Is Diagnostic Arthroscopy at the Time of Medial Patellofemoral Ligament Reconstruction Necessary?

Background: Although medial patellofemoral ligament (MPFL) reconstruction is well described for patellar instability, the utility of arthroscopy at the time of stabilization has not been fully defined. Purpose: To determine whether diagnostic arthroscopy in conjunction with MPFL reconstruction is associated with improvement in functional outcome, pain, and stability or a decrease in perioperative complications. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent primary MPFL reconstruction without tibial tubercle osteotomy were reviewed (96 patients, 101 knees). Knees were divided into MPFL reconstruction without arthroscopy (n = 37), MPFL reconstruction with diagnostic arthroscopy (n = 41), and MPFL reconstruction with a targeted arthroscopic procedure (n = 23). Postoperative pain, motion, imaging, operative findings, perioperative complications, need for revision procedure, and postoperative Kujala scores were recorded. Results: Pain at 2 weeks and 3 months postoperatively was similar between groups. Significantly improved knee flexion at 2 weeks was seen after MPFL reconstruction without arthroscopy versus reconstruction with diagnostic and reconstruction with targeted arthroscopic procedures (58° vs 42° and 48°, respectively; P = .02). Significantly longer tourniquet times were seen for targeted arthroscopic procedures versus the diagnostic and no arthroscopic procedures (73 vs 57 and 58 min, respectively; P = .0002), and significantly higher Kujala scores at follow-up were recorded after MPFL reconstruction without arthroscopy versus reconstruction with diagnostic and targeted arthroscopic procedures (87.8 vs 80.2 and 70.1, respectively; P = .05; 42% response rate). There was no difference between groups in knee flexion, recurrent instability, or perioperative complications at 3 months. Diagnostic arthroscopy yielded findings not previously appreciated on magnetic resonance imaging (MRI) in 35% of patients, usually resulting in partial meniscectomy. Conclusion: Diagnostic arthroscopy with MPFL reconstruction may result in findings not previously appreciated on MRI. Postoperative pain, range of motion, and risk of complications were equal at 3 months postoperatively with or without arthroscopy. Despite higher Kujala scores in MPFL reconstruction without arthroscopy, the relationship between arthroscopy and patient-reported outcomes remains unclear. Surgeons can consider diagnostic arthroscopy but should be aware of no clear benefits in patient outcomes.

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Age at Time of Surgery but Not Sex Is Related to Outcomes After Medial Patellofemoral Ligament Reconstruction

The American Journal of Sports Medicine ◽

10.1177/0363546519841371 ◽

2019 ◽

Vol 47 (7) ◽

pp. 1638-1644 ◽

Cited By ~ 2

Author(s):

Laurie A. Hiemstra ◽

Sarah Kerslake

Keyword(s):

Quality Of Life ◽

Medial Patellofemoral Ligament ◽

Trochlear Dysplasia ◽

Patellofemoral Instability ◽

Mpfl Reconstruction ◽

Linear Regression Models ◽

Level Of Evidence ◽

Time Of Surgery ◽

Patient Reported

Background: Medial patellofemoral ligament (MPFL) reconstruction has become a well-accepted procedure for recurrent patellofemoral instability. Despite a growing volume of research assessing surgical results, the relationship of age and sex to outcomes after MPFL reconstruction surgery is unclear. Purpose: To investigate whether age at the time of surgery or sex influenced patient-reported quality of life and clinical outcome after MPFL reconstruction for recurrent lateral patellofemoral instability. Study Design: Cohort study; Level of evidence, 3. Methods: Between January 2010 and May 2016, 328 patients underwent primary patellofemoral stabilization. Demographic and clinical data were collected preoperatively. Patients completed the Banff Patellofemoral Instability Instrument (BPII) at the pre- and postoperative visits and were assessed clinically at 12 and 24 months. To assess the effects of age at surgery and sex on BPII, multiple linear regression models were fit predicting BPII at 12 and 24 months. An unadjusted regression was applied with the predictors being age at the time of surgery and sex. A second regression model was applied adjusting for age at first dislocation, grade of trochlear dysplasia, knee hyperextension, and the WARPS/STAID score—a measure of the risky patellofemoral instability characteristics of the patient. Results: Of 328 patients, 298 (91%) had complete data and minimum 12-month BPII scores available for analysis. There were 11 redislocations in the cohort (3.4%), all in female patients. When stratified by sex, baseline characteristics were not statistically different except for higher age at first dislocation ( P = .022) as well as higher WARPS/STAID scores ( P = .006) for males. Age at the time of surgery was statistically significant for each postoperative follow-up, with lower BPII scores apparent for each 10-year increase in age at the time of surgery. In the adjusted model, the WARPS/STAID score was significantly associated with the preoperative BPII score. For the 24-month postoperative BPII scores, age at time of surgery and preoperative WARPS/STAID score were both significant. Lower BPII scores were apparent for each 10-year increase in age at the time of surgery, as well as for lower scores on the WARPS/STAID classification. Conclusion: This study demonstrated that when adjusted for risky pathoanatomy, neither age at first dislocation nor sex influences patient-reported quality of life outcomes after MPFL reconstruction. Age at the time of surgery was correlated with outcome, with lower BPII scores apparent for each 10-year increase in age at the time of MPFL reconstruction.

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Comparable outcome for autografts and allografts in primary medial patellofemoral ligament reconstruction for patellofemoral instability: systematic review and meta-analysis

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-021-06569-w ◽

2021 ◽

Author(s):

Filippo Migliorini ◽

Andromahi Trivellas ◽

Jörg Eschweiler ◽

Matthias Knobe ◽

Markus Tingart ◽

...

Keyword(s):

Medial Patellofemoral Ligament ◽

Meta Analysis ◽

Patellofemoral Instability ◽

Mpfl Reconstruction ◽

Current Evidence ◽

Level Of Evidence ◽

Feasible Alternative ◽

The Mean ◽

Persistent Instability

Abstract Purpose This study updates the current evidence on the role of allografts versus autografts for medial patellofemoral ligament (MPFL) reconstruction in patients with patellofemoral instability. Methods The study was performed according to the PRISMA guidelines. In March 2021, a literature search in the main online databases was performed. Studies reporting quantitative data concerning primary MPFL reconstruction using an allograft were considered for inclusion. The Coleman Methodology Score was used to assess the methodological quality of the selected articles. Results Data from 12 studies (474 procedures) were retrieved. The mean follow-up was 42.2 (15–78.5) months. The mean age was 21.1 ± 6.2 years. 64.9% (285 of 439) of patients were female. At the last follow-up, the Tegner (p < 0.0001), Kujala (p = 0.002) and the Lysholm (p < 0.0001) scores were minimally greater in the autografts. The similarity was found in the rate of persistent instability sensation and revision. The allograft group evidenced a lower rate of re-dislocations (p = 0.003). Conclusion Allografts may represent a feasible alternative to traditional autograft for MPFL reconstruction in selected patients with patellofemoral instability. Allograft tendons yielded similar PROMs, rates of persistent instability, and revision. Allograft reconstructions tended to have modestly lower re-dislocation rates. Level of evidence IV.

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Ability of Medial Patellofemoral Ligament Reconstruction to Overcome Lateral Patellar Motion in the Presence of Trochlear Flattening: A Cadaveric Biomechanical Study

The American Journal of Sports Medicine ◽

10.1177/03635465211041087 ◽

2021 ◽

pp. 036354652110410

Author(s):

Amrit V. Vinod ◽

Alex M. Hollenberg ◽

Melissa A. Kluczynski ◽

John M. Marzo

Keyword(s):

Repeated Measures ◽

Knee Flexion ◽

Medial Patellofemoral Ligament ◽

Operative Procedure ◽

Biomechanical Study ◽

Mpfl Reconstruction ◽

Trochlear Groove ◽

Sulcus Angle ◽

Fresh Frozen ◽

Patellar Stability

Background: Medial patellofemoral ligament (MPFL) reconstruction is an established operative procedure to restore medial restraining force in patients with patellar instability. In the setting of a shallow sulcus, it is unclear whether an isolated MPFL reconstruction is sufficient to restore patellofemoral stability. Hypothesis: Progressively increasing the sulcus angle would have an adverse effect on the ability of an MPFL reconstruction to restrain lateral patellar motion. Study Design: Controlled laboratory study. Methods: Seven fresh-frozen human cadaveric knees were harvested and prepared for experimentation. Each specimen was run through the following test conditions: native, lateral retinacular release, lateral retinacular repair, MPFL release, MPFL reconstruction, and MPFL reconstruction with trochlear flattening. Four 3-dimensional printed wedges (10°, 20°, 30°, and 40°) were created to insert beneath the native trochlea to raise the sulcus angle incrementally and simulate progressive trochlear flattening. For each test condition, the knee was positioned at 0°, 15°, 30°, and 45° of flexion, and the force required to displace the patella 1 cm laterally at 10 mm/s was measured. Group comparisons were made with repeated measures analysis of variance. Results: In the setting of an MPFL reconstruction, as the trochlear groove was incrementally flattened, the force required to laterally displace the patella progressively decreased. A 10° increase in the sulcus angle significantly reduced the force at 15° ( P = .01) and 30° ( P = .03) of knee flexion. The force required to laterally displace the patella was also significantly lower at all knee flexion angles after the addition of the 20°, 30°, and 40° wedges ( P≤ .05). Specifically, a 20° increase in the sulcus angle reduced the force by 29% to 36%; a 30° increase, by 35% to 43%; and a 40° increase, by 40% to 47%. Conclusion: Despite an MPFL reconstruction, the force required to laterally displace the patella decreased as the sulcus angle was increased in our cadaveric model. Clinical Relevance: An isolated MPFL reconstruction may not be sufficient to restore patellar stability in the setting of a shallow or flat trochlea. Patients with an abnormal sulcus angle may have recurrent instability postoperatively if treated with an isolated MPFL reconstruction.

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Medial Patellofemoral Ligament Reconstruction with and without Tibial Tubercle Osteotomy

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00307 ◽

2019 ◽

Vol 7 (7_suppl5) ◽

pp. 2325967119S0030

Author(s):

Seth L. Sherman ◽

John W. Welsh ◽

Joseph M. Rund ◽

Lasun O. Oladeji ◽

John R. Worley ◽

...

Keyword(s):

Soft Tissue ◽

Medial Patellofemoral Ligament ◽

Mpfl Reconstruction ◽

Tibial Tubercle ◽

Subjective Outcome ◽

Recurrent Instability ◽

Outcome Scores ◽

Tissue Stabilization

Objectives: 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. The role of tibial tubercle osteotomy (TTO) as an adjunct to MPFL reconstruction remains controversial. Our purpose was to evaluate a cohort of patella instability patients undergoing surgical soft tissue stabilization with or without concomitant TTO. Our hypothesis was that there would be no difference between cohorts in baseline values, subjective outcome scores at final follow-up, or complication profile. Methods: Following IRB approval, retrospective review of prospectively collected data identified a consecutive cohort of patients undergoing soft tissue stabilization for recurrent patella instability, with or without concomitant TTO. Indications for TTO were at the surgeon’s discretion, including elevated TT-TG, Caton-Deschamps ratio, and/or unloading chondral lesion(s). Surgery was performed by a single sports fellowship trained surgeon. Pre-surgical and post-surgical patient reported outcomes were collected including KOOS domains, PROMIS (global health, mental health, physical function, pain interference), IKDC, SANE, and Marx scores. Complications requiring re-operation (infection, stiffness, recurrent instability) were recorded. Results were analyzed statistically. Results: The cohort was comprised of 87 patients (95 knees), with 25 males (28.7%) and 62 females (71.3%). The MPFL-TTO cohort had 32 patients (38 knees) and the MPFL-Iso had 55 patients (57 knees). The average age of the MPFL-TTO cohort was 28.3 (range 19.5-44.6) and the average age of the MPFL-Iso group was 29.8 (18.7-55.3). There was no significant difference in pre-operation outcome scores between groups (p>.05). Significant improvements were seen for all KOOS domains in both patient cohorts with no significant differences detected between groups. SANE, IKDC, and PROMIS scores improved significantly with no differences detected between groups. Marx activity score at 6 months post-operatively was significantly different between the groups favoring the isolate MPFL reconstruction cohort. (MPFL-TTO 0.79 +/- 2.15 vs. 4.61 +/- 5.44 in the MPFL-Iso group (p=0.01)). In terms of complications, 4 knees in the MPFL-TTO group required further surgery (2 for stiffness, 1 for infection, and 1 for fracture) and 6 knees in the MPFL-Iso cohort required surgery (4 for stiffness, 1 for infection, and 1 for recurrent instability). Neither the overall complication rate of 4 vs. 6 (p=1) nor the recurrent instability rate of 0 vs. 1 (p=0.41) was significant. Conclusion: In a cohort of patients undergoing MPFL reconstruction, the addition of an appropriately indicated TTO appears to be both safe and effective. Both MPFL-TTO and MPFL-Iso groups demonstrated significant improvement in the majority of subjective outcome scores without major difference between groups. Marx activity scores were higher for the isolated MPFL reconstruction cohort at relatively short term follow-up. The surgical complication profile was similar between groups. Further work is needed to clearly define the role of TTO as an adjunct procedure to MPFL reconstruction.

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How Does Isolated Medial Patellofemoral Ligament Reconstruction Influence Patellar Height?

The American Journal of Sports Medicine ◽

10.1177/0363546520902132 ◽

2020 ◽

Vol 48 (4) ◽

pp. 895-900 ◽

Cited By ~ 1

Author(s):

Francesco Luceri ◽

Julien Roger ◽

Pietro Simone Randelli ◽

Sébastien Lustig ◽

Elvire Servien

Keyword(s):

Patellar Instability ◽

Medial Patellofemoral Ligament ◽

Case Series ◽

Patellofemoral Instability ◽

Patellar Height ◽

Patella Alta ◽

Level Of Evidence ◽

Normal Limits ◽

Patient Reported ◽

History Of

Background: Reconstruction of the medial patellofemoral ligament (MPFL) is the gold standard treatment for recurrent patellar dislocation. Patella alta has been reported in about half of patients with recurrent patellofemoral instability. Hypothesis: MPFL reconstruction (MPFLr) has a beneficial role in the correction of patellar height in patients with mild patella alta (Caton-Deschamps index [CDI] between 1.20 and 1.40). Study Design: Case series; Level of evidence, 4. Methods: Skeletally mature patients, with no history of previous or concomitant knee surgical procedures, who underwent isolated MPFLr using hamstring autograft for recurrent patellar instability between 2005 and 2018, were included in this study. The authors calculated CDI, modified Insall-Salvati index (MISI), and Blackburne-Peel index (BPI) ratios. Measurements done by 2 independent observers were calculated and used to compare pre- and postoperative patellar height (patella alta: CDI >1.20). Results: A total of 89 patients (95 knees) were included in the study, with a mean age of 25.0 years (range, 15.0-45.0 years). There were 70% women and 30% men. We found patella alta in 35.8% of cases preoperatively. Among them, 79.4% had reduced patellar height indices, within normal limits, postoperatively (mean follow-up, 18.4 ± 12.0 months). All the ratios showed a significant reduction in patellar height after surgery (CDI: 0.19 [range, –0.05, 0.60]; MISI: 0.22 [–0.14, 0.76]; BPI: 0.18 [–0.08, 0.59]; P < .00001). The CDI of 79.4% of the study knees was reduced to within normal limits postoperatively. The CDI was maintained within normal limits postoperatively in 93.4% of the knees with normal patellar height and reduced to normal in 50% of the knees with severe patella alta before surgery . No patient reported patella infera before surgery, whereas this condition was found in 8.2% of study patients postoperatively. A moderate correlation was reported between preoperative radiographic indices and their reduction after surgery (CDI: P < .001, ρ = 0.39; MISI: P < .001, ρ = 0.39; BPI: P < .001, ρ = 0.48). Conclusion: The higher the preoperative patellar height, the more important is the lowering effect of MPFLr using the hamstring for patellar instability. Bony procedures should not be indicated in patients with patellar instability and a CDI between 1.20 and 1.40.

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The Medial Patellofemoral Ligament Is a Dynamic and Anisometric Structure: An In Vivo Study on Length Changes and Isometry

The American Journal of Sports Medicine ◽

10.1177/0363546519840278 ◽

2019 ◽

Vol 47 (7) ◽

pp. 1645-1653 ◽

Cited By ~ 7

Author(s):

Willem A. Kernkamp ◽

Cong Wang ◽

Changzou Li ◽

Hai Hu ◽

Ewoud R.A. van Arkel ◽

...

Keyword(s):

Knee Flexion ◽

Medial Patellofemoral Ligament ◽

Length Change ◽

High Rate ◽

Mpfl Reconstruction ◽

Full Extension ◽

3 Dimensional ◽

Technical Errors ◽

Length Changes

Background: Medial patellofemoral ligament (MPFL) reconstruction is associated with a high rate of complications, including recurrent instability and persistent knee pain. Technical errors are among the primary causes of these complications. Understanding the effect of adjusting patellofemoral attachments on length change patterns may help surgeons to optimize graft placement during MPFL reconstruction and to reduce graft failure rates. Purpose: To determine the in vivo length changes of the MPFL during dynamic, weightbearing motion and to map the isometry of the 3-dimensional wrapping paths from various attachments on the medial femoral epicondyle to the patella. Study Design: Descriptive laboratory study. Methods: Fifteen healthy participants were studied with a combined computed tomography and biplane fluoroscopic imaging technique during a lunge motion (full extension to ~110° of flexion). On the medial femoral epicondyle, 185 attachments were projected, including the anatomic MPFL footprint, which was divided into 5 attachments (central, proximal, distal, posterior, and anterior). The patellar MPFL area was divided into 3 possible attachments (proximal, central, and distal). The length changes of the shortest 3-dimensional wrapping paths of the various patellofemoral combinations were subsequently measured and mapped. Results: For the 3 patellar attachments, the most isometric attachment, with an approximate 4% length change, was located posterior and proximal to the anatomic femoral MPFL attachment, close to the adductor tubercle. Attachments proximal and anterior to the isometric area resulted in increasing lengths with increasing knee flexion, whereas distal and posterior attachments caused decreasing lengths with increasing knee flexion. The anatomic MPFL was tightest in extension, decreased in length until approximately 30° of flexion, and then stayed near isometric for the remainder of the motion. Changing both the femoral and patellar attachments significantly affected the length changes of the anatomic MPFL ( P < .001 for both). Conclusion: The most isometric location for MPFL reconstruction was posterior and proximal to the anatomic femoral MPFL attachment. The anatomic MPFL is a dynamic, anisometric structure that was tight in extension and early flexion and near isometric beyond 30° of flexion. Clinical Relevance: Proximal and anterior MPFL tunnel positioning should be avoided, and the importance of anatomic MPFL reconstruction is underscored with the results found in this study.

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Intermediate-term Experience With the STAR Total Ankle in the United States

Foot & Ankle International ◽

10.1177/1071100718808743 ◽

2018 ◽

Vol 40 (3) ◽

pp. 268-275 ◽

Cited By ~ 2

Author(s):

Evan M. Loewy ◽

Thomas H. Sanders ◽

Arthur K. Walling

Keyword(s):

United States ◽

Perioperative Complications ◽

Case Series ◽

Major Complication ◽

The United States ◽

Complication Rates ◽

Level Of Evidence ◽

Patient Reported ◽

The Mean

Background: Limited intermediate and no real long-term follow-up data have been published for total ankle arthroplasty (TAA) in the United States. This is a report of clinical follow-up data of a prospective, consecutive cohort of patients who underwent TAA by a single surgeon from 1999 to 2013 with the Scandinavian Total Ankle Replacement (STAR) prosthesis. Methods: Patients undergoing TAA at a single US institution were enrolled into a prospective study. These patients were followed at regular intervals with history, physical examination, and radiographs; American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale scores were obtained and recorded. Primary outcomes included implant survivability and functional outcomes scores. Secondary outcomes included perioperative complications such as periprosthetic or polyethylene fracture. Between 1999 and 2013, a total of 138 STAR TAAs were performed in 131 patients; 81 patients were female. The mean age at surgery was 61.5 ± 12.3 years (range, 30-88 years). The mean duration of follow-up for living patients who retained both initial components at final follow-up was 8.8±4.3 years (range 2-16.9 years). Results: The mean change in AOFAS Ankle-Hindfoot scores from preoperative to final follow-up was 36.0 ± 16.8 ( P < .0001). There were 21 (15.2%) implant failures that occurred at a mean 4.9 ± 4.5 years postoperation. Ten polyethylene components in 9 TAAs (6.5%) required replacement for fracture at an average 8.9 ± 3.3 years postoperatively. Fourteen patients died with their initial implants in place. Conclusion: This cohort of patients with true intermediate follow-up after TAA with the STAR prosthesis had acceptable implant survival, maintenance of improved patient-reported outcome scores, and low major complication rates. Level of Evidence: Level IV, case series.

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Identifying Patients With Patella Alta and/or Severe Trochlear Dysplasia Through the Presence of Patellar Apprehension in Higher Degrees of Flexion

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120925486 ◽

2020 ◽

Vol 8 (6) ◽

pp. 232596712092548

Author(s):

Matthew Colatruglio ◽

David C. Flanigan ◽

Sarah Harangody ◽

Robert A. Duerr ◽

Christopher C. Kaeding ◽

...

Keyword(s):

Knee Flexion ◽

Patellar Instability ◽

Trochlear Dysplasia ◽

Patella Alta ◽

Tibial Tubercle ◽

Trochlear Groove ◽

Type B ◽

Level Of Evidence ◽

Sulcus Angle ◽

Recurrent Patellar Instability

Background: Recurrent patellar instability is frequently treated surgically with reconstruction of the medial patellofemoral ligament (MPFL). Patients with significant patella alta, trochlear dysplasia, and/or an elevated tibial tubercle–trochlear groove (TT-TG) distance may benefit from a concurrent bony procedure such as tibial tubercle osteotomy or trochleoplasty. The indications to perform such procedures are traditionally based on imaging criteria but remain controversial. Patellar apprehension is common in patients with patellar instability but typically resolves in higher degrees of knee flexion. Hypothesis: The persistence of patellar apprehension at greater than 60° of knee flexion is associated with patella alta, an increased TT-TG distance, and trochlear dysplasia. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 76 patients with recurrent patellar instability were prospectively identified in a sports medicine clinic. Patellar apprehension was evaluated in each patient. Apprehension was defined as the patient reporting that the patella felt unstable to lateral patellar translation. Apprehension was first assessed at full knee extension and repeatedly assessed as the knee was flexed in 10° intervals, as measured using a goniometer. The degree of flexion at which patellar apprehension disappeared was recorded. Plain radiographs and magnetic resonance imaging (MRI) scans were obtained for all patients. Patellar height was assessed with the Caton-Deschamps (CD) index, and trochlear morphology was assessed through measurements of the sulcus angle and depth on MRI and classified using the Dejour classification system. Imaging measurements of patients in whom apprehension resolved by 60° of knee flexion were compared with measurements for those with apprehension that persisted deeper into flexion. Results: Apprehension resolved by 60° of flexion in 56 patients and persisted into deeper flexion in 20 patients. The patients with a delayed resolution of apprehension demonstrated a higher CD index; elevated TT-TG distance; increased sulcus angle; decreased sulcus depth; and higher incidence of Dejour type B, C, or D dysplasia (all P < .05). Of the 20 patients with a delayed resolution of apprehension, 18 had either Dejour type B, C, or D dysplasia or a CD index of at least 1.30. A delayed resolution of apprehension was present in 11 of the 16 patients with Dejour type B, C, or D dysplasia. Conclusion: Overall, 90% of patients with significant patella alta and the majority of patients with high-grade trochlear dysplasia demonstrated patellar apprehension that persisted beyond 60° of knee flexion. Additionally, 90% of patients with persistent apprehension had significant patella alta and/or trochlear dysplasia. Further work is needed to evaluate the utility of these findings to inform surgical decision-making in this population.

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Postoperative Pain Is Correlated with Scaphoid Dorsal Translation following Scapholunate Interosseous Ligament Reconstruction

Journal of Wrist Surgery ◽

10.1055/s-0040-1713656 ◽

2020 ◽

Vol 9 (06) ◽

pp. 487-492

Author(s):

Emil S. Vutescu ◽

Scott W. Wolfe ◽

Kevin Sung ◽

Rishabh Jethanandani ◽

Steve K. Lee

Keyword(s):

Postoperative Pain ◽

Rating Scale ◽

Numerical Rating Scale ◽

Level Of Evidence ◽

Interosseous Ligament ◽

Statistical Correlations ◽

Pain Scores ◽

Radiographic Parameters ◽

Radiographic Measurements ◽

Patient Reported

Abstract Background Dorsal scaphoid translation (DST) has been demonstrated to occur in patients with complete scapholunate interosseous ligament (SLIL) tears. Radiographs and magnetic resonance imaging (MRI) have demonstrated ability to detect DST in patients with documented complete scapholunate (SL) disruption, but the relevance of this parameter to outcomes of reconstruction has not been determined. Purpose The purpose of this article is to determine how radiographic parameters of SL dissociation correlate with postoperative pain and functional outcomes of SLIL reconstruction. Methods We performed a retrospective review of prospectively collected data on a cohort of 14 patients who underwent SLIL repair or reconstruction. Preoperative data included radiographic measurements of carpal posture and alignment (SL angle, radiolunate [RL] angle, SL gap, and DST), self-reported measure of average pain on a numerical rating scale (NRS) of 0 to 10, and the patient rated wrist evaluation (PRWE) survey. Postoperatively, the same data were collected at each follow-up visit. Radiographic parameters were statistically compared with postoperative NRS pain score and PRWE scores. Statistical correlations were calculated using Spearman's correlation coefficient, and mean NRS pain scores were compared using Wilcoxon's rank-sum tests, with an α value of p = 0.05. Results Mean NRS pain scores improved significantly after surgery. Mean DST improved significantly after surgery. The presence of postoperative dorsal scaphoid translation (DST) correlated strongly with postoperative pain. SL angle, RL angle, and SL gap showed no correlation with patient reported pain. There was no correlation with any radiographic parameter and PRWE. Conclusions Our study demonstrates that the presence of DST in postoperative radiographs has a strong correlation with patient reported pain following SLIL reconstruction. We conclude that correction of dorsal translation of the scaphoid is a more sensitive predictor of postoperative pain relief than SL gap, RL angle, or SL angle. Level of evidence This is a Level IV study.

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Isolated Medial Patellofemoral Ligament Reconstruction for Patellar Instability Regardless of the Tibial Tubercle Trochlear Groove Distance: Outcomes at 1 and 2 Years

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118s00078 ◽

2018 ◽

Vol 6 (7_suppl4) ◽

pp. 2325967118S0007

Author(s):

Brandon J. Erickson ◽

Joseph Nguyen ◽

Katelyn Gasik ◽

Jacqueline Brady ◽

Beth E. Shubin Stein

Keyword(s):

Patellar Instability ◽

Medial Patellofemoral Ligament ◽

Trochlear Dysplasia ◽

Patellar Height ◽

Mpfl Reconstruction ◽

Tibial Tubercle ◽

Trochlear Groove ◽

One Year ◽

Recurrent Patellar Instability

Background: Several surgical options exist for treatment of recurrent patellar instability. The treatments can be divided into ligamentous and bony procedures. It is currently unclear which patients require a bony procedure in addition to a soft tissue reconstruction. Purpose: To report the one and two-year outcomes of patients following medial patellofemoral ligament (MPFL) reconstruction performed in isolation regardless of the patellar height, tibial tubercle trochlear groove distance (TT-TG) or trochlear dysplasia. Hypothesis:: Patients will have <5% re-dislocation rate and significant improvements in patient reported outcome measures (PROMs) following isolated MPFL reconstruction. Methods: All patients with recurrent patellar instability and without significant unloadable chondral defects, failed previous surgery or pain greater than or equal to 50% as their chief complaint, were prospectively enrolled beginning March of 2014. All patients underwent a primary, unilateral, isolated MPFL reconstruction regardless of concomitant bony pathology for treatment of recurrent patellar instability. Patients were followed at standard intervals. PROMs were collected at one year and two year follow up visits. Information on recurrent subjective instability, dislocations, and ability to return to sport (RTS) was recorded. TT-TG and patellar height (using the Caton-Deschamps index) were measured on magnetic resonance images. Results: Overall, 90 patients (77% female; average age 19.4 +/- 5.6 years) underwent a MPFL reconstruction from March 2014 to August 2017; 63 (70%) of whom reached one year follow up, and 35 of these patients (39%) reached 2-year follow-up. No patient experienced a redislocation; 96% of patients at one year and 100% of patients at two years had no subjective patellofemoral instability. RTS rates at one and two years were 59% and 75% respectively. No patient experienced a complication at one year. All patients had a clinically and statistically significant improvement from baseline to 1-year follow-up in the following PROMs: Knee injury and Osteoarthritis Outcome Score Quality of Life (KOOS QOL) (32.7 to 72.0; p<0.001), International Knee Documentation Committee (IKDC) (51.4 to 82.6; p<0.001) Kujala (62.2 to 89.5; p<0.001), and all general health PROM. No clinically and statistically significant change was seen between 1- and 2-year follow-ups in all outcome scores (all p>0.05). A non-statistically significant increase was seen in sporting activity of the Pediatric Functional Activity Brief Scale (Pedi-FABS) (13.9 to 16.7 p=0.292) at 2 years. Average patient satisfaction was 9.3 of 10 (10 being most satisfied) at 1- and 2-year follow-up. Average TT-TG was 15.1 +/- 4.0. Average patellar height was 1.25 +/- 0.17. Conclusion: Isolated MPFL reconstruction is an effective treatment for patellar instability and provides significant improvements in PROMs with a low redislocation/instability rate at early 1 and 2 year follow up, regardless of bony pathologies including TT-TG, Caton-Deschamps Index and trochlear dysplasia. The goal of this ongoing prospective study is to follow these patients out for 5 to 10 years to assess what radiologic and physical examination factors predict failure of isolated MPFL reconstruction.

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