scholarly journals Medial patellofemoral ligament reconstruction using autologous hamstring graft for recurrent patellar dislocation: a clinical and functional outcome evaluation

2021 ◽  
Vol 7 (4) ◽  
pp. 854
Author(s):  
Sanjib Ghosh ◽  
Ayon Das ◽  
Mahak Baid ◽  
Arijit Das
Keyword(s):  
Patellar Dislocation ◽  
Medial Patellofemoral Ligament ◽  
Patellofemoral Instability ◽  
Outcome Evaluation ◽  
Mpfl Reconstruction ◽  
Anatomical Reconstruction ◽  
Complication Rates ◽  
Hamstring Graft ◽  
Recurrent Patellar Dislocation ◽  
Kujala Score

<p>Patellofemoral instability is a painful and often recurring disorder with many negative long-term consequences. Surgical treatment for patellar dislocation has evolved from the initial medial reefing to the present-day anatomical reconstruction of medial patellofemoral ligament (MPFL) which is thought to be the most appropriate treatment. MPFL reconstruction successfully addresses patellofemoral instability by restoring the deficient most important static primary soft tissue restraint. This prospective case series was conducted at a Tertiary care Govt. Hospital in Kolkata between January 2019 to August 2020 on 15 patients who underwent MPFL reconstruction for recurrent patellar dislocation. All patients were followed up at an interval of 2 weeks, 6 weeks, 3 months and 6 months. Kujala score was used to assess the functional outcomes of the patients. Out of 15 patients, 13 (86.7%) showed good to excellent results whereas 2 (13.3%) had Fair outcome and none of the patients demonstrated Poor surgical result. The mean Kujala score improved from 49.6 pre-operatively to 92.7 post-operatively. By the end of 6 months follow-up, 13 (86.7%) patients achieved almost full range of motion. Majority (80%) of patients did not have any complications. Only 2 patients had a post-operative recurrence (13.3%). Reconstruction of MPFL using autologous hamstring graft showed excellent results over the short term with a low re-dislocation rate and acceptable complication rates. It greatly helps in preventing further episodes of patellar subluxations or dislocations and in improving quality of life.</p>

scholarly journals Functional outcome and prognostic implications in patellofemoral instability using Elmslie-Trillat and MPFL reconstruction procedures

2019 ◽  
Vol 2 (2) ◽  
pp. 75-83
Author(s):  
Georgian Iacobescu ◽  
Cătălin Cîrstoiu ◽  
Adrian Cursaru ◽  
Dan Anghelescu ◽  
Dumitru Stănculescu
Keyword(s):  
Functional Outcome ◽  
Patellar Dislocation ◽  
Patellofemoral Instability ◽  
Mpfl Reconstruction ◽  
Ct Scans ◽  
Recurrent Patellar Dislocation ◽  
Kujala Score ◽  
Group 2 ◽  
The Impact ◽  
Group 1

AbstractIntroduction. Patellofemoral instability is a troublesome condition that results in significant morbidity, frequently associated with persistent anterior knee pain, long-term osteoarthritis and reduced quality of life.Purpose. The purpose of this study was to describe functional outcomes following surgical treatment of patients who underwent Elmslie-Trillat procedure and reconstruction of medial patellofemoral ligament (MPFL) correlated with Elmslie-Trillat in the treatment of recurrent patellar dislocation and subluxation.Methods. We prospectively followed 23 patients (24 knees) with patellofemoral instability who underwent realignment surgery procedures between 2015 and 2017, 14 knees by the Elmslie-Trillat procedure (Group 1) and 10 knees by Elmslie-Trillat combined with MPFL reconstruction (Group 2). The patients were evaluated pre and postoperatively by clinical examination, knee radiographs, CT scans and functional outcome Kujala score.Results. At a follow up period of 2 years, the apprehension sign remained positive in 6 knees in Group 1, and only one in Group 2. On the skyline radiographs and axial CT scans, stability was significantly better in group 2 than in group 1. The mean Kujala score was 65.2+/ -9.39 points in group 1, and 87.1+/ -6.43 points in group 2, at 2 years evaluation, significantly higher than before surgery. No patient developed osteoarthritis while being followed up.Conclusion. Based on these findings, we were able to conclude that the reconstruction of the MPFL combined with the osteotomy of distal tuberosity is a useful treatment of recurrent patellar dislocation and subluxation. However, further studies are needed to assess the impact of the realignment procedures in the prevention of joint degeneration.

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 Acute patellofemoral instability in children and adolescents

Joints ◽  
2016 ◽  
Vol 04 (01) ◽  
pp. 047-051 ◽  
Author(s):  
Pierluigi Antinolfi ◽  
Matteo Bartoli ◽  
Giacomo Placella ◽  
Andrea Speziali ◽  
Valerio Pace ◽  
...  
Keyword(s):  
Children And Adolescents ◽  
Medial Patellofemoral Ligament ◽  
Patellofemoral Instability ◽  
Rehabilitation Program ◽  
Mpfl Reconstruction ◽  
Anatomical Reconstruction ◽  
Targeted Interventions ◽  
Physeal Sparing ◽  
Patellar Stabilization ◽  
Bone Abnormalities

Patellofemoral problems are considered to be among the most frequent causes of knee pain in children and adolescents. Correcting bone abnormalities through specific and targeted interventions is mandatory in skeletally immature patients. Medial patellofemoral ligament (MPFL) reconstruction is the preferred procedure, but there are several important precautionary considerations that the surgeon must take into account. it must always be remembered that MPFL rupture is the result, not the cause, of an altered extensor mechanism; therefore, patellar stabilization with MPFL reconstruction is only the first step to be accomplished in the management of an MPFL rupture. If other anatomical alterations are encountered, alternative/additional surgical procedures should be considered. If MPFL rupture occurs without associated anatomical or functional knee alterations, an ap propriate rehabilitation program after MPFL reconstruction should be sufficient to achieve a good outcome.In conclusion, an acute patellar dislocation should be managed conservatively unless there is evidence of osteochondral damage or medial retinaculum lesions. Osseous procedures are contraindicated in children, while MPFL anatomical reconstruction with “physeal sparing” is the primary surgical option.

scholarly journals Medial patellofemoral ligament reconstruction for patellofemoral instability: a new surgical technique

2021 ◽  
Vol 7 (4) ◽  
pp. 843
Author(s):  
Shreekantha K. S. ◽  
Mohammed Usman ◽  
Deepak Malik ◽  
Mahammad Aseem ◽  
Mohammad Gous Mulla
Keyword(s):  
Surgical Technique ◽  
Functional Outcome ◽  
Ligament Reconstruction ◽  
Medial Patellofemoral Ligament ◽  
Patellofemoral Instability ◽  
Lysholm Score ◽  
Mpfl Reconstruction ◽  
Kujala Score ◽  
New Surgical Technique

<p class="abstract"><span lang="EN-US">The purpose of this study was to present new surgical technique for MPFL reconstruction. We also describe its functional outcome, complications, and the advantages of the procedure. This study is a prospective analysis of collected data during the period of august 2018 to January 2020. Ten cases of patients with recurrent symptomatic patellar instability and who underwent isolated MPFL reconstruction were included in the study. Kujala scoring and lysholm scoring was done to assess the functional outcome at follow-up. Post-operative dislocation and apprehension were recorded in each case along with any complication. Pre-operative Kujala score was 36.80 which improved to 89.80 postoperatively at the time follow-up. Pre-operative lysholm score was 36.80 which improved to 92.70 postoperatively at the time follow-up. The improvement in Kujala score and Lysholm score was found to be highly significant (p&lt;0.01). We have done a simple technique where MPFL is reconstructed anatomically to restore kinematics and stability. Consistent good results with early rehabilitation can be obtained using the described technique.</span></p>

scholarly journals 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

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.

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

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.

scholarly journals Medial Patellofemoral Ligament Reconstruction in Skeletally Immature Patients

2014 ◽  
Vol 2 (11_suppl3) ◽  
pp. 2325967114S0015
Author(s):  
Hüseyin Serhat Yercan ◽  
Gürler Kale ◽  
Serkan Erkan ◽  
Taçkın Özalp ◽  
Güvenir Okcu
Keyword(s):  
Medial Patellofemoral Ligament ◽  
Patellofemoral Instability ◽  
Clinical Results ◽  
Mpfl Reconstruction ◽  
Skeletally Immature ◽  
Open Physis ◽  
Kujala Score ◽  
Patellar Shift ◽  
Study Participants

Objectives: To evaluate the clinical outcome after medial patellofemoral ligament (MPFL) reconstruction for patellofemoral instability in skeletally immature patients. Methods: Study participants were 8 patients ( median age, 10 years; range, 5-14 and one male , others female) who had suffered from persistent patellofemoral instability. Our technique preserves femoral and patellar insertion anatomy of MPFL using a free semitendinosus autograft, together with tenodesis to the adductor magnus tendon thus sparing the open physis of distal femur and the patellar attachment of MPFL. The clinical results were evaluated preoperatively and the final follow-up period using the Kujala patellofemoral score. Patellar shift, tilt and height were measured preoperatively and on the latest follow-up on plain radiographs. Results: At average 42 months follow-up ( range, 16 to 56), %80 of patients were satisfied with the treatment. Redislocation or instability symptoms occurred in two patients. No apprehension signs or redislocations were seen in the remanining six patients. A significant improvement (p&#x2039;0.05) in Kujala score (from 36 to 77) was found. Patellar shift & tilt decreased to anatomic values in six patients but patella alta persisted. Conclusion: The result of this study show that MPFL reconstruction with our technique seems to be an effective treatment for recurrent and habitual patellofemoral dislocation in skeletally immature patients; leading to significant increases in stability and functionality.

scholarly journals Efficacy Study of Medial Patellofemoral Ligament Single-bundle Reconstruction with Anterior Half of the Peroneus Longus Tendon Autograft for Treatment of Recurrent Patellar Dislocation

2020 ◽  
Author(s):  
Junjun Zha ◽  
Tianwei Zhang ◽  
E Cai ◽  
Ju Tang
Keyword(s):  
Patellar Dislocation ◽  
Medial Patellofemoral Ligament ◽  
Mpfl Reconstruction ◽  
Lateral Release ◽  
Recurrent Patellar Dislocation ◽  
Peroneus Longus Tendon ◽  
Longus Tendon ◽  
Peroneus Longus ◽  
Anterior Half ◽  
Tendon Autograft

Abstract Background To report the clinical outcomes of a longitudinal patellar tunnel technique in reconstruction of the medial patellofemoral ligament(MPFL) with anterior half of the peroneus longus tendon autograft treatment of recurrent patellar dislocation.Methods From May 2010 to January 2019, we performed MPFL reconstruction with anterior half of the peroneus longus tendon autograft by using a longitudinal patellar tunnel technique on 48 knees in 45 patients(26 female, 19 male) with the median age was 24 (17 ~ 44) years old with recurrent patellar dislocation. We made one 4. 5 mm channel from the medial upper edge of the patella to the surface (medial half) of the patella so that to introduce autograft into the medial femoral channel. The autograft was fixed with absorbable screws with the knee bent at 30°. CT and X-rays were used to assess the correction of the tibia tuberosity- trochlear groove (TT-TG) distance, patellar tilt angle, Caton-Deschamps index, femoral anteversion angle, tibial extorsion angle, and the presence or absence of knee valgus. Subjective scores, such as Kujala score and Lysholm score, were used to evaluate knee function preoperatively and postoperatively.Results No recurrence of patellar dislocation occurred in these patients during an average of 25 ± 7.6 months (range, 6 to 54 months) of follow-up. Preoperative TT-TG distance, patellar tilt angles, and Caton-Deschamps index was (18.9 ± 5.7)mm(10.2mm ~ 32.4 mm),31.5°±13.7° (20.3°~58.4°),1.1 ± 0.2 (1.0 ~ 1.5), respectively, which were corrected by (10.8 ± 4.3) mm (4.5 mm ~ 17.1 mm), 10.7°±2.6° (5.6°~15.3°), and 1.07 ± 0.06 (1.02 ~ 1.15) postoperatively(P < 0.05). 28 knees were treated with lateral release + MPFL reconstruction; 11 knees were treated with lateral release + tibial tubercle ingression + MPFL reconstruction; 9 knees were treated with lateral release + tibial tubercle ingression and depression + MPFL reconstruction. At the last follow-up, Lysholm score was (89.7 ± 2.3), which significantly improved (P < 0.05) compared with the pre-operational score of (54.4 ± 5.9); Kujala score was (91.5 ± 4.4) points, which significantly improved (P < 0.05) compared with the pre-operational score of (60.6 ± 5.8).Conclusion One patellar tunnels in reconstruction of the medial patellofemoral ligament (MPFL) with anterior half of the peroneus longus tendon autograft is a safe, effective, and economic method for recurrent patellar dislocation.

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