Reconstruction of the medial patello-femoral and patello-tibial ligaments for treatment of patellar instability (original) (raw)
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Acta orthopaedica Belgica
Complications and results of medial patellofemoral ligament (MPFL) reconstruction, performed between 2000 and 2003, were studied retrospectively in 24 randomised patients (24 knees). All procedures were performed for recurrent dislocation or subluxation of the patella, using an autogenous semitendinosus tendon. Two different methods of anchoring of the transplant were compared. After a 2-year follow-up, patellar stability was found to be similar, when the transplant was sutured to the fibrous tissue and periosteum overlying the patella or when it was fixed in a bone tunnel through the patella. The majority of the patients who had undergone MPFL reconstruction have returned to their previous level of sports activities. We had two cases of patella fracture and one case of persisting patella apprehension after surgery. Further studies must determine which measures are necessary to prevent these complications.
European Journal of Orthopaedic Surgery & Traumatology, 2012
Purpose To report the midterm results of mini-invasive anatomical no hardware combined reconstruction of the medial patellofemoral ligament (MPFL) and medial patellotibial (MPTL) using single semitendinosus tendon autograft. Materials and methods A prospective study was performed on 33 cases with recurrent patellar dislocation treated with combined MPFL and MPTL reconstruction by a described Relay Technique. Evaluation was focusing on return to previous level of activity, range of motion, apprehension, overall patient satisfaction and scoring with VAS, Cincinnati, Kujala's, Lysholm scores. Radiological evaluation was based on congruence and tilting angles. Four cases were lost to follow-up and excluded from the study, so the study included 29 patients. Results The mean VAS had improved from 6.3 to 1.8. Cincinnati score increased from 50 § 7.1 (range, 38-60) to 88 § 6 (range, 76-100). The mean Kujala score increased from 36.6 § 6 (range, 22-48) to 90.6 § 7 (range, 78-100). The mean Lysholm score increased from 51.9 § 4.7 (range, 42-59) to 89.5 § 5.6 (range, 78-98). The congruence angle improved from 11.93° to ¡6.48°, and the patellar tilt angle from 10.9° to 2.45°. All improvements were statistically signiWcant. Only one case reported unsatisfaction, and 96.4 % were satisWed and returned to previous activity. No single recurrence was reported. Conclusion Combined anatomical MPFL and MPTL reconstruction with semitendinosus (ST) autograft using mini-invasive Relay Technique is safe, and its midterm results show signiWcant clinical and radiological improvements with 96.4 % patient satisfaction and nil rate of recurrence. Level of evidence Therapeutic case series, Level IV.
Medial Patellofemoral Ligament Repair for Recurrent Patellar Dislocation
The American Journal of Sports Medicine, 2010
Background: The medial patellofemoral ligament (MPFL) is the primary restraint to extreme lateral displacement and is typically disrupted with an acute lateral patellar dislocation. Patients who fail a comprehensive nonoperative program and experience recurrent lateral patellar instability episodes are candidates for surgical treatment. Current surgical procedures include a variety of proximal realignment techniques, including repair or reconstruction of the MPFL along with distal realignment of the tibial tubercle when indicated.
International Journal of Research in Orthopaedics, 2021
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<0.01). We have done a simple technique where MPFL is reconstructed anatomically to...
Acta orthopaedica Belgica, 2006
Complications and results of medial patellofemoral ligament (MPFL) reconstruction, performed between 2000 and 2003, were studied retrospectively in 24 randomised patients (24 knees). All procedures were performed for recurrent dislocation or subluxation of the patella, using an autogenous semitendinosus tendon. Two different methods of anchoring of the transplant were compared. After a 2-year follow-up, patellar stability was found to be similar, when the transplant was sutured to the fibrous tissue and periosteum overlying the patella or when it was fixed in a bone tunnel through the patella. The majority of the patients who had undergone MPFL reconstruction have returned to their previous level of sports activities. We had two cases of patella fracture and one case of persisting patella apprehension after surgery. Further studies must determine which measures are necessary to prevent these complications.
Medial Patellofemoral Ligament Reconstruction-State of the Art
The management of recurrent patellar instability has undergone progressive changes over the past few decades with improved optimal and predictable outcomes for the patients. Open surgical realignment procedures with bony osteotomies either proximal or distal to the Patella, designed to correct the imbalance of the extensor mechanism such that the patella tracks smoothly over the trochlea were commonly advocated. These procedures aimed to restore normal chondral loading of the patellofemoral joint and modify or delay progression of arthritic changes at an early age. With enhanced knowledge on the biomechanics of the anatomical structures providing medial and lateral restraints around the knee, the role of the Medial Patello-Femoral Ligament has been shown to be a vital one. This has refined the surgical options available to minimally invasive arthroscopic approaches with satisfying calculable results. This review article outlines the evolution of the surgical management of patellar instability and the prominent role of the MPFL reconstruction in achieving it. The biomechanics, surgical principles, anatomic landmarks, types of grafts and fixation methods, along with the senior surgeon's preferred surgical technique are described in detail.
MEDIAL PATELLOFEMORAL LIGAMENT RECONSTRUCTION: A COMPREHENSIVE REVIEW.
In the majority of patellar dislocation cases, the medial patellofemoral ligament (MPFL) is disrupted with a high recurrence rate especially in female patients. Although MPFL tear is not the primary cause of instability, MPFL reconstruction is effective for stabilizing the knee and may alone prevent lateral patellar dislocation. There is limited but growing evidence that MPFL reconstruction for patellofemoral instability leads to excellent functional outcomes. Growing awareness of the biomechanical contribution of the MPFL has led to an upsurge in the publication of techniques and trials dealing with reconstructive techniques, warranting a review that includes the most recent evidence. The aim of this article was to review and summarize the recent literatures concerning MPFL reconstruction and provide a comprehensive review of previous studies ranging from basic science to current surgical techniques and results.
Medial Patellofemoral Ligament Reconstruction
Video Journal of Sports Medicine, 2021
Background: Patellar instability is a relatively common condition in the young, active population and causes disruption of the medial patellofemoral ligament (MPFL). MPFL reconstruction is often performed to restore this medial stabilizer and reduce the risk of recurrent instability. Indications: Isolated MPFL reconstruction has been shown to reduce the risk of recurrent patellar dislocation. It is indicated in our patients who have had more than 1 dislocation in the absence of other significant bony malalignment or cartilage defects that require concurrent surgery. Technique Description: Diagnostic arthroscopy is first performed to evaluate the patellar and trochlear cartilage surfaces. A medial approach to the patella is then performed and the 2 free limbs of the allograft are secured to the patella at the 9 to 11 (or 1 to 3) o’clock position. A small approach to the femoral insertion site of the MPFL is performed and confirmed with fluoroscopy, and the graft is secured to the fem...
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2008
The purpose of this study was to evaluate the effect of surgical reinsertion of the medial patellofemoral ligament (MPFL) to the adductor tubercle compared with conservative treatment in patients with primary dislocation of the patella. Methods: Eighty patients with primary patella dislocation were included in the study. Delayed arthroscopy (mean, 50 days after injury) was performed to assess cartilage injury and status. During arthroscopy, patients were randomized to surgical reinsertion of the MPFL or to conservative treatment. Conservative treatment was use of a brace with 0° to 20° motion for the first 2 weeks after dislocation. Patients were followed up for 2 years. The incidence of recurrent patella dislocation was recorded along with the clinical Kujala scores and Knee Injury and Osteoarthritis Outcome Scores. Results: The redislocation rates were 17% and 20% in the operative and conservative treatment groups, respectively (P ϭ not significant). Kujala scores were 85 and 78 in the operative and conservative treatment groups, respectively (P ϭ .07). The patella stability subscore was significantly higher in the operative group. No difference in Knee Injury and Osteoarthritis Outcome Scores was found. Conclusions: Delayed primary repair of the MPFL by use of an anchor-based reattachment to the adductor tubercle without vastus medialis obliquus repair after primary patella dislocation does not reduce the risk of redislocation nor does it produce any significantly better subjective functional outcome based on the Kujala knee score. Only the specific subjective patella stability score was improved by MPFL repair compared with conservative treatment. Level of Evidence: Level I, therapeutic randomized controlled trial.