Cartilage Injury after Patellar Dislocation Surgery and Evaluation of the Effect of Platelet-Rich Plasma Treatment by Algebraic Reconstruction Techniques Based MRI

The study focused on the application value of Algebraic Reconstruction Techniques (ART) based magnetic resonance imaging (MRI) in the diagnosis of cartilage injury in patients with patellar dislocation, as well as the treatment effect of platelet-rich plasma (PRP). 50 patients with patellar dislocation admitted to the hospital were selected as the research subjects, and they were randomly divided into the experimental group (lateral retinaculum plasty and PRP treatment) and the control group (lateral retinaculum plasty), with 25 cases in each group. The ART-based MRI technology was used to judge the recovery of patients after surgery and analyze the differences in clinical data between the two groups. The results showed that the running speed under ART algorithm was significantly faster than the traditional Joseph algorithm and Siddon algorithm, and the image reconstruction effect was better. The visual analog scale (VAS) scores of preoperative and postoperative pain and the Hospital for Special Surgery (HSS) score in the experimental group were better than those of the control group ( P < 0.05 ). In conclusion, the ART-based MRI technology can clearly show cartilage injury and the PRP treatment can effectively relieve postoperative pain, with reliable curative effects and simple operations.

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

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.

Lateral retinacular release combined with MPFL reconstruction for patellofemoral instability: a systematic review

Introduction The role of the lateral retinaculum in patellofemoral instability is still debated. Lateral retinacular release (LRR), has been extensively performed in combination with different surgical procedures, including reconstruction of medio-patellofemoral ligament (MPFL). Despite controversial indications, the results from these studies seem promising. The present study conducts a systematic review about current biomechanical and clinical evidence concerning the role of LRR in combination with MPFL reconstruction. We performed a comprehensive literature research, comparing the outcomes of MPFL reconstruction with and without LRR. Materials and methods This systematic review was conducted according to the PRISMA guidelines. The literature search was performed in August 2020. All articles describing the outcome of isolated MPFL reconstruction alone or in combination with a LRR in patients with recurrent patellofemoral instability were considered for inclusion. Only articles reporting data on patients with a minimum of 12-month follow-up were included. Only articles reporting quantitative data under the outcomes of interest were included. Results A total of 63 articles were eligible for this systematic review, including 2131 knees. The mean follow-up was 40.87 ± 24.1 months. All scores of interests improved in favour of the combined group: Kujala + 3.8% (P = 0.01), Lysholm + 4.2% (P = 0.004), Tegner + 0.8 points (P = 0.04), IKDC + 9.8% (P = 0.02). The ROM was comparable between the two groups (P = 0.4). Similarity was found in terms of positivity to the apprehension test (P = 0.05), rate of complications (P = 0.1), re-dislocations (P = 0.8), and revision surgeries (P = 0.1). Conclusion There is no evidence that adding a lateral release impacts positively on the outcome of MPFL reconstruction. Level of evidence: IV, Systematic review