Skip to main content
Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy 10/2014

01.10.2014 | Knee

Medial patellofemoral ligament reconstruction with bioactive synthetic ligament is an option. A 3-year follow-up study

verfasst von: Massimo Berruto, Paolo Ferrua, Francesco Uboldi, Eva Usellini, Luca Gala, Alberto Tassi, Bruno Marelli

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

Einloggen, um Zugang zu erhalten

Abstract

Purpose

The purpose of this study was to evaluate mid-term follow-up results of medial patellofemoral ligament (MPFL) reconstruction using a bioactive synthetic ligament in the treatment of objective patellofemoral (PF) instability.

Methods

Sixteen patients (18 knees) presenting with objective PF instability underwent a MPFL reconstruction, isolated or associated with other surgical procedures for PF stabilization. All patients were clinically evaluated at a minimum follow-up of 3 years. Kujala, subjective IKDC and KOOS scores were used to assess clinical outcome. Pre-operative and post-operative pain was quantified with VAS scale and the overall satisfaction graded according to Insall and Crosby. Although none of the patients in this series were involved in high-level sports activity because of patellofemoral instability, activity level pre-operatively and at follow-up were evaluated according to Tegner scale.

Results

No recurrence of dislocation was observed in this series. The overall satisfaction rate was 88.8 %. Kujala score improved significantly from 57 ± 8.4 to 84.3 ± 10.2 points (p < .01). Both subjective IKDC (42.4 ± 7.13 to 70.1 ± 3.9) and KOOS (62.7 ± 4.34 to 82.8 ± 8.8) significantly improved from pre-operative evaluation (p < .01). VAS decreased from a mean pre-operative value of 2.5 ± 1.6 to 1.4 ± 1.5 at 3 years follow-up. Only one patient required revision debridement surgery for persistent medial epicondylar pain.

Conclusions

Isolated or associated MPFL reconstruction with bioactive synthetic ligament is a valid option in surgical treatment of objective PF instability, with results at mid-term follow-up comparable to autologous graft, thus minimizing donor-site morbidity and associated complications.

Level of evidence

IV.
Literatur
1.
Zurück zum Zitat Caton J, Deschamps G, Chambat P et al (1982) Patella infera. A propos of 128 cases. Rev Chir Orthop Reparatrice Appar Mot 68(5):317–325PubMed Caton J, Deschamps G, Chambat P et al (1982) Patella infera. A propos of 128 cases. Rev Chir Orthop Reparatrice Appar Mot 68(5):317–325PubMed
2.
Zurück zum Zitat Charles MD, Haloman S, Chen L (2013) Magnetic resonance imaging-based topographical differences between control and recurrent patellofemoral instability patients. Am J Sports Med 41(2):374–384PubMedCrossRef Charles MD, Haloman S, Chen L (2013) Magnetic resonance imaging-based topographical differences between control and recurrent patellofemoral instability patients. Am J Sports Med 41(2):374–384PubMedCrossRef
3.
Zurück zum Zitat Conti C, Berruto M, Bianchi M (1992) The Elmslie-Trillat procedure for recurrent subluxation of the patella. One to five years follow-up. Ital J Orthop Traumatol 18(3):341–349PubMed Conti C, Berruto M, Bianchi M (1992) The Elmslie-Trillat procedure for recurrent subluxation of the patella. One to five years follow-up. Ital J Orthop Traumatol 18(3):341–349PubMed
4.
Zurück zum Zitat Crosby EB, Insall J (1976) Recurrent dislocation of the patella. Relation of treatment to osteoarthritis. J Bone Joint Surg Am 58(1):9–13PubMed Crosby EB, Insall J (1976) Recurrent dislocation of the patella. Relation of treatment to osteoarthritis. J Bone Joint Surg Am 58(1):9–13PubMed
5.
Zurück zum Zitat Deie M, Ochi M, Sumen Y (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(7):522–528PubMedCrossRef Deie M, Ochi M, Sumen Y (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(7):522–528PubMedCrossRef
6.
Zurück zum Zitat Desio SM, Burks RT, Bachus KN (1998) Soft tissue restraints to lateral patellar translation in the human knee. Am J Sports Med 26(1):59–65PubMed Desio SM, Burks RT, Bachus KN (1998) Soft tissue restraints to lateral patellar translation in the human knee. Am J Sports Med 26(1):59–65PubMed
7.
Zurück zum Zitat Drez D, Edwards T, Williams C (2001) Results of medial patellofemoral ligament reconstruction in the treatment of patellar dislocation. Arthroscopy 17(3):298–306PubMedCrossRef Drez D, Edwards T, Williams C (2001) Results of medial patellofemoral ligament reconstruction in the treatment of patellar dislocation. Arthroscopy 17(3):298–306PubMedCrossRef
8.
Zurück zum Zitat Ellera Gomes JL (1992) Medial patellofemoral ligament reconstruction for recurrent dislocation of the patella: a preliminary report. Arthroscopy 8(3):335–340PubMedCrossRef Ellera Gomes JL (1992) Medial patellofemoral ligament reconstruction for recurrent dislocation of the patella: a preliminary report. Arthroscopy 8(3):335–340PubMedCrossRef
9.
Zurück zum Zitat Ellera Gomes JL, Stigler Marczyk LR, César de César P, Jungblut CF (2004) Medial patellofemoral reconstruction with semitendinosus autograft for chronic patellar instability: a follow-up study. Arthroscopy 20(2):147–151PubMedCrossRef Ellera Gomes JL, Stigler Marczyk LR, César de César P, Jungblut CF (2004) Medial patellofemoral reconstruction with semitendinosus autograft for chronic patellar instability: a follow-up study. Arthroscopy 20(2):147–151PubMedCrossRef
10.
Zurück zum Zitat Fithian DC, Paxton EW, Cohen AB (2004) Indications in the treatment of patellar instability. J Knee Surg 17(1):47–56PubMed Fithian DC, Paxton EW, Cohen AB (2004) Indications in the treatment of patellar instability. J Knee Surg 17(1):47–56PubMed
11.
Zurück zum Zitat Gao K et al (2010) Anterior cruciate ligament reconstruction with LARS artificial ligament: a multicenter study with 3- to 5-year follow-up. Arthroscopy 4(26):515–523CrossRef Gao K et al (2010) Anterior cruciate ligament reconstruction with LARS artificial ligament: a multicenter study with 3- to 5-year follow-up. Arthroscopy 4(26):515–523CrossRef
12.
Zurück zum Zitat Goutallier D, Bernageau J, Lecudonnec B (1978) The measurement of the tibial tuberosity. Patella groove distanced technique and results. Rev Chir Orthop Reparatrice Appar Mot 64(5):423–428PubMed Goutallier D, Bernageau J, Lecudonnec B (1978) The measurement of the tibial tuberosity. Patella groove distanced technique and results. Rev Chir Orthop Reparatrice Appar Mot 64(5):423–428PubMed
13.
Zurück zum Zitat Hapa H, Aksahin E, Ozden R et al (2012) Aperture fixation instead of transverse tunnels at the patella for medial patellofemoral ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 20:322–326PubMedCrossRef Hapa H, Aksahin E, Ozden R et al (2012) Aperture fixation instead of transverse tunnels at the patella for medial patellofemoral ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 20:322–326PubMedCrossRef
14.
Zurück zum Zitat Irrgang JJ, Anderson AF, Boland AL et al (2001) Development and validation of the international knee documentation committee subjective knee form. Am J Sports Med 29:600–613PubMed Irrgang JJ, Anderson AF, Boland AL et al (2001) Development and validation of the international knee documentation committee subjective knee form. Am J Sports Med 29:600–613PubMed
15.
Zurück zum Zitat Kang HJ, Wang F, Chen BC, Su YL, Zhang ZC, Yan CB (2010) Functional bundles of the medial patellofemoral ligament. Knee Surg Sports Traumatol Arthrosc 18(11):1511–1516PubMedCrossRef Kang HJ, Wang F, Chen BC, Su YL, Zhang ZC, Yan CB (2010) Functional bundles of the medial patellofemoral ligament. Knee Surg Sports Traumatol Arthrosc 18(11):1511–1516PubMedCrossRef
16.
Zurück zum Zitat Kujala UM, Jaakkola LH, Koskinen SK, Taimela S, Hurme M, Nelimarkka O (1993) Scoring of patellofemoral disorders. Arthroscopy 9(2):159–163PubMedCrossRef Kujala UM, Jaakkola LH, Koskinen SK, Taimela S, Hurme M, Nelimarkka O (1993) Scoring of patellofemoral disorders. Arthroscopy 9(2):159–163PubMedCrossRef
17.
Zurück zum Zitat Legnani C, Ventura A, Terzaghi C, Borgo E, Albisetti W (2010) Anterior cruciate ligament reconstruction with synthetic grafts. A review of literature. Int Orthop 34:465–471PubMedCrossRefPubMedCentral Legnani C, Ventura A, Terzaghi C, Borgo E, Albisetti W (2010) Anterior cruciate ligament reconstruction with synthetic grafts. A review of literature. Int Orthop 34:465–471PubMedCrossRefPubMedCentral
18.
Zurück zum Zitat Ma LF, Wang F, Chen BC et al (2013) Medial retinaculum plasty versus medial patellofemoral ligament reconstruction for recurrent patellar instability in adults: a randomized controlled trial. Arthroscopy 29(5):891–897PubMedCrossRef Ma LF, Wang F, Chen BC et al (2013) Medial retinaculum plasty versus medial patellofemoral ligament reconstruction for recurrent patellar instability in adults: a randomized controlled trial. Arthroscopy 29(5):891–897PubMedCrossRef
19.
Zurück zum Zitat Mikashima Y, Kimura M, Kobayashi Y et al (2004) Medial patellofemoral ligament reconstruction for recurrent patellar instability. Acta Orthop Belg 70(6):545–555PubMed Mikashima Y, Kimura M, Kobayashi Y et al (2004) Medial patellofemoral ligament reconstruction for recurrent patellar instability. Acta Orthop Belg 70(6):545–555PubMed
20.
Zurück zum Zitat Muneta T, Sekiya I, Tsuchiya M, Shinomiya K (1999) A technique for reconstruction of the medial patellofemoral ligament. Clin Orthop Relat Res 359:151–155PubMedCrossRef Muneta T, Sekiya I, Tsuchiya M, Shinomiya K (1999) A technique for reconstruction of the medial patellofemoral ligament. Clin Orthop Relat Res 359:151–155PubMedCrossRef
21.
Zurück zum Zitat Nomura E, Inoue M, Kobayashi S (2007) Long-term follow-up and knee osteoarthritis change after medial patellofemoral ligament reconstruction for recurrent patellar dislocation. Am J Sports Med 35(11):1851–1858PubMedCrossRef Nomura E, Inoue M, Kobayashi S (2007) Long-term follow-up and knee osteoarthritis change after medial patellofemoral ligament reconstruction for recurrent patellar dislocation. Am J Sports Med 35(11):1851–1858PubMedCrossRef
22.
Zurück zum Zitat Nomura E, Horiuchi Y, Kihara M (2000) A mid-term follow-up of medial patellarfemoral ligament reconstruction using an artificial ligament for recurrent patellar dislocation. Knee 7(4):211–215PubMedCrossRef Nomura E, Horiuchi Y, Kihara M (2000) A mid-term follow-up of medial patellarfemoral ligament reconstruction using an artificial ligament for recurrent patellar dislocation. Knee 7(4):211–215PubMedCrossRef
23.
Zurück zum Zitat Nomura E, Horiuchi Y, Kihara M (2000) Medial patellofemoral ligament restraint in lateral patellar translation and reconstruction. Knee 7(2):121–127PubMedCrossRef Nomura E, Horiuchi Y, Kihara M (2000) Medial patellofemoral ligament restraint in lateral patellar translation and reconstruction. Knee 7(2):121–127PubMedCrossRef
24.
25.
Zurück zum Zitat Nomura E, Inoue M, Sugiura H (2005) Histological evaluation of medial patellofemoral ligament reconstructed using the Leed-Keio ligament prothesis. Biomaterials 26:2663–2670PubMedCrossRef Nomura E, Inoue M, Sugiura H (2005) Histological evaluation of medial patellofemoral ligament reconstructed using the Leed-Keio ligament prothesis. Biomaterials 26:2663–2670PubMedCrossRef
26.
Zurück zum Zitat Oragui E, Onyema C, Louay A, Kandiah R (2013) Medial patellofemoral ligament reconstruction using a LARS ligament. Tech Ortopaedics 28(1):111–112CrossRef Oragui E, Onyema C, Louay A, Kandiah R (2013) Medial patellofemoral ligament reconstruction using a LARS ligament. Tech Ortopaedics 28(1):111–112CrossRef
27.
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 techinique. Am J Sports Med 39(12):2647–2655PubMedCrossRef Panni AS, Alam M, Cerciello S, Vasso M, Maffulli N (2011) Medial patellofemoral ligament reconstruction with a divergent patellar transverse 2-tunnel techinique. Am J Sports Med 39(12):2647–2655PubMedCrossRef
28.
Zurück zum Zitat Roos EM, Roos HP, Lohmander LS et al (1998) Knee injury and osteoarthritis outcome score (KOOS) development of a self-administered outcome measure. J Orthop Sports Phys Ther 28:88–96PubMedCrossRef Roos EM, Roos HP, Lohmander LS et al (1998) Knee injury and osteoarthritis outcome score (KOOS) development of a self-administered outcome measure. J Orthop Sports Phys Ther 28:88–96PubMedCrossRef
29.
Zurück zum Zitat Sallay PI, Poggi J, Speer KP, Garrett WE (1996) Acute dislocation of the patella. A correlative pathoanatomic study. Am J Sports Med 24(1):52–60PubMedCrossRef Sallay PI, Poggi J, Speer KP, Garrett WE (1996) Acute dislocation of the patella. A correlative pathoanatomic study. Am J Sports Med 24(1):52–60PubMedCrossRef
30.
Zurück zum Zitat Schöttle PB, Fucentese SF, Romero J (2005) Clinical and radiological outcome of medial patellofemoral ligament reconstruction with a semitendinosus autograft for patella instability. Knee Surg Sports Traumatol Arthrosc 13(7):516–521PubMedCrossRef Schöttle PB, Fucentese SF, Romero J (2005) Clinical and radiological outcome of medial patellofemoral ligament reconstruction with a semitendinosus autograft for patella instability. Knee Surg Sports Traumatol Arthrosc 13(7):516–521PubMedCrossRef
31.
Zurück zum Zitat Schöttle PB, Schmeling A, Rosenstiel N et al (2007) Radiographic landmarks for femoral tunnel placement in medial patellofemoral ligament reconstruction. Am J Sports Med 35(5):801–804PubMedCrossRef Schöttle PB, Schmeling A, Rosenstiel N et al (2007) Radiographic landmarks for femoral tunnel placement in medial patellofemoral ligament reconstruction. Am J Sports Med 35(5):801–804PubMedCrossRef
32.
Zurück zum Zitat Senavongse W, Amis AA (2005) The effects of articular, retinacular, or muscular deficiencies on patellofemoral joint stability: a biomechanical study in vitro. J Bone Joint Surg Br 87(4):577–582PubMedCrossRef Senavongse W, Amis AA (2005) The effects of articular, retinacular, or muscular deficiencies on patellofemoral joint stability: a biomechanical study in vitro. J Bone Joint Surg Br 87(4):577–582PubMedCrossRef
33.
Zurück zum Zitat Shah JN, Howard JS, Flanigan D et al (2012) A systemic review of complications and failures associated with medial patellofemoral ligament reconstruction for recurrent patellar dislocation. Am J Sports Med 40(8):1916–1923PubMedCrossRefPubMedCentral Shah JN, Howard JS, Flanigan D et al (2012) A systemic review of complications and failures associated with medial patellofemoral ligament reconstruction for recurrent patellar dislocation. Am J Sports Med 40(8):1916–1923PubMedCrossRefPubMedCentral
34.
Zurück zum Zitat Slenker NR, Tucker BS, Pepe MD (2013) Short-/intermediate-term outcomes after medial patellofemoral ligament reconstruction in the treatment of chronic lateral patellofemoral instability. Phys Sportsmed 41(2):26–33PubMedCrossRef Slenker NR, Tucker BS, Pepe MD (2013) Short-/intermediate-term outcomes after medial patellofemoral ligament reconstruction in the treatment of chronic lateral patellofemoral instability. Phys Sportsmed 41(2):26–33PubMedCrossRef
35.
Zurück zum Zitat Smith TO, Davies L, O'Driscoll ML, Donell ST (2008) An evaluation of the clinical tests and outcome measures used to assess patellar instability. Knee 15(4):255–262PubMedCrossRef Smith TO, Davies L, O'Driscoll ML, Donell ST (2008) An evaluation of the clinical tests and outcome measures used to assess patellar instability. Knee 15(4):255–262PubMedCrossRef
36.
Zurück zum Zitat Smith TO, Walker J, Russell N (2007) Outcomes of medial patellofemoral ligament reconstruction for patellar instability: a systematic review. Knee Surg Sports Traumatol Arthrosc 15(11):1301–1314PubMedCrossRef Smith TO, Walker J, Russell N (2007) Outcomes of medial patellofemoral ligament reconstruction for patellar instability: a systematic review. Knee Surg Sports Traumatol Arthrosc 15(11):1301–1314PubMedCrossRef
37.
Zurück zum Zitat Song SY, Kim IS, Chang HG et al (2013) Anatomic medial patellofemoral ligament reconstruction using patellar suture anchor fixation for recurrent patellar instability. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-013-2730-6 Song SY, Kim IS, Chang HG et al (2013) Anatomic medial patellofemoral ligament reconstruction using patellar suture anchor fixation for recurrent patellar instability. Knee Surg Sports Traumatol Arthrosc. doi:10.​1007/​s00167-013-2730-6
38.
Zurück zum Zitat Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligaments injuries. Clin Orthop Relat Res 198:43–49PubMed Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligaments injuries. Clin Orthop Relat Res 198:43–49PubMed
39.
Zurück zum Zitat Trillat A, Dejour H, Couette A (1964) Diagnosis and treatment of recurrent dislocation of the patella. Rev Chir Orthop Reparatrice Appar Mot 50:813–824PubMed Trillat A, Dejour H, Couette A (1964) Diagnosis and treatment of recurrent dislocation of the patella. Rev Chir Orthop Reparatrice Appar Mot 50:813–824PubMed
40.
Zurück zum Zitat Zaffagnini S, Colle F, Lopomo N et al (2013) The influence of medial patellofemoral ligament on patellofemoral joint kinematics and patellar stability. Knee Surg Sports Traumatol Arthrosc 21(9):2164–2171PubMedCrossRef Zaffagnini S, Colle F, Lopomo N et al (2013) The influence of medial patellofemoral ligament on patellofemoral joint kinematics and patellar stability. Knee Surg Sports Traumatol Arthrosc 21(9):2164–2171PubMedCrossRef
Metadaten
Titel
Medial patellofemoral ligament reconstruction with bioactive synthetic ligament is an option. A 3-year follow-up study
verfasst von
Massimo Berruto
Paolo Ferrua
Francesco Uboldi
Eva Usellini
Luca Gala
Alberto Tassi
Bruno Marelli
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/s00167-014-2970-0

Weitere Artikel der Ausgabe 10/2014

Knee Surgery, Sports Traumatology, Arthroscopy 10/2014 Zur Ausgabe

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.