in medial patellofemoral ligament (MPFL) reconstruction is commonly performed using an interference screw (IS). However, the IS method is associated with several clinical disadvantages that may be ameliorated by the use of suture anchors (SAs) for femoral fixation. Purpose: To compare the load to failure and stiffness of SAs versus an IS for the femoral fixation of a semitendinosus autograft in MPFL reconstruction. Study Design: Controlled laboratory study. Methods: Based on a priori power analysis, a total of 6 matched pairs of cadaveric knees were included. Specimens in each pair were randomly assigned to receive either SA or IS fixation. After an appropriate reconstruction procedure, the looped end of the MPFL graft was pulled laterally at a rate of 6 mm/s until construct failure. The best-fit slope of the load-displacement curve was then used to calculate the stiffness (N/mm) in a post hoc fashion. A paired t test was used to compare the mean load to failure and the mean stiffness between groups. Results: No significant difference in load to failure was observed between the IS and the SA fixation groups (294.0 ± 61.1 vs 250.0 ± 55.9; P = .352), although the mean stiffness was significantly higher in IS specimens (34.5 ± 9.6 vs 14.7 ± 1.2; P = .004). All IS reconstructions failed by graft pullout from the femoral tunnel, whereas 5 of the 6 SA reconstructions failed by anchor pullout. Conclusion: In this biomechanical study using a cadaveric model of MPFL reconstruction, SA femoral fixation was not significantly different from IS fixation in terms of load to failure. The mean load-to-failure values for both reconstruction techniques were greater than the literature-reported values for the native MPFL. Clinical Relevance: These results suggest that SAs are a biomechanically viable alternative for femoral-sided graft fixation in MPFL reconstruction.

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