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Medial patellofemoral ligament reconstruction in patellar instability

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Abstract

Background

Medial patellofemoral ligament (MPFL) is one of the major static medial stabilising structures of the patella. MPFL is most often damaged in patients with patellar instability. Reconstruction of MPFL is becoming a common surgical procedure in treating patellar instability. We hypothesised that MPFL reconstruction was adequate to treat patients with patellar instability if the tibial tubercle and the centre of the trochlear groove (TT-TG) value was less than 20 mm and without a dysplastic trochlea.

Materials and Methods

30 patients matching our inclusion criteria and operated between April 2009 and May 2011 were included in the study. MPFL reconstruction was performed using gracilis tendon fxed with endobutton on the patellar side and bio absorbable interference screw or staple on the femoral side. Patients were followed up with subjective criteria, Kujala score and Lysholm score.

Results

The mean duration of followup was 25 months (range 14-38 months). The mean preoperative Kujala score was 47.5 and Lysholm score was 44.7. The mean postoperative Kujala score was 87 and Lysholm score was 88.06. None of the patients had redislocation.

Conclusion

MPFL reconstruction using gracilis tendon gives excellent results in patients with patellar instability with no redislocations. Some patients may have persistence of apprehension.

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References

  1. Cofield RH, Bryan RS. Acute dislocation of the patella: Results of conservative treatment. J Trauma 1977;17:526–31.

    Article  CAS  Google Scholar 

  2. Larsen E, Lauridsen F. Conservative treatment of patellar dislocations. Influence of evident factors on the tendency to redislocation and the therapeutic result. Clin Orthop Relat Res 1982;171:131–6.

    Google Scholar 

  3. Warren LF, Marshall JL. The supporting structures and layers on the medial side of the knee: An anatomical analysis. J Bone Joint Surg Am 1979;61:56–62.

    Article  CAS  Google Scholar 

  4. LaPrade RF, Engebretsen AH, Ly TV, Johansen S, Wentorf FA, Engebretsen L. The anatomy of the medial part of the knee. J Bone Joint Surg Am 2007;89:2000–10.

    Article  Google Scholar 

  5. Insall John N, John N, Scott W Norman. Surgery of the Knee. 5th ed. ISBN 978-1-4377-1503-3: Elsevier Churchill Livingstone; 2012. p. 680–44.

    Google Scholar 

  6. Conlan T, Garth WP Jr, Lemons JE. Evaluation of the medial soft-tissue restraints of the extensor mechanism of the knee. J Bone Joint Surg Am 1993;75:682–93.

    Article  CAS  Google Scholar 

  7. Desio SM, Burks RT, Bachus KN. Soft tissue restraints to lateral patellar translation in the human knee. Am J Sports Med 1998;26:59–65.

    Article  CAS  Google Scholar 

  8. Sallay PI, Poggi J, Speer KP, Garrett WE. Acute dislocation of the patella. A correlative pathoanatomic study. Am J Sports Med 1996;24:52–60.

    Article  CAS  Google Scholar 

  9. Muneta T, Sekiya I, Tsuchiya M, Shinomiya K. A technique for reconstruction of the medial patellofemoral ligament. Clin Orthop Relat Res 1999;359:51–5.

    Article  Google Scholar 

  10. Schöttle PB, Schmeling A, Rosenstiel N, Weiler A. Radiographic landmarks for femoral tunnel placement in medial patellofemoral ligament reconstruction. Am J Sports Med 2007;35:801–4.

    Article  Google Scholar 

  11. LeGrand AB, Greis PE, Dobbs RE, Burks RT. MPFL reconstruction. Sports Med Arthrosc 2007;15:72–7.

    Article  Google Scholar 

  12. Fithian DC, Nomura E, Arendt E. Anatomy of patellar dislocation. Oper Tech Sports Med 2001;9:102–111.

    Article  Google Scholar 

  13. Aichroth PM, Al-Duri Z. Dislocation and subluxation of the patella: An overview. In: Aichroth PM, Al-Duri Z, editors. Knee Surgery. London: Martin Dunitz; 1992. p. 354–79.

    Google Scholar 

  14. Scuderi G, Cuomo F, Scott WN. Lateral release and proximal realignment for patellar subluxation and dislocation. A long term followup. J Bone Joint Surg Am 1988;70:856–61.

    Article  CAS  Google Scholar 

  15. Zeichen J, Lobenhoffer P, Gerich T, Tscherne H, Bosch U. Medium-term results of the operative treatment of recurrent patellar dislocation by Insall proximal realignment. Knee Surg Sports Traumatol Arthrosc 1999;7:173–6.

    Article  CAS  Google Scholar 

  16. Brown DE, Alexander AH, Lichtman DM. The Elmslie-Trillat procedure: Evaluation in patellar dislocation and subluxation. Am J Sports Med 1984;12:104–9.

    Article  CAS  Google Scholar 

  17. Conti C, Berruto M, Bianchi M. The Elmslie-Trillat procedure for recurrent subluxation of the patella One to five year followup. Ital J Orthop Traumatol 1992;18:341–9.

    PubMed  CAS  Google Scholar 

  18. Ostermeier S, Stukenborg-Colsman C, Hurschler C, Wirth CJ. In vitro investigation of the effect of medial patellofemoral ligament reconstruction and medial tibial tuberosity transfer on lateral patellar stability. Arthroscopy 2006;22:308–19.

    Article  Google Scholar 

  19. Burks RT, Desio SM, Bachus KN, Tyson L, Springer K. Biomechanical evaluation of lateral patellar dislocations. Am J Knee Surg 1998;11:24–31.

    PubMed  CAS  Google Scholar 

  20. Nomura E, Fujikawa K, Takeda T, Matsumoto H. Functional anatomy of the medial patellofemoral ligament (in Japanese) Clinical orthopedic surgery 1993;28:5–10.

    Google Scholar 

  21. Nomura E. Classification of lesions of the medial patello-femoral ligament in patellar dislocation. Int Orthop 1999;23:260–3.

    Article  CAS  Google Scholar 

  22. Ahmad CS, Stein BE, Matuz D, Henry JH. Immediate surgical repair of the medial patellar stabilizers for acute patellar dislocation. A review of eight cases. Am J Sports Med 2000;28:804–10.

    Article  CAS  Google Scholar 

  23. Hautamaa PV, Fithian DC, Kaufman KR, Daniel DM, Pohlmeyer AM. Medial soft tissue restraints in lateral patellar instability and repair. Clin Orthop Relat Res 1998;349:174–82.

    Article  Google Scholar 

  24. Nomura E, Horiuchi Y, Kihara M. Medial patellofemoral ligament restraint in lateral patellar translation and reconstruction. Knee 2000;7:121–17.

    Article  CAS  Google Scholar 

  25. Smith TO, Walker J, Russell N. Outcomes of medial patellofemoral ligament reconstruction for patellar instability: A systematic review. Knee Surg Sports Traumatol Arthrosc 2007;15:1301–14.

    Article  Google Scholar 

  26. Panagopoulos A, van Niekerk L, Triantafillopoulos IK. MPFL reconstruction for recurrent patella dislocation: A new surgical technique and review of the literature. Int J Sports Med 2008;29:359–65.

    Article  CAS  Google Scholar 

  27. Christiansen SE, Jacobsen BW, Lund B, Lind M. Reconstruction of the medial patellofemoral ligament with gracilis tendon autograft in transverse patellar drill holes. Arthroscopy 2008;24:82–7.

    Article  Google Scholar 

  28. Ellera Gomes JL. Medial patellofemoral ligament reconstruction for recurrent dislocation of the patella: A preliminary report. Arthroscopy 1992;8:335–40.

    Article  CAS  Google Scholar 

  29. Ellera Gomes JL, Stigler Marczyk LR, César de César P, Jungblut CF. Medial patellofemoral ligament reconstruction with semitendinosus autograft for chronic patellar instability: A followup study. Arthroscopy 2004;20:147–51.

    Article  Google Scholar 

  30. Steiner TM, Torga-Spak R, Teitge RA. Medial patellofemoral ligament reconstruction in patients with lateral patellar instability and trochlear dysplasia. Am J Sports Med 2006;34:1254–61.

    Article  Google Scholar 

  31. Deie M, Ochi M, Sumen Y, Adachi N, Kobayashi K, Yasumoto M. A long term followup study after medial patellofemoral ligament reconstruction using the transferred semitendinosus tendon for patellar dislocation. Knee Surg Sports Traumatol Arthrosc 2005;13:522–8.

    Article  Google Scholar 

  32. Cossey AJ, Paterson R. A new technique for reconstructing the medial patellofemoral ligament. Knee 2005;12:93–8.

    Article  CAS  Google Scholar 

  33. Drez D Jr, Edwards TB, Williams CS. Results of medial patellofemoral ligament reconstruction in the treatment of patellar dislocation. Arthroscopy 2001;17:298–306.

    Article  Google Scholar 

  34. Schöttle PB, Fucentese SF, Romero J. Clinical and radiological outcome of medial patellofemoral ligament reconstruction with a semitendinosus autograft for patella instability. Knee Surg Sports Traumatol Arthrosc 2005;13:516–21.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Arthroscopy and Sports Medicine, Ortho One Orthopaedic Speciality Centre, Coimbatore, Tamil Nadu, India

    M. S. Krishna Kumar, Sankarram Renganathan, Clement J. Joseph, T. R. Easwar & David V. Rajan

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  1. M. S. Krishna Kumar
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  2. Sankarram Renganathan
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  3. Clement J. Joseph
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  4. T. R. Easwar
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  5. David V. Rajan
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Correspondence to M. S. Krishna Kumar.

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Kumar, M.S.K., Renganathan, S., Joseph, C.J. et al. Medial patellofemoral ligament reconstruction in patellar instability. IJOO 48, 501–505 (2014). https://doi.org/10.4103/0019-5413.139864

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  • DOI: https://doi.org/10.4103/0019-5413.139864

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