scholarly journals Lateral Retinaculum Lengthening and Medial Patellofemoral Ligament Reconstruction With Adductor Sling Technique

2021 ◽  
Vol 1 (4) ◽  
pp. 263502542110142
Author(s):  
Juan Pablo Martinez-Cano ◽  
Maria Antonia Gomez-Sierra ◽  
Andreu Castelo ◽  
Fernando Manuel Mejía
Keyword(s):  
Patellar Dislocation ◽  
Medial Patellofemoral Ligament ◽  
Soft Tissues ◽  
Return To Sport ◽  
Double Bundle ◽  
Minimum Length ◽  
Recurrent Patellar Dislocation ◽  
Lateral Tilt ◽  
Adductor Magnus ◽  
Lateral Retinaculum

Background: There are multiple ways of reconstructing the medial patellofemoral ligament (MPFL), including dynamic techniques that fix the graft to the adductor magnus tendon. We present this technique associated to an increasingly common surgery used as adjuvant in some patients with patellar instability, lateral retinaculum lengthening. Indications: Recurrent patellar dislocation with medial laxity and lateral tightness/lateral tilt. Technique Description: This is double bundle MPFL reconstruction with anterior tibialis tendon allograft. Both autograft or allograft may be used, with a minimum length of 15 cm. The graft is fixed to the proximal third of the patella, passing as a sling under the adductor magnus tendon where it is fixed with sutures and returns to the patella. The patellar fixation includes a 10 to 15 mm deep and 4 to 4.5 mm diameter tunnel in the proximal third with suture stitches to the soft tissues in the entrance of the tunnel, plus an anterior periostic tunnel for the second bundle in the proximal third of the patella fixed with suture stitches. Meanwhile, the lateral retinaculum is incised longitudinally into a superficial and deep layer, in order to lengthen it the desired length. Results: The expected outcome of the procedure is to have a stable patellofemoral joint, with patients that gain the lost function and may return to sport without recurrence of patellar dislocation. Discussion/Conclusion: This is a simple, cheap, and reproducible technique that corrects both medial laxity and lateral tightness for patients with recurrent patellar dislocation.

Return to Sport After Medial Patellofemoral Ligament Reconstruction: A Systematic Review and Meta-analysis

2021 ◽  
pp. 036354652199000
Author(s):  
Brooks N. Platt ◽  
Lucy A. Bowers ◽  
Justin A. Magnuson ◽  
Sean M. Marx ◽  
Joseph N. Liu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Patellar Dislocation ◽  
Patellar Instability ◽  
Medial Patellofemoral Ligament ◽  
Meta Analysis ◽  
Return To Sport ◽  
High Rate ◽  
Mpfl Reconstruction ◽  
Recurrent Patellar Dislocation ◽  
Preoperative Level

Background: Patellar instability is frequently encountered in the athletic population. Medial patellofemoral ligament (MPFL) reconstruction is a common strategy to treat recurrent patellar dislocation and demonstrates good clinical outcomes. Purpose/Hypothesis: The purpose was to examine return to sport after MPFL reconstruction for patellar instability. We hypothesized that patients would resume athletic activity at a high rate and that a large proportion would return to their preoperative level of performance. Study Design: Systematic review and meta-analysis. Methods: A systematic review of the literature was conducted using PubMed and Cochrane Library databases to identify articles reporting return to sport after MPFL reconstruction for recurrent patellar dislocation. Athletes were defined as those reporting a preoperative sport. A random-effects model was used to evaluate return to sport rates, subsequent level, and rate of instability recurrence. Meta-regression was used to compare return to sport rates in patients undergoing MPFL reconstruction without osteotomy compared with those treated with simultaneous tibial tubercle osteotomy or trochleoplasty. Results: In total, 23 articles met inclusion criteria after full-text review. A total of 930 patients were analyzed, including 786 athletes. Women represented 61.3% of all patients. The overall mean age was 21.1 years (range, 9.5-60.0 years), with a mean follow-up time of 3.0 years (range, 0.8-8.5 years). The return to sport rate was 92.8% (95% CI, 86.4-97.6). Patients returned to or surpassed their preoperative level of activity in 71.3% (95% CI, 63.7-78.4) of cases. An osteotomy was performed on 10.5% of athletes. Return to sport did not differ significantly in patients undergoing MPFL reconstruction without osteotomy versus those receiving additional osteotomy (95.4% vs 86.9%; P = .22). Patients returned to sport at a mean of 6.7 months (range, 3.0-6.4 months) postoperatively. Osteotomy did not affect return time. Complications occurred at an overall rate of 8.8%. The most common complication was recurrence of instability (1.9%; 95% CI, 0.4-4.0). The Kujala score was reported by 13 studies, with pre- and postoperative combined means of 60.3 and 90.0, respectively. Conclusion: MPFL reconstruction is an effective and reliable treatment in the setting of patellofemoral instability. Surgeons can counsel their patients that they can expect a high rate of return to sport after MPFL reconstruction surgery alone or with concomitant osteotomy.

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.

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