Management of Injuries to the Medial Patellofemoral Ligament: A Review

The medial patellofemoral ligament (MPFL) is thought to be the most important medial structure providing restraint to lateral subluxation of the patella. After an initial patellar dislocation, the MPFL is frequently injured and can usually be treated with conservative measures. However, these patients often suffer from recurrent dislocations, which thereby necessitate operative intervention. In the setting of normal anatomy and kinematics, isolated reconstruction of the MPFL is an effective treatment for preventing recurrent dislocations. Various surgical techniques have been described, with differences in fixation and graft selection. The treatment of MPFL injuries should aim to provide patellar stabilization and restore normal kinematics throughout the joint. This review will discuss the following: (1) anatomy of the MPFL, (2) presentation and assessment of MPFL injuries, (3) management of patients with MPFL injuries, and (4) complications following MPFL reconstruction.

Results of Arthroscopic Medial Retinacular Release for Treatment of Medial Subluxation of the Patella

Background Medial subluxation of the patella is a rare, disabling condition that has iatrogenic and traumatic causation. To date, only open reconstructions have been reported for operative treatment of this condition, but these procedures have a high rate of complications, revisions, and subsequent surgery. This is the first study to present the results of arthroscopic medial retinacular release for treatment of this problem. Hypothesis Arthroscopic release will alleviate painful medial patellar subluxation. Study Design Case series; Level of evidence, 4. Methods Nine knees (7 patients) with painful, recurrent medial subluxation of the patella that occurred spontaneously (2 knees) or after a lateral release (5 knees) or an injury (2 knees) were treated with an arthroscopic medial retinacular release. The retinaculum was released 2 cm medial to the superior pole of the patella down to the anteromedial portal. At a mean follow-up of 2.7 years (range, 1-8 years), all knees were evaluated, and the results were graded according to the Merchant and Mercer rating scale. Results The mean age of the patients was 25 years (range, 15-38 years), and the mean duration of the subluxations before surgery was 28 months (range, 6-48 months). In all 7 patients (9 knees), the medial release relieved their medial subluxation and knee pain, and there were 6 excellent and 3 good results. There were no complications or further realignment surgery needed after this procedure. Conclusion An arthroscopic medial retinacular release will successfully treat painful medial subluxation of the patella.

Long-Term Evaluation of the Roux-Elmslie-Trillat Procedure for Patellar Instability

Background Few published articles exist reporting the long-term evaluation of the Roux-Elmslie-Trillat procedure. Purpose To assess the long-term effect of the Roux-Elmslie-Trillat procedure in preventing recurrent subluxation and dislocation of the patella. Study Design Case series; Level of evidence, 4. Methods Eighteen patients who underwent the Roux-Elmslie-Trillat procedure for dislocation or subluxation of the patella were identified from a group previously evaluated at a mean follow-up of 3 years. The prevalence of recurrent subluxation or dislocation at a mean follow-up of 26 years was compared with the prevalence reported at the mean follow-up of 3 years. Although not the focus of this study, Cox functional scores were obtained from the smaller group and compared with the results at the 3-year follow-up. Results Seven percent (95% confidence interval, 0.00-0.32) of the patients had recurrent subluxation at 26 years compared with 7% (95% confidence interval, 0.03-0.13) of the study population reported at 3 years (P = 1.00). Fifty-four percent (95% confidence interval, 0.27-0.79) rated their affected knee as good or excellent at 26 years compared with 73% (95% confidence interval, 0.64-0.81) of the larger study population reported at 3 years (P = .14). Conclusion The prevalence of recurrent subluxation and dislocation in patients with patellofemoral malalignment who underwent the Roux-Elmslie-Trillat procedure for dislocation or subluxation of the patella is similar at 3 and 26 years after the procedure. The long-term functional status of the affected knee in patients who underwent the Roux-Elmslie-Trillat procedure declined.