Medial patellofemoral ligament reconstruction for recurrent patellar instability

The purpose of this study was to determine the value of reconstruction of the medial patellofemoral ligament (MPFL) in the treatment of recurrent patellar dislocation and subluxation. We retrospectively reviewed 40 randomised patients with recurrent patellar dislocation or subluxation, who had undergone realignment surgery from July 1999 to December 2001. Group E consisted of 20 patients who had undergone an Elmslie-Trillat procedure. In Group M, also consisting of 20 patients, the Elmslie-Trillat procedure was combined with reconstruction of the MPFL. Pre and postoperative data were collected and compared. At follow-up after 2 years, the apprehension sign remained positive in 6 knees of Group E, but in none of Group M. On a stress skyline radiograph, stability was significantly better in Group M than in Group E. Based on these findings, it appears that reconstruction of the MPFL is a useful addition to the treatment of recurrent patellar dislocation and subluxation.     

Medial patellofemoral ligament reconstruction in patellar instability

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 fixed 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.     

Medial patellofemoral ligament reconstruction with semitendinosus autograft for chronic patellar instability: a follow-up study

PurposeThe purpose of this study was to describe the long-term results of medial patellofemoral ligament reconstruction with a free semitendinosus graft.Type of studyProspective nonrandomized study.MethodsWe assessed 15 patients (16 knees) treated between 1992 and 1996 (follow-up > 5 years). Diagnosis of patellofemoral dislocation or subluxation was based on the patient’s report plus reproduction of subjective complaints of instability on physical examination. All patients were treated by the same surgeon. Assessment was performed by a different surgeon based on Crosby-Insall and Aglietti criteria.ResultsAccording to Crosby-Insall criteria, 11 knees were rated as excellent, 4 good, and 1 poor. According to Aglietti criteria, 11 knees were rated as excellent, 3 good, 1 fair, and 1 poor. According to both protocols, 15 knees showed negative apprehension test, absence of patellofemoral pain, and normal patellar tracking. In one knee, the apprehension test was positive, patellofemoral pain was present, and patellar tracking was abnormal. Patellofemoral crepitus was detected in 10 knees (attenuated in 6). Thirteen patients (14 knees) were satisfied with the results. One patient considered the result acceptable, but below expectations. The final patient underwent an additional procedure. No cases of infection and no vascular problems were seen.ConclusionsMedial patellofemoral ligament reconstruction proves to be useful in improving unstable extension mechanisms and in preventing insecurity, gradual joint deterioration, and disabling pain during dislocation episodes, in a minimal 5-year follow-up study.Level of evidenceLevel IV.     

Medial reefing versus medial patellofemoral ligament reconstruction for patellar instability

The standard surgical treatment for patellar instability has been lateral release and medial reefing proximally, with a Roux-Goldthwaite tendon transfer distally. More recently, reconstruction of the medial patellofemoral ligament (MPFL) has become popular. The aim of this study was to determine whether MPFL reconstruction improved the functional outcomes over patients treated with medial reefing. A group of 28 knees in 25 patients treated with a MPFL reconstruction were identified and matched for age and gender with 28 operated knees in 27 patients treated with a medial reefing. Clinical assessment included pre-operative and 1 year Kujala scores. Radiological assessment used the Dejour protocol. The two groups were comparable with respect to gender, age, pre-operative Kujala score, type of trochlear dysplasia, tibial tubercle–trochlear groove distance and patellar tilt angle. It was concluded that although there was better patellar tracking at 1 year with an MPFL reconstruction compared to medial reefing, there was no significant functional improvement as measured by the Kujala score.     

Reconstruction of the medial patellofemoral ligament for patellar instability using a semitendinosus autograft

Between 1999 and 2001 thirty knees underwent a semitendinosus tendon plasty to recreate the medial patellofemoral ligament for recurrent patellar dislocation. The mean follow-up was 38 months. The mean improvement of the patellofemoral congruence angle after surgery was 14 +/- 7 degrees. All patients ended up with a full range of motion, except one patient, whose flexion was limited to 120 degrees due to superficial wound infections. Dislocation did not recur. According to the Larsen and Lauridsen outcome score the clinical results were excellent in 27 patients, good in 2 and fair in one. In conclusion this procedure is indicated for the chronic dislocation and cases of severe femoral dysplasia with marked laxity. The procedure assures the stabilisation of the patella, although it doesn't restore the patellofemoral congruence angle to normal values.     

Anatomical reconstruction of the medial patellofemoral ligament using a free gracilis autograft

Since biomechanical studies have shown that the medial patellofemoral ligament (MPFL) is the main restraint against lateral patella displacement, reconstruction of the MPFL has become an accepted surgical technique to restore patellofemoral stability. Recently, various procedures have been described that address reconstruction of the medial patellofemoral complex. We present a technique, where the MPFL is reconstructed anatomically to restore physiological kinematics and stability, using a free gracilis tendon autograft.     

单隧道异体肌腱重建内侧髌股韧带治疗髌骨不稳——12例临床报告

目的探讨单隧道同种异体肌腱移植重建内侧髌股韧带（MPFL）治疗髌骨不稳的手术技巧及临床疗效。方法回顾性分析2010年6月至2012年1月广州军区广州总医院采用膝关节镜监视下单隧道异体肌腱移植重建MPFL的12例（15膝）髌骨不稳患者的临床资料,评估患者术前和末次随访时Kujala评分、Lysholm评分等指标。结果术后随访时间3～21个月（平均12.3个月）。患者术前和末次随访时Kujala评分为（71.5±5.1）分和（93.2±2.4）分,两者比较,差异有统计学意义（t=-12.659,P=0.004）;Lysholm评分为（70.2±6.0）分和（94.4±1.8）分,两者比较,差异有统计学意义（t=-12.286,P=0.013）。结论膝关节镜监视下单隧道同种异体肌腱移植重建MPFL是一种治疗髌骨不稳的有效方法,对维持髌骨稳定有重要作用,但远期效果需进一步观察。     

Anterior cruciate ligament reconstruction with patellar autograft tendon

There are many techniques, graft choices, and outcome studies evaluating anterior cruciate ligament reconstruction. The current authors specifically look at reconstruction with the patellar tendon from a scientific perspective. Miniopen, endoscopic, and two-incision operative techniques in addition to hamstring versus patellar tendon autograft reconstructions are compared via randomized prospective studies. A review of all studies evaluating arthroscopically-assisted anterior cruciate ligament reconstruction with patellar tendon was conducted. The authors found arthroscopically-assisted anterior cruciate ligament reconstruction to have a high short-term stability rate, extremely high patient satisfaction level, and a low postoperative complication rate. When the endoscopic technique was compared with the two-incision technique, there were no major differences. The difference between patellar tendon and hamstring autograft reconstruction can be described best as subtle, except for the consistent finding of an increased activity level in the patellar tendon group. When the principles of anterior cruciate reconstruction are followed, one can expect consistent results with patellar tendon autograft reconstruction.     

Reconstruction of medial patellofemoral ligament for chronic patellar instability

Background:

Disruption of the capsule, medial patellar retinaculum, and/or vastus medialis obliqus has been associated with recurrent patellar instability. Biomechanical studies have shown that the medial patellofemoral ligament (MPFL) is the main restraint against lateral patella displacement and reconstruction of the MPFL has become an accepted surgical technique to restore patellofemoral stability in patients having recurrent patellar dislocation. We report a prospective series of patients of chronic patellar instability treated by reconstruction of medial patellofemoral ligament.

Materials and Methods:

Twelve patients (15 knees) with recurrent dislocation of patella, were operated between January 2006 and December 2008. All patients had generalised ligament laxity with none had severe grade of patella alta or trochlear dysplasia. The MPFL was reconstructed with doubled semitendinosus tendon. Patients were followed up with subjective criteria, patellar inclination angle, and Kujala score.

Results:

The mean duration of followup after the operative procedures was an average of 42 months (range 24–60 months) 10 knees showed excellent results, 3 knees gave good results, and 2 knees had a fair result. The average patellar inclination angle decreased from 34.3° to 18.6°. The average preoperative Kujala functional score was 44.8 and the average postoperative score was 91.9.

Conclusion:

MPFL reconstruction using the semitendinosus tendon gives good results in patients with chronic patellar instability without predisposing factors like severe patella alta and high-grade trochlear dysplasia, and for revision cases.     

Dynamic medial patellofemoral ligament reconstruction in recurrent patellar instability: A surgical technique

The medial patellofemoral ligament (MPFL) is the primary stabilizer of the patellofemoral joint; its reconstruction has been recommended in adults over the past decade after recurrent patellar instability. However, there has been no standardized technique for reconstruction, therefore, ideal graft and technique for reconstruction are yet undetermined. However, dynamic MPFL reconstruction studies claim to be superior to other procedures as it is more anatomical. This preliminary study aims at assessing the outcomes of MPFL reconstruction in a dynamic pattern using hamstring graft. We performed this procedure in four consecutive patients with chronic patellar instability following trauma. MPFL reconstruction was done with hamstring tendons detached distally and secured to patellar periosteum after being passed through a bony tunnel in the patella without an implant and using the medial collateral ligament as a pulley. In all 4 knees, the MPFL reconstruction was isolated and was not associated with any other realignment procedures. No recurrent episodes of dislocation or subluxation were reported at 24 months followup.     

Technical note: anatomical reconstruction of the medial patellofemoral ligament using a free gracilis autograft

Since biomechanical studies have shown that the medial patellofemoral ligament (MPFL) is the main restraint against lateral patella displacement, reconstruction of the MPFL has become an accepted surgical technique to restore patellofemoral stability. Recently, various procedures have been described addressing the reconstruction of the medial patellofemoral complex. We present a technique where the MPFL is reconstructed anatomically to restore physiological kinematics and stability using a free gracilis tendon autograft.     

Implantless patellar fixation in medial patellofemoral ligament reconstruction

Purpose: The medial patellofemoral ligament (MPFL) acts as primary restraint to lateral patellar dislo cation and its rupture has been reported in almost all cases of acute patellar dislocation. Various surgical techniques have been described for MPFL reconstruction, using many femoral and patellar fixation techniques and different grafts. This article details our technique for MPFL reconstruction using sem itendinosus graft which avoids the use of implant at patellar end. Methods: Twenty patients (8 males and 12 females) with complaints regarding acute and chronic lateral patellar instability were evaluated and treated by MPFL reconstruction procedure. The mean age of patients was 21 years (range 17e34 years). MPFL reconstruction was performed using semitendinosus graft passing through two parallel, obliquely directed tunnels created in patella. Fixation of graft was done with an interference screw only at the femoral end. Mean follow-up period after intervention was 26.4 months (range 23-30 months). Results were evaluated using Kujala score. Results: All patients gained adequate patellar stability and full arc of motion. No incidence of patella fracture was noted. There were no postoperative complications related to the procedure. There was no recurrence of instability in patella at final follow-up. Conclusion: Passing the graft through the tunnels in patella without use of any implant has given excellent functional outcome and moreover has the advantages of less implant-related complications and cost-effectiveness.     

Anatomical transverse patella double tunnel reconstruction of medial patellofemoral ligament with a hamstring tendon autograft for recurrent patellar dislocation

Introduction  

The purpose of this study was to describe our transverse patella double tunnel technique to reconstruct the medial patellofemoral ligament (MPFL) with a hamstring tendon autograft in patients who suffered recurrent dislocation of the patella, and to evaluate the intermediate-term outcomes of reconstruction treatment.     

Medial patellofemoral ligament reconstruction: a novel approach

Recurrent patellar instability is common, and multiple procedures have been described for its treatment. Medial patellofemoral ligament reconstruction can be successful in patients who have an incompetent medial patellofemoral ligament or who have failed medial patellofemoral ligament repair and present with recurrent patellar instability. This article describes a novel approach to medial patellofemoral ligament reconstruction using a folded hamstring allograft with a new knotless suture anchor and bio-interference screw fixation. The principal advantage of this construct is the ability to definitively fix the medial patellofemoral ligament soft-tissue graft on the femur and provisionally fix the graft to the patella while assessing for reasonable medial patellofemoral ligament isometry throughout the arc of knee motion.     

Medial patellofemoral ligament reconstruction: a new technique

Background  

Primary patellofemoral dislocations are common. In most patients, non-operative management produces satisfactory outcome. If the dislocation recurs after a trial of rehabilitation, operative intervention is considered, with the aim of restoring the soft tissue anatomy to normal. Ninety four percent of patients suffer a tear to the medial patellofemoral ligament (MPFL) following a patellar dislocation.