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Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy 10/2014

01.10.2014 | Knee

Medial patellofemoral ligament reconstruction as an isolated or combined procedure for recurrent patellar instability

verfasst von: Julian A. Feller, Anneka K. Richmond, Jason Wasiak

Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy | Ausgabe 10/2014

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Abstract

Purpose

The principal aim of this study was to report the outcomes of medial patellofemoral ligament (MPFL) reconstruction, used as either an isolated procedure or in combination with another stabilization procedure, for the primary treatment of recurrent patellar instability.

Methods

Between 2007 and 2012, 45 patients with recurrent patellar instability and no prior stabilization surgery had an MPFL reconstruction by a single surgeon, either as an isolated procedure or in combination with another stabilization procedure. Questionnaires detailing patellar instability since surgery, knee pain, ability to negotiate stairs, and sports participation were completed, and data regarding examination and radiological findings were collected from the medical record.

Results

A total of 36 (80 %) patients completed the questionnaire at a mean of 3.1 years (minimum 1 year), whilst a further 11 % had clinical follow-up of greater than 1 year. Four patients were excluded due to lack of adequate follow-up. Thirty-one patients had an isolated MPFL reconstruction and none had further patellar instability. Of the ten patients who had a combined procedure, one experienced recurrent instability. Return to sport rates were 81 and 57 % for the isolated and combined groups, respectively, with the majority returning to strenuous sport (81 and 57 %, respectively). Most patients (96 and 80 %) could negotiate stairs without difficulty, whilst 38 and 40 % reported some degree of anterior knee pain.

Conclusions

This study shows that satisfactory results can be obtained using MPFL reconstruction either in isolation or in combination to treat recurrent patellar instability. Whether the indications for an isolated MPFL can be extended further remains unclear.

Level of evidence

III.
Literatur
1.
Zurück zum Zitat Ahmad CS, Brown GD, Stein BS (2009) The docking technique for medial patellofemoral ligament reconstruction: surgical technique and clinical outcome. Am J Sports Med 37:2021–2027PubMedCrossRef Ahmad CS, Brown GD, Stein BS (2009) The docking technique for medial patellofemoral ligament reconstruction: surgical technique and clinical outcome. Am J Sports Med 37:2021–2027PubMedCrossRef
2.
Zurück zum Zitat Arendt EA, Dejour D (2012) Patella instability: building bridges across the ocean a historic review. Knee Surg Sports Traumatol Arthrosc 21:279–293PubMedCrossRef Arendt EA, Dejour D (2012) Patella instability: building bridges across the ocean a historic review. Knee Surg Sports Traumatol Arthrosc 21:279–293PubMedCrossRef
3.
Zurück zum Zitat Bernageau J, Goutallier D, Debeyre J, Ferrané J (1975) New exploration technic of the patellofemoral joint. Relaxed axial quadriceps and contracted quadriceps. Rev Chir Orthop Reparatrice Appar Mot 61(Suppl 2):286–290PubMed Bernageau J, Goutallier D, Debeyre J, Ferrané J (1975) New exploration technic of the patellofemoral joint. Relaxed axial quadriceps and contracted quadriceps. Rev Chir Orthop Reparatrice Appar Mot 61(Suppl 2):286–290PubMed
4.
Zurück zum Zitat Biedert RM, Albrecht S (2006) The patellotrochlear index: a new index for assessing patellar height. Knee Surg Sports Traumatol Arthrosc 14:707–712PubMedCrossRef Biedert RM, Albrecht S (2006) The patellotrochlear index: a new index for assessing patellar height. Knee Surg Sports Traumatol Arthrosc 14:707–712PubMedCrossRef
5.
Zurück zum Zitat Bitar AC, Howells NR, Demange MK, Barnett AJ, D’Elia CO, Ahearn N, Camanho GL, Ansari A, Eldridge JD (2012) Medial patellofemoral ligament reconstruction: a prospective outcome assessment of a large single centre series. J Bone Joint Surg Br 94:1202–1208 Bitar AC, Howells NR, Demange MK, Barnett AJ, D’Elia CO, Ahearn N, Camanho GL, Ansari A, Eldridge JD (2012) Medial patellofemoral ligament reconstruction: a prospective outcome assessment of a large single centre series. J Bone Joint Surg Br 94:1202–1208
6.
Zurück zum Zitat Cossey AJ, Paterson R (2005) A new technique for reconstructing the medial patellofemoral ligament. Knee 12:93–98PubMedCrossRef Cossey AJ, Paterson R (2005) A new technique for reconstructing the medial patellofemoral ligament. Knee 12:93–98PubMedCrossRef
7.
Zurück zum Zitat Deie M, Ochi M, Adachi N, Shibuya H, Nakamae A (2011) Medial patellofemoral ligament reconstruction fixed with a cylindrical bone plug and a grafted semitendinosus tendon at the original femoral site for recurrent patellar dislocation. Am J Sports Med 39:140–145PubMedCrossRef Deie M, Ochi M, Adachi N, Shibuya H, Nakamae A (2011) Medial patellofemoral ligament reconstruction fixed with a cylindrical bone plug and a grafted semitendinosus tendon at the original femoral site for recurrent patellar dislocation. Am J Sports Med 39:140–145PubMedCrossRef
8.
Zurück zum Zitat Deie M, Ochi M, Sumen Y, Adachi N, Kobayashi K, Yasumoto M (2005) A long-term follow-up study after medial patellofemoral ligament reconstruction using the transferred semitendinosus tendon for patellar dislocation. Knee Surg Sports Traumatol Arthrosc 13:522–528PubMedCrossRef Deie M, Ochi M, Sumen Y, Adachi N, Kobayashi K, Yasumoto M (2005) A long-term follow-up study after medial patellofemoral ligament reconstruction using the transferred semitendinosus tendon for patellar dislocation. Knee Surg Sports Traumatol Arthrosc 13:522–528PubMedCrossRef
9.
Zurück zum Zitat Dejour H, Walch G, Nove-Josserand L, Guier C (1994) Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 2:19–26PubMedCrossRef Dejour H, Walch G, Nove-Josserand L, Guier C (1994) Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 2:19–26PubMedCrossRef
10.
Zurück zum Zitat Dopirak R, Adamany D, Bickel B, Steensen R (2008) Reconstruction of the medial patellofemoral ligament using a quadriceps tendon graft: a case series. Orthopedics 31:217PubMed Dopirak R, Adamany D, Bickel B, Steensen R (2008) Reconstruction of the medial patellofemoral ligament using a quadriceps tendon graft: a case series. Orthopedics 31:217PubMed
11.
Zurück zum Zitat Ellera Gomes JL, Stigler Marczyk LR, César de César P, Jungblut CF (2004) Medial patellofemoral ligament reconstruction with semitendinosus autograft for chronic patellar instability: a follow-up study. Arthroscopy 20:147–151PubMedCrossRef Ellera Gomes JL, Stigler Marczyk LR, César de César P, Jungblut CF (2004) Medial patellofemoral ligament reconstruction with semitendinosus autograft for chronic patellar instability: a follow-up study. Arthroscopy 20:147–151PubMedCrossRef
12.
Zurück zum Zitat Fernandez E, Caton JH, Sala D, Dejour D, Castejon M, Castejon M (2005) Reconstruction of the medial patellofemoral ligament for patellar instability using a semitendinosus autograft. Acta Orthop Belg 71:303–308PubMed Fernandez E, Caton JH, Sala D, Dejour D, Castejon M, Castejon M (2005) Reconstruction of the medial patellofemoral ligament for patellar instability using a semitendinosus autograft. Acta Orthop Belg 71:303–308PubMed
13.
Zurück zum Zitat Fisher B, Nyland J, Brand E, Curtin B (2010) Medial patellofemoral ligament reconstruction for recurrent patellar dislocation: a systematic review including rehabilitation and return-to-sports efficacy. Arthroscopy 26:1384–1394PubMedCrossRef Fisher B, Nyland J, Brand E, Curtin B (2010) Medial patellofemoral ligament reconstruction for recurrent patellar dislocation: a systematic review including rehabilitation and return-to-sports efficacy. Arthroscopy 26:1384–1394PubMedCrossRef
14.
Zurück zum Zitat Gomes JE (2008) Comparison between a static and a dynamic technique for medial patellofemoral ligament reconstruction. Arthroscopy 24:430–435PubMedCrossRef Gomes JE (2008) Comparison between a static and a dynamic technique for medial patellofemoral ligament reconstruction. Arthroscopy 24:430–435PubMedCrossRef
15.
Zurück zum Zitat Gomes JLE (2008) Medial patellofemoral ligament reconstruction with half width (hemi tendon) semitendinosus graft. Orthopedics 31:322–326PubMedCrossRef Gomes JLE (2008) Medial patellofemoral ligament reconstruction with half width (hemi tendon) semitendinosus graft. Orthopedics 31:322–326PubMedCrossRef
16.
Zurück zum Zitat Goyal D (2013) Medial patellofemoral ligament reconstruction: the superficial quad technique. Am J Sports Med 41:1022–1029PubMedCrossRef Goyal D (2013) Medial patellofemoral ligament reconstruction: the superficial quad technique. Am J Sports Med 41:1022–1029PubMedCrossRef
17.
Zurück zum Zitat Insall J, Salvati E (1971) Patella position in the normal knee joint. Radiology 101:101–104PubMedCrossRef Insall J, Salvati E (1971) Patella position in the normal knee joint. Radiology 101:101–104PubMedCrossRef
18.
Zurück zum Zitat Kang H, Cao J, Yu D, Zheng Z, Wang F (2013) Comparison of 2 different techniques for anatomic reconstruction of the medial patellofemoral ligament: a prospective randomized study. Am J Sports Med 41:1013–1021PubMedCrossRef Kang H, Cao J, Yu D, Zheng Z, Wang F (2013) Comparison of 2 different techniques for anatomic reconstruction of the medial patellofemoral ligament: a prospective randomized study. Am J Sports Med 41:1013–1021PubMedCrossRef
19.
Zurück zum Zitat Koëter S, Horstmann WG, Wagenaar F-CBM, Huysse W, Wymenga AB, Anderson PG (2007) A new CT scan method for measuring the tibial tubercle trochlear groove distance in patellar instability. Knee 14:128–132PubMedCrossRef Koëter S, Horstmann WG, Wagenaar F-CBM, Huysse W, Wymenga AB, Anderson PG (2007) A new CT scan method for measuring the tibial tubercle trochlear groove distance in patellar instability. Knee 14:128–132PubMedCrossRef
20.
Zurück zum Zitat Kohn LM, Meidinger G, Beitzel K, Banke IJ, Hensler D, Imhoff AB, Schottle PB (2013) Isolated and combined medial patellofemoral ligament reconstruction in revision surgery for patellofemoral instability: a prospective study. Am J Sports Med 41:2128–2135PubMedCrossRef Kohn LM, Meidinger G, Beitzel K, Banke IJ, Hensler D, Imhoff AB, Schottle PB (2013) Isolated and combined medial patellofemoral ligament reconstruction in revision surgery for patellofemoral instability: a prospective study. Am J Sports Med 41:2128–2135PubMedCrossRef
21.
Zurück zum Zitat Labelle H, Peides JP, Levesque HP, Fauteux P, Laurin CA (1976) Evaluation of patellar position by tangential X-ray visualization. Union Med Can 105:870–873PubMed Labelle H, Peides JP, Levesque HP, Fauteux P, Laurin CA (1976) Evaluation of patellar position by tangential X-ray visualization. Union Med Can 105:870–873PubMed
22.
Zurück zum Zitat Lustig S, Servien E, Ait Si Selmi T, Neyret P (2006) Factors affecting reliability of TT-TG measurements before and after medialization: a CT-scan study. Rev Chir Orthop Reparatrice Appar Mot 92:429–436PubMedCrossRef Lustig S, Servien E, Ait Si Selmi T, Neyret P (2006) Factors affecting reliability of TT-TG measurements before and after medialization: a CT-scan study. Rev Chir Orthop Reparatrice Appar Mot 92:429–436PubMedCrossRef
23.
Zurück zum Zitat Matthews JJ, Schranz P (2009) Reconstruction of the medial patellofemoral ligament using a longitudinal patellar tunnel technique. Int Orthop 34:1321–1325PubMedCrossRefPubMedCentral Matthews JJ, Schranz P (2009) Reconstruction of the medial patellofemoral ligament using a longitudinal patellar tunnel technique. Int Orthop 34:1321–1325PubMedCrossRefPubMedCentral
24.
Zurück zum Zitat Mikashima Y, Mikashima Y, Kimura M, Kimura M, Kobayashi Y, Kobayashi Y, Miyawaki M, Miyawaki M, Tomatsu T, Tomatsu T (2006) Clinical results of isolated reconstruction of the medial patellofemoral ligament for recurrent dislocation and subluxation of the patella. Acta Orthop Belg 72:65–71PubMed Mikashima Y, Mikashima Y, Kimura M, Kimura M, Kobayashi Y, Kobayashi Y, Miyawaki M, Miyawaki M, Tomatsu T, Tomatsu T (2006) Clinical results of isolated reconstruction of the medial patellofemoral ligament for recurrent dislocation and subluxation of the patella. Acta Orthop Belg 72:65–71PubMed
25.
Zurück zum Zitat Mulford JS, Wakeley CJ, Eldridge JDJ (2007) Assessment and management of chronic patellofemoral instability. J Bone Joint Surg Br 89:709–716PubMedCrossRef Mulford JS, Wakeley CJ, Eldridge JDJ (2007) Assessment and management of chronic patellofemoral instability. J Bone Joint Surg Br 89:709–716PubMedCrossRef
26.
Zurück zum Zitat Nomura E, Nomura E, Horiuchi Y, Horiuchi Y, Kihara M, Kihara M (2000) A mid-term follow-up of medial patellofemoral ligament reconstruction using an artificial ligament for recurrent patellar dislocation. Knee 7:211–215PubMedCrossRef Nomura E, Nomura E, Horiuchi Y, Horiuchi Y, Kihara M, Kihara M (2000) A mid-term follow-up of medial patellofemoral ligament reconstruction using an artificial ligament for recurrent patellar dislocation. Knee 7:211–215PubMedCrossRef
27.
Zurück zum Zitat Noyes FR, Stabler CL (1989) A system for grading articular cartilage lesions at arthroscopy. Am J Sports Med 17:505–513PubMedCrossRef Noyes FR, Stabler CL (1989) A system for grading articular cartilage lesions at arthroscopy. Am J Sports Med 17:505–513PubMedCrossRef
28.
Zurück zum Zitat Pandit S, Frampton C, Stoddart J, Lynskey T (2011) Magnetic resonance imaging assessment of tibial tuberosity–trochlear groove distance: normal values for males and females. Int Orthop 35:1799–1803PubMedCrossRefPubMedCentral Pandit S, Frampton C, Stoddart J, Lynskey T (2011) Magnetic resonance imaging assessment of tibial tuberosity–trochlear groove distance: normal values for males and females. Int Orthop 35:1799–1803PubMedCrossRefPubMedCentral
29.
Zurück zum Zitat Panni AS, Alam M, Cerciello S, Vasso M, Maffulli N (2011) Medial patellofemoral ligament reconstruction with a divergent patellar transverse 2-tunnel technique. Am J Sports Med 39:2647–2655PubMedCrossRef Panni AS, Alam M, Cerciello S, Vasso M, Maffulli N (2011) Medial patellofemoral ligament reconstruction with a divergent patellar transverse 2-tunnel technique. Am J Sports Med 39:2647–2655PubMedCrossRef
30.
Zurück zum Zitat Phillips CL, Silver DAT, Schranz PJ, Mandalia V (2010) The measurement of patellar height: a review of the methods of imaging. J Bone Joint Surg Br 92:1045–1053PubMedCrossRef Phillips CL, Silver DAT, Schranz PJ, Mandalia V (2010) The measurement of patellar height: a review of the methods of imaging. J Bone Joint Surg Br 92:1045–1053PubMedCrossRef
31.
Zurück zum Zitat Saudan M, Fritschy D (2000) AT-TG (anterior tuberosity-trochlear groove): interobserver variability in CT measurements in subjects with patellar instability. Rev Chir Orthop Reparatrice Appar Mot 86:250–255PubMed Saudan M, Fritschy D (2000) AT-TG (anterior tuberosity-trochlear groove): interobserver variability in CT measurements in subjects with patellar instability. Rev Chir Orthop Reparatrice Appar Mot 86:250–255PubMed
32.
Zurück zum Zitat Schoettle PB, Zanetti M, Seifert B, Pfirrmann CWA, Fucentese SF, Romero J (2006) The tibial tuberosity–trochlear groove distance; a comparative study between CT and MRI scanning. Knee 13:26–31PubMedCrossRef Schoettle PB, Zanetti M, Seifert B, Pfirrmann CWA, Fucentese SF, Romero J (2006) The tibial tuberosity–trochlear groove distance; a comparative study between CT and MRI scanning. Knee 13:26–31PubMedCrossRef
33.
Zurück zum Zitat Shah JN, Howard JS, Flanigan DC, Brophy RH, Carey JL, Lattermann C (2012) A systematic review of complications and failures associated with medial patellofemoral ligament reconstruction for recurrent patellar dislocation. Am J Sports Med 40:1916–1923PubMedCrossRefPubMedCentral Shah JN, Howard JS, Flanigan DC, Brophy RH, Carey JL, Lattermann C (2012) A systematic review of complications and failures associated with medial patellofemoral ligament reconstruction for recurrent patellar dislocation. Am J Sports Med 40:1916–1923PubMedCrossRefPubMedCentral
34.
Zurück zum Zitat Siebold R, Borbon CAV (2012) Arthroscopic extraarticular reconstruction of the medial patellofemoral ligament with gracilis tendon autograft—surgical technique. Knee Surg Sports Traumatol Arthrosc 20:1245–1251PubMedCrossRef Siebold R, Borbon CAV (2012) Arthroscopic extraarticular reconstruction of the medial patellofemoral ligament with gracilis tendon autograft—surgical technique. Knee Surg Sports Traumatol Arthrosc 20:1245–1251PubMedCrossRef
35.
Zurück zum Zitat Slenker NR, Tucker BS, Pepe MD, Marchetto PA, Cohen SB (2013) Short-/intermediate-term outcomes after medial patellofemoral ligament reconstruction in the treatment of chronic lateral patellofemoral instability. Phys Sportsmed 41:26–33PubMedCrossRef Slenker NR, Tucker BS, Pepe MD, Marchetto PA, Cohen SB (2013) Short-/intermediate-term outcomes after medial patellofemoral ligament reconstruction in the treatment of chronic lateral patellofemoral instability. Phys Sportsmed 41:26–33PubMedCrossRef
36.
Zurück zum Zitat Tecklenburg K, Feller JA, Whitehead TS, Webster KE, Elzarka A (2010) Outcome of surgery for recurrent patellar dislocation based on the distance of the tibial tuberosity to the trochlear groove. J Bone Joint Surg Br 92:1376–1380PubMedCrossRef Tecklenburg K, Feller JA, Whitehead TS, Webster KE, Elzarka A (2010) Outcome of surgery for recurrent patellar dislocation based on the distance of the tibial tuberosity to the trochlear groove. J Bone Joint Surg Br 92:1376–1380PubMedCrossRef
37.
Zurück zum Zitat Wagner D, Pfalzer F, Hingelbaum S, Huth J, Mauch F, Bauer G (2012) The influence of risk factors on clinical outcomes following anatomical medial patellofemoral ligament (MPFL) reconstruction using the gracilis tendon. Knee Surg Sports Traumatol Arthrosc 21:318–324PubMedCrossRef Wagner D, Pfalzer F, Hingelbaum S, Huth J, Mauch F, Bauer G (2012) The influence of risk factors on clinical outcomes following anatomical medial patellofemoral ligament (MPFL) reconstruction using the gracilis tendon. Knee Surg Sports Traumatol Arthrosc 21:318–324PubMedCrossRef
38.
Zurück zum Zitat Zhao J, Huangfu X, He Y (2012) The role of medial retinaculum plication versus medial patellofemoral ligament reconstruction in combined procedures for recurrent patellar instability in adults. Am J Sports Med 40:1355–1364PubMedCrossRef Zhao J, Huangfu X, He Y (2012) The role of medial retinaculum plication versus medial patellofemoral ligament reconstruction in combined procedures for recurrent patellar instability in adults. Am J Sports Med 40:1355–1364PubMedCrossRef
Metadaten
Titel
Medial patellofemoral ligament reconstruction as an isolated or combined procedure for recurrent patellar instability
verfasst von
Julian A. Feller
Anneka K. Richmond
Jason Wasiak
Publikationsdatum
01.10.2014
Verlag
Springer Berlin Heidelberg
Erschienen in
Knee Surgery, Sports Traumatology, Arthroscopy / Ausgabe 10/2014
Print ISSN: 0942-2056
Elektronische ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-014-3132-0

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