scholarly journals Extensive Lateral Release and Medial Patello-femoral Ligament Reconstruction in 25 years of Chronic Fixed Lateral Patellar Dislocation: A 5 year follow up Case Report

2019 ◽  
Vol 7 (11_suppl6) ◽  
pp. 2325967119S0048
Author(s):  
Andri Lubis ◽  
Petrus Aprianto ◽  
Yudistira P. Siregar
Keyword(s):  
Case Report ◽  
Patellar Dislocation ◽  
Femoral Tunnel ◽  
Mpfl Reconstruction ◽  
Lateral Release ◽  
Modified Technique ◽  
Lateral Dislocation ◽  
Cortical Screw ◽  
Lateral Patellar Dislocation

Objectives: Chronically fixed lateral patellar dislocation is uncommon and mostly associated with disruption of the medial patellofemoral ligament (MPFL) which is a major risk factor for this condition, as it functions as the main patella medial stabilizer. This paper focuses on the reconstruction of the MPFL after an extensive lateral release in a fixed lateral patellar dislocation. We aim to explain the technique that was used to reduce and maintain the position of the patella and prevent it from re-dislocation. Extensive lateral release and modified MPFL reconstruction for a chronically fixed patellar lateral dislocation provide a satisfactory result. We aim to explain a modified technique to treat a chronically fixed patellar lateral dislocation Case presentation: We present a case report of a 49-year-old Caucasian male with a history of falling on his right knee 25 years before. He complained of pain on his knee for 8 months before. Physical examination showed chronically fixed lateral patellar dislocation with a normal range of motion. The diagnosis of patellar dislocation was confirmed with a conventional radiograph. The patient underwent extensive lateral release of the knee followed by a modified technique for MPFL reconstruction. Semitendinosus tendon was used as the graft because of the chronic nature of this condition. The graft was inserted into the patellar tunnel and fixed using endobutton®. The graft was inserted into the femoral tunnel that was made at Schottle point from the medial through the lateral side. After that, the cortical screw with the washer was inserted on the lateral femoral side just above the femoral tunnel as an anchor to make sure the tendon is secured. We follow-up the patient for 5 years. Results and Conclusion: On a 5 year follow-up, there was no complaint of recurrent patellar dislocation. The result of this extensive lateral release followed by modified MPFL reconstruction for a chronically fixed lateral patellar dislocation is satisfactory. The extensive release was needed to reduce the fixed dislocated patella and this modified technique of MPFL reconstruction by using screw and washer as an anchor on lateral sides of the femur could be an alternative to prevent re-dislocation.

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

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.

Medial Patellofemoral Ligament Reconstruction With a Divergent Patellar Transverse 2-Tunnel Technique

2011 ◽  
Vol 39 (12) ◽  
pp. 2647-2655 ◽  
Author(s):  
Alfredo Schiavone Panni ◽  
Mahbub Alam ◽  
Simone Cerciello ◽  
Michele Vasso ◽  
Nicola Maffulli
Keyword(s):  
Patient Satisfaction ◽  
Patellar Dislocation ◽  
Medial Patellofemoral Ligament ◽  
Mpfl Reconstruction ◽  
Patella Dislocation ◽  
Reconstruction Technique ◽  
Lateral Patellar Dislocation ◽  
Tunnel Technique ◽  
The Mean

Background: The medial patellofemoral ligament (MPFL) is the primary passive restraint to lateral patellar dislocation and there is increasing awareness of its role in recurrent lateral patellar instability. Purpose: This study was conducted to prospectively analyze the functional results of a modified MPFL reconstruction technique in recurrent patellar dislocation. Study Design: Case series; Level of evidence, 4. Methods: Forty-eight patients (51 knees) with at least 3 episodes of lateral patellar dislocation who had been treated with a 6-month rehabilitation protocol were included in this study. All patients practiced sports regularly. Reconstruction was with a semitendinosus tendon using a divergent 2-tunnel technique. Outcome was evaluated with the Kujala, Larsen, modified Lysholm, and Fulkerson outcome scores. Patient satisfaction with range of motion, pain, and sporting activities was also assessed. Results: Three patients were lost at the final follow-up, giving a follow-up rate of 94%. The mean follow-up was 33 months. There was no patella dislocation postoperatively. The mean Kujala score improved significantly ( P < .01) from 56.7 ± 17.7 (2 × standard deviation) preoperatively to 86.8 ± 14.4 postoperatively. The mean Larsen score improved significantly ( P < .01) from 12.4 ± 3.2 to 17.1 ± 2.7. The mean Fulkerson score improved significantly ( P < .01) from 59.2 ± 21.8 to 90.1 ± 14. The mean modified Lysholm score improved significantly ( P < .01) from 57.6 ± 19.6 to 88.1 ± 16.2. Sixty-four percent of patients returned to the same type of sport at the same level, 16% reduced the level or type of sport for reasons unrelated to the surgery, while 20% reduced the level of sport or changed it for reasons related to surgery. Eighty-seven percent were either satisfied or very satisfied with the pain relief achieved. The patellar tilt decreased significantly from a preoperative mean of 11.1° to 8.9° at the last follow-up ( P = .02). The mean preoperative Insall-Salvati ratio of 1.1 decreased to 1.06, although the change was not significant ( P = .1). Conclusion: The results of modified MPFL reconstructions are encouraging, with minimal risks of redislocation and an overall patient satisfaction rate of over 80%. These early and medium-term results are comparable with those of other MPFL reconstruction techniques reported in the literature.

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 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 Visualization of osteochondral fragments in the cavity of the knee joint in case of patellar dislocation in children

2021 ◽  
Vol 24 (5) ◽  
pp. 317-322
Author(s):  
Olga V. Bozhko ◽  
Tolibdzhon A. Akhadov ◽  
Ilya A. Melnikov ◽  
Dmitry M. Dmitrenko ◽  
Tatyana D. Kostikova ◽  
...  
Keyword(s):  
Patellar Dislocation ◽  
Outer Edge ◽  
Lateral Condyle ◽  
Mri Scan ◽  
Lateral Dislocation ◽  
Observation Methods ◽  
Lateral Patellar Dislocation ◽  
Extent Of Damage ◽  
Ct And Mri ◽  
Dislocation Of The Patella

The objective was to assess the capabilities of MRI and CT in visualizing free bone and cartilage fragments in the knee cavity after lateral dislocation of the patella. Materials and methods. CT and MRI were performed in 220 patients, including 127 girls and 93 boys aged 12 to 18 years (mean age 14.5 years), with acute lateral patellar dislocation. Results. Lateral dislocation of the patella in 25% of cases led to the appearance of osteochondral fragments. CT scan revealed and confirmed osteochondral fragments surgery in 55 people (100%), MRI scan - in 50 people (90%). The sites of the detachment of the osteochondral fragments were: a medial facet of the patella in 22 (38.8%), the outer edge of femur lateral condyle in 33 (58.2%), t patella and lateral condyle of the femur in 2 patients (3%). Free cartilage fragments not detected by CT were detected by MRI in 2 patients. Conclusion. Patellar dislocation is an injury that is likely to require surgery. The volume of osteochondral and soft tissue lesions can be established with the maximum degree of probability by MRI while detecting small osteochondral fragments is most reliable with CT. Combining these two observation methods provides the complete possible information about the extent of damage, which allows timely resolution of treatment tactics.

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.

Surgical Treatment With Closing-Wedge Distal Femoral Osteotomy for Recurrent Patellar Dislocation With Genu Valgum

2018 ◽  
Vol 46 (7) ◽  
pp. 1632-1640 ◽  
Author(s):  
Kyung Wook Nha ◽  
Yoonwon Ha ◽  
Seungmin Oh ◽  
Vivek P. Nikumbha ◽  
Sae Kwang Kwon ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Patellar Dislocation ◽  
Femoral Osteotomy ◽  
Genu Valgum ◽  
Lateral Release ◽  
Trochlear Groove ◽  
Recurrent Patellar Dislocation ◽  
Distal Femoral Osteotomy ◽  
The Mean

Background: Closing-wedge distal femoral osteotomy (CWDFO)—combined with medial reefing and lateral release, if necessary— has been used to treat recurrent patellar dislocation (RPD) with genu valgum. Purpose: To evaluate the clinical and radiologic outcomes of surgical treatment with CWDFO for treatment of RPD with genu valgum. Study Design: Case series; Level of evidence, 4. Methods: Fourteen consecutive patients (23 knees) with RPD and genu valgum were treated with CWDFO. Patients with a minimum 2-year follow-up period were eligible for this study. Patients with prior failed surgery were also eligible. Radiographic evaluation was performed with mechanical femorotibial and lateral distal femoral angle. The radiographic parameters presenting patellar positions and pathologic abnormalities associated with RPD were evaluated. Chondral lesion changes in second-look arthroscopic examination were examined, and clinical outcomes (eg, occurrence of redislocation, range of motion, and clinical scores) were assessed pre- and postoperatively at a minimum of 2 years. Results: At a mean follow-up of 30.7 months (range, 25-62 months), the mean mechanical femorotibial and mechanical lateral distal femoral angles changed significantly from valgus 5° (range, 2°-11°) to varus 3° (2°-11°; P < .001) and from 83° (range, 78°-86°) to 89° (84°-92°; P < .001), respectively. The mean patellar congruence angle improved from 40° lateral (range, 20°-53° lateral) to 4° medial (23° medial to 21° lateral; P < .001), as did the lateral patellofemoral angle from 26° (range, 8°-62°) to 9° (0°-15°; P < .001). Computed tomography scans showed that the mean distance of patellar lateral shift decreased from 13.5 mm (range, 4-22 mm) to 2.0 mm (–4 to 5 mm; P < .001). The mean tibial tubercle to trochlear groove distance significantly decreased from 20.4 to 13.5 mm ( P < .001), while the Caton-Deschamps ratio did not change significantly after surgery ( P = .984). Chondral lesions of the patella and trochlear groove significantly improved or were maintained. None of the patients experienced subluxation or redislocation after surgery. Patellar instability symptoms also improved, as validated by radiographic and other clinical outcomes. Conclusion: CWDFO combined with medial reefing and lateral release successfully treated RPD with genu valgum for a minimum follow-up of 2 years, with improved patellar alignment and stability.

scholarly journals Traumatic Patellar Dislocation and Cartilage Injury: A Follow-up Study of Long-Term Cartilage Deterioration

2017 ◽  
Vol 45 (6) ◽  
pp. 1376-1382 ◽  
Author(s):  
Essi E. Salonen ◽  
Teemu Magga ◽  
Petri J. Sillanpää ◽  
Tommi Kiekara ◽  
Heikki Mäenpää ◽  
...  
Keyword(s):  
Patellofemoral Joint ◽  
Patellar Dislocation ◽  
Cartilage Injury ◽  
Cartilage Lesions ◽  
Patellar Cartilage ◽  
Lateral Patellar Dislocation ◽  
First Time ◽  
And Cartilage

Background: Patellofemoral cartilage deterioration and osteoarthritis are reported to be associated with recurrent patellar dislocation. However, the association between first-time traumatic patellar dislocation and cartilage deterioration is unknown. Purpose: The aim of this study was to assess long-term cartilage deterioration in the patellofemoral and tibiofemoral joint after conservatively treated traumatic lateral patellar dislocation. Study Design: Case series; Level of evidence, 4. Methods: Twenty patients (mean age, 25 years) who sustained first-time traumatic lateral patellar dislocation with no previous patellofemoral instability symptoms were initially scanned with 1.5-T magnetic resonance imaging (MRI). A follow-up 3-T MRI was conducted, on average, 8 years after first-time lateral patellar dislocation. Subjective instability symptoms and Knee injury and Osteoarthritis Outcome Score were also assessed. Results: In the primary MRI, patellofemoral cartilage injury was seen in 14 of 20 patients (70%). Most (14/15) of the injuries were seen in the patellar cartilage, especially at the medial facet. On the follow-up MRI, patellofemoral cartilage deterioration was visible for all patients. The central patella ( P = .005) seemed especially prone to cartilage deterioration during the follow-up. Half of the patients (10/20) had grade 3-4 cartilage lesions in the patellofemoral joint in the follow-up MRI. In the primary MRI, only 1 patient exhibited tibiofemoral joint cartilage lesions, whereas at the time of follow-up, 10 of 20 patients exhibited tibiofemoral cartilage lesions. The majority of these lesions were considered clinically nonsignificant (International Cartilage Repair Society = 1) and were seen in the lateral compartment (6/10, 60%). Of the 14 patients (36%) with injury to the patellar cartilage, 5 reported subsequent instability of the patellofemoral joint, but this was not associated with more significant cartilage deterioration in the follow-up MRI compared with patients without redislocation. Conclusion: While recurrent lateral patellar dislocation is known to lead to degenerative process, a single first-time or infrequently recurring traumatic lateral patellar dislocation also seems to be associated with gradual cartilage deterioration. Traumatic lateral patellar dislocation might initiate gradual degeneration of the cartilage in the patellofemoral joint and can lead to the development of generalized knee osteoarthritis. Instability symptoms of the patellofemoral joint, however, were not related to the severity of the deterioration.

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