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

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.

Download Full-text

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

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119900373 ◽

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.

Download Full-text

Comparison of Clinical and Radiological Outcomes Between Transosseous Tunnel and Suture Anchor Patellar Fixation for Medial Patellofemoral Ligament Reconstruction: A Cohort Study With 2-Year Follow-up

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120917660 ◽

2020 ◽

Vol 8 (5) ◽

pp. 232596712091766

Author(s):

Kyoung Ho Yoon ◽

Eung Ju Kim ◽

Yoo Beom Kwon ◽

In Uk Hwang ◽

Sang-Gyun Kim

Keyword(s):

Clinical Outcomes ◽

Ligament Reconstruction ◽

Medial Patellofemoral Ligament ◽

Suture Anchor ◽

Patellar Tilt ◽

Lower Complication ◽

Lower Complication Rate ◽

Osteoarthritis Progression ◽

Patellar Tilt Angle

Background: Several surgical methods have been developed for medial patellofemoral ligament reconstruction (MPFLR). However, the question of which patellar fixation method, suture anchor (SA) or transosseous tunnel (TO) fixation, achieves better overall outcomes remains to be answered. Hypothesis: SA patellar fixation will present comparable clinical outcomes and a lower complication rate compared with TO patellar fixation for MPFLR. Study Design: Cohort study; Level of evidence, 3. Methods: We retrospectively reviewed the outcomes of 46 patients who underwent MPFLR with either TO fixation (n = 21; mean age, 24.4 ± 6.1 years) or SA fixation (n = 25; mean age, 24.1 ± 12.1 years) for the treatment of recurrent patellar dislocation. Clinical findings (International Knee Documentation Committee [IKDC] subjective score, Lysholm score, and Tegner activity score), radiological findings (congruence angle and patellar tilt angle), and complications (redislocation, patellar fracture, patellofemoral osteoarthritis progression, infection, and stiffness) were compared between the TO and SA groups at the 2-year follow-up visit. Results: The mean postoperative IKDC subjective and Lysholm scores did not differ significantly between groups. However, postoperative Tegner activity scores were significantly higher in the TO group than in the SA group (TO, 5.8 ± 1.4; SA, 4.9 ± 1.2; P = .012). Congruence angle did not differ significantly between the groups (TO, −3.2 ± 22.8; SA, −7.6 ± 17.8; P = .464). Patellar tilt angle was lower in the TO group than in the SA group (TO, 10.5 ± 5.4; SA, 13.7 ± 2.8; P = .015). During the follow-up period, the TO group had 1 redislocation and 2 patellar fractures, whereas the SA group had no redislocations or fractures. Patellofemoral osteoarthritis progression was significantly higher in the TO group than in the SA group at the 2-year follow-up visit (TO, 9/21; SA, 2/25; P = .006). Conclusion: Both TO and SA patellar fixation methods for MPFLR showed improved clinical outcomes. When compared with TO fixation, SA fixation presented comparable clinical outcomes and a lower complication rate.

Download Full-text

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.

Download Full-text

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.

Download Full-text

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.

Download Full-text

Repair of Distal Biceps Tendon Ruptures Using a Suture Anchor and an Anterior Approach

Journal of Hand Surgery (European Volume) ◽

10.1016/j.jhsb.2003.07.002 ◽

2004 ◽

Vol 29 (2) ◽

pp. 178-182 ◽

Cited By ~ 86

Author(s):

L. BALABAUD ◽

C. RUIZ ◽

J. NONNENMACHER ◽

P. SEYNAEVE ◽

P. KEHR ◽

...

Keyword(s):

Anterior Approach ◽

Suture Anchor ◽

Single Incision ◽

Biceps Tendon ◽

Clinical Results ◽

Distal Biceps Tendon ◽

Isokinetic Testing ◽

Distal Biceps ◽

Tendon Ruptures ◽

A Prospective Study

In a prospective study, eight consecutive patients with nine ruptures of the distal biceps tendon underwent repair through a single incision. All patients were satisfied with their clinical results and had full ranges of elbow and forearm motion. There were no radial nerve injuries and no radio-ulnar synostoses. Isokinetic testing, after correction for dominance, demonstrated a 6% strength deficit, but 7% higher endurance in the repaired extremity for the flexion-concentric test, and no strength deficit and 13% higher endurance for supination. The improved endurance is probably explained by initial reduced effort due to apprehension which minimized subsequent fatigue.

Download Full-text

Early experience with the NexGen® CR-Flex Mobile knee arthroplasty system: results of 2-year follow-up

Orthopedic Reviews ◽

10.4081/or.2010.e2 ◽

2010 ◽

Vol 2 (1) ◽

pp. 2

Author(s):

Stefan Endres ◽

Axel Wilke

Keyword(s):

Anterior Approach ◽

Early Experience ◽

Surface Replacement ◽

Radiological Findings ◽

Patellar Tilt ◽

Post Operative Period ◽

Operative Complications ◽

A Prospective Study ◽

Initial Results

We evaluated our initial results in 57 patients who received the NexGen® CR-Flex Mobile knee system using the standard anterior approach in a prospective study. The bicondylar surface implant was cemented in position (Palacos®) without posterior patellar resurfacing. The clinical outcome and perioperative and post-operative complications were documented over 24 months of its use. Overall, after two years, good results were obtained for the categories of pain and ROM (range of motion), and for the HSS (knee society score) (pre-operative: 42/57; post-operative: 87/80). No pathological radiological findings were made during this period. Two patients, however, felt that the primary operation had not been successful because of lateral patellar tilt. This was corrected with revision surgery. It was remarkable that our patients achieved greater than 100° flexion within the first 14 days of the immediate post-operative period. Evaluation and comparison of the scores with those of conventional bicondylar surface replacement systems showed no relevant differences.

Download Full-text

Long-Term Clinical Results following Correction of Incompetent Superficial and Perforating Veins in Patients with Deep Venous Incompetence and Ulcers

Phlebology The Journal of Venous Disease ◽

10.1177/026835559300800310 ◽

1993 ◽

Vol 8 (3) ◽

pp. 128-131 ◽

Cited By ~ 3

Author(s):

H. Åkesson

Keyword(s):

Venous Pressure ◽

Clinical Results ◽

Venous Ulceration ◽

Perforating Veins ◽

Venous Ulcers ◽

Increased Risk ◽

A Prospective Study ◽

Volumetric Measures

Objectives: To assess the presence of venous ulcers following stripping of the saphenous vein and ligation of perforating veins in patients with deep venous incompetence. Design: Retrospective follow-up after a median of 41 months following surgery. Patients: Thirty operated limbs in 25 patients with venous ulcers, originally entering a prospective study of physiological changes following surgery for venous insufficiency. Interventions: An interview regarding absence of ulcers, expressed as a percentage of the follow-up time after surgery – the ‘ulcer-free period’. Correlation with ambulatory venous pressure (AVP) and foot volumetric measures following surgery. Main outcome measures: The presence or absence of venous ulcers. Results: The ulcer-free period for the whole group was 76%. There was a significant (p<0.05) difference in the ulcer-free period in limbs with an AVP below 60 mmHg (89%) compared with limbs with a higher AVP (70%). Conclusion: Failure to normalize AVP with surgery results in persistent high venous pressure and an increased risk of venous ulceration recurrences.

Download Full-text