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

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

The Journal of Knee Surgery ◽

10.1055/s-0040-1713898 ◽

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.

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Anatomical Medial Patellofemoral Ligament Reconstruction for Recurrent Patella Dislocation: Two-Strand Grafts versus Four-Strand Grafts

The Journal of Knee Surgery ◽

10.1055/s-0039-1694039 ◽

2019 ◽

Author(s):

Jinghui Niu ◽

Wei Lin ◽

Qi Qi ◽

Jiangfeng Lu ◽

Yike Dai ◽

...

Keyword(s):

Tilt Angle ◽

Medial Patellofemoral Ligament ◽

Lysholm Score ◽

Mpfl Reconstruction ◽

Patella Dislocation ◽

Reconstruction Method ◽

Patellar Tilt ◽

Kujala Score ◽

Patellar Tilt Angle

AbstractThe purpose of this study was to describe two anatomical medial patellofemoral ligament (MPFL) reconstruction methods: reconstruction with two-strand grafts and reconstruction with four-strand grafts and to evaluate the clinical and radiological results. From January 2010 to January 2013, patients who sustained recurrent patella dislocation and met inclusion criteria were included in the study and divided into two groups randomly to undergo MPFL reconstruction either by two-strand grafts (T group) or four-strand grafts (F group). Patients were followed up 1 month, 1 year, 2 years, and 3 years postoperatively. The apprehension test was applied to test patella stability. The Kujala score, Lysholm score, and Crosby–Insall grading were used to evaluate the function of the affected knee. The patellar congruence and patellar tilt angle were used to measure the morphology of the patellofemoral joint. In addition, patients' subjective assessments and complications were recorded. Thirty-eight patients in T group and 38 patients in F group were followed for at least 36 months. The apprehension test was positive in all patients preoperatively but was negative at follow-up. The Kujala score, Lysholm score, patellar congruence angle, and the patellar tilt angle of patients in both groups improved significantly at 36-month follow-up when compared with those assessed preoperatively. However, patients in the F group achieved better clinical results in terms of Kujala score, patellar congruence angle, patellar tilt angle, and Crosby–Insall grading when compared with those in the T group 3 years after the operation. Most patients (92% of patients in the T group and 97% of patients in the F group) were satisfied with the surgery. The anatomical MPFL reconstruction with two-strand grafts or four-strand grafts were both safe techniques for recurrent patella dislocation with satisfactory clinical outcomes. The anatomical fixation with four-strand grafts achieved better clinical and radiographic results in the follow-up, which may be a better reconstruction method.

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

10.21203/rs.3.rs-123552/v1 ◽

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.

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Arthroscopic Medial Patellofemoral Ligament Insertion Reconstruction and Plication for Medial Patellar Retinaculum Using Suture Anchor in First Acute Patellar Dislocation

10.21203/rs.3.rs-1012304/v1 ◽

2021 ◽

Author(s):

Tao Xu ◽

Liuhai Xu ◽

Xinzhi Li ◽

You Zhou

Keyword(s):

Patellar Dislocation ◽

Medial Patellofemoral Ligament ◽

Suture Anchor ◽

Clinical Results ◽

Lateral Retinacular Release ◽

Patellar Tilt ◽

The Stability ◽

A Prospective Study ◽

Patellar Tilt Angle

Abstract Background: The objective of this study was to evaluate the clinical results of arthroscopic medial patellofemoral ligament (MPFL) insertion reconstruction and plication for medial patellar retinaculum using suture anchor combined with lateral retinacular release in first acute patellar dislocation (APD) with MPFL insertion injury in adolescents.Methods: A prospective study was performed between January 2016 and July 2019. The series included 61 cases of adolescent patients with first APD. There were 7 males and 54 females with an average age of 15.5 years (10 to 22). All cases were treated with arthroscopic suture anchor plication for medial patellar retinaculum combined with lateral retinacular release. Congruence angle (CA), lateral patellar angle (LPA), and patellar tilt angle (PTA) are measured by CT scan between last follow-up and preoperative. In addition, the patients were evaluated with the Lysholm and Kujala scores.Results: The average follow-up time was 40.9 months (24-60 months). All 61 knees showed excellent or good results postoperatively. The Lysholm score increased significantly from 58.6±8.1 to 91.9±5.0 at the last follow-up postoperatively (P<0.001 ). The Kujala scores increased significantly from 60.4±7.3 to 88.9±4.8 at the last follow-up postoperatively (P < 0.001). CA in 0° extension position was improved significantly from 19.8±2.1° preoperatively to -6.7±1.7° at the last follow-up (P<0.001), LPA was increased from -7.4±2.2° to 5.7±1.8° (P<0.001), and PTA was increased from 23.8±2.9° to 12.3 ±2.3° (P<0.001). The postoperative mean Lysholm and Kujala scores were 91.9 (81–100) and 88.9 (79–100), respectively.Conclusions: When the first APD occurs associated with the MPFL avulsed from the patella, the presented technique could not only reattach MPFL at the patellar border but also strengthen the medial patellar retinaculum. This anatomical repair technique can significantly improve the stability of the patella and has the advantage of being less invasive by the full-arthroscopic approach.

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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 study

10.21203/rs.3.rs-327972/v1 ◽

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

10.21203/rs.3.rs-529098/v1 ◽

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

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The 3-in-1 Procedure for Recurrent Dislocation of the Patella in Skeletally Immature Children and Adolescents

The American Journal of Sports Medicine ◽

10.1177/0363546509333480 ◽

2009 ◽

Vol 37 (9) ◽

pp. 1814-1820 ◽

Cited By ~ 48

Author(s):

Francesco Oliva ◽

Mario Ronga ◽

Umile Giuseppe Longo ◽

Vittorino Testa ◽

Giovanni Capasso ◽

...

Keyword(s):

Children And Adolescents ◽

Patellar Dislocation ◽

Case Series ◽

Skeletal Maturation ◽

Isokinetic Strength ◽

Skeletally Immature ◽

Recurrent Patellar Dislocation ◽

Level Of Evidence ◽

The Mean

Background Recurrent patellar dislocations are common injuries in children and adolescents. The subjective and functional results of soft tissue surgical management in a population that was skeletally immature at the time of surgery have not been reported. Hypothesis The 3-in-1 procedure is an effective treatment for recurrent patellar dislocation in skeletally immature patients. Study Design Case series; Level of evidence, 4. Methods Twenty-five skeletally immature patients (age at operation, 13.5 ± 3.8 years) who were practicing sports and suffering from recurrent unilateral patellar dislocation were included in the study and followed until skeletal maturation. Clinical evaluation included the modified Cincinnati rating system and the Kujala score, anthropometry, plain radiography, and isokinetic dynamometry. Results The average follow-up was 3.8 years (range, 2.5-6 years). The mean modified Cincinnati score increased from 51.7 ± 12.6 preoperatively to 94.3 ± 10.8 (P < .02), while the mean Kujala scores increased from 52.4 ± 12.7 preoperatively to 93.8 ± 14.2 (P < .02). The Insall-Salvati index remained essentially unchanged, being 1.04 ± 0.2 preoperatively and 1.02 ± 0.3 at latest follow-up. Significant differences were found between the operated and the contralateral limb in the various isokinetic strength variables at all angular velocities measured at the latest follow-up (.05 < P < .0042). Conclusion The 3-in-1 procedure is a safe, reliable management option for recurrent patellar dislocation in skeletally immature patients. Side-to-side differences in isokinetic strength and in anthropometric indices persist despite subjective success of the procedure.

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