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Double-bundle anatomical versus single-bundle isometric medial patellofemoral ligament reconstruction for patellar dislocation

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Abstract

Purpose

The purpose of this study was to evaluate reconstruction of the medial patellofemoral ligament (MPFL) using the double-bundle anatomical or single-bundle isometric procedure with respect to the patients’ clinical outcomes.

Methods

In this retrospective study, we evaluated the clinical outcome of double-bundle anatomical versus single-bundle isometric reconstruction of the MPFL for patellar dislocation patients. Sixty-three patients were included in this study from August 2004 to January 2008. From August 2004 to September 2006, MPFL reconstruction using a single-bundle isometric technique was performed in 21 patients (26 knees). Since October 2006, the double-bundle anatomical reconstruction of the MPFL has been used as the routine surgical procedure. It was performed in 37 patients (44 knees). Fifty-eight patients (70 knees) could be followed up. According to the different techniques, we divided the patients into two groups: group D with double-bundle anatomical reconstruction (37 patients) and group S with single-bundle isometric reconstruction (21 patients). Clinical evaluation consisted of the number with a patellar re-dislocation, patellar apprehension sign, Kujala score, subjective questionnaire score, the patella lateral shift rate and patellar tilt angle measured by cross-sectional CT scan.

Results

According to the Kujala score and the subjective questionnaire score, the outcome of the double-bundle group was better than the outcome of the single-bundle group especially in the long-term. Patellar re-dislocation occurred in three patients in the group S, while no re-dislocation occurred in the group D. In total, 26.9 % of group S was considered to have patellar instability, compared to 4.54 % of the group D. After operation, the patellar tilt angle (PTA) and the patella lateral shift rate (PLSR) were restored to the normal range, with statistical significance (P < 0.05) compared to the preoperative state.

Conclusion

Single- and double-bundle reconstruction of the MPFL can both effectively restore patella stability and improve knee function. However, outcomes in the follow-up period showed that the double-bundle surgery procedure was much better than in single-bundle surgery.

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References

  1. Haspl M, Cicak N, Klobucar H, Pecina M (2002) Fully arthroscopic stabilization of the patella. Arthroscopy 18(1):E2

    Article  PubMed  Google Scholar 

  2. Rhee SJ, Pavlou G, Oakley J et al (2012) Modern management of patellar instability. Int Orthop 36(12):2447–2456

    Article  PubMed  Google Scholar 

  3. Ji G, Wang F, Zhang Y et al (2012) Medial patella retinaculum plasty for treatment of habitual patellar dislocation in adolescents. Int Orthop 36(9):1819–1825

    Article  PubMed  Google Scholar 

  4. Freitag S, Lill H, Hepp P et al (2005) Locked lateral patella dislocation with generalized ligamentous laxity after arthroscopic lateral release of the knee. Arthroscopy 21(5):628.e1–628.e4

    Article  Google Scholar 

  5. Sillanpää P, Mattila VM, Visuri T et al (2008) Ligament reconstruction versus distal realignment for patellar dislocation. Clin Orthop Relat Res 466(6):1475–1484

    Article  PubMed  Google Scholar 

  6. Davis DK, Fithian DC (2002) Techniques of medial retinacular repair and reconstruction. Clin Orthop Relat Res 402:38–52

    Article  PubMed  Google Scholar 

  7. Ahmad CS, Stein BE, Matuz D et al (2000) Immediate surgical repair of the medial patellar stabilizers for acute patellar dislocation: a review of eight cases. Am J Sports Med 28:804–810

    PubMed  CAS  Google Scholar 

  8. Andrikoula S, Tokis A, Vasiliadis HS et al (2006) The extensor mechanism of the knee joint: an anatomical study. Knee Surg Sports Traumatol Arthrosc 14(3):214–220

    Article  PubMed  Google Scholar 

  9. Steensen RN, Dopirak RM, McDonald WG (2004) The anatomy and isometry of the medial patellofemoral ligament: implications for reconstruction: implications for reconstruction. Am J Sports Med 32:1509–1513

    Article  PubMed  Google Scholar 

  10. Sallay PI, Poggi J, Speer KP et al (1996) Acute dislocation of the patella: a correlative pathoanatomic study. Am J Sports Med 24(1):52–60

    Article  PubMed  CAS  Google Scholar 

  11. Conlan T, Garth WP Jr, Lemons JE (1993) Evaluation of the medial soft-tissue restraints of the extensor mechanism of the knee. J Bone Joint Surg Am 75(5):682–693

    PubMed  CAS  Google Scholar 

  12. Desio SM, Burks RT, Bachus KN (1998) Soft tissue restraints to lateral patellar translation in the human knee. Am J Sports Med 26(1):59–65

    PubMed  CAS  Google Scholar 

  13. Kang HJ, Wang F, Chen BC et al (2010) Functional bundles of the medial patellofemoral ligament. Knee Surg Sports Traumatol Arthrosc 18(11):1511–1516

    Article  PubMed  Google Scholar 

  14. Steiner TM, Torga-Spak R, Teitge RA (2006) Medial patellofemoral ligament reconstruction in patients with lateral patellar instability and trochlear dysplasia. Am J Sports Med 34(8):1254–1261

    Article  PubMed  Google Scholar 

  15. Parker DA, Alexander JW, Conditt MA et al (2008) Comparison of isometric and anatomic reconstruction of the medial patellofemoral ligament: a cadaveric study. Orthopedics 31(4):339–343

    Article  PubMed  Google Scholar 

  16. Nomura E (1999) Classification of lesions of the medial patello-femoral ligament in patellar dislocation. Int Orthop 23(5):260–263

    Article  PubMed  CAS  Google Scholar 

  17. Deie M, Ochi M, Sumen Y et al (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):522–528

    Article  PubMed  Google Scholar 

  18. Nomura E, Horiuchi Y, Kihara M (2000) Medial patellofemoral ligament restraint in lateral patellar translation and reconstruction. Knee 7(2):121–127

    Article  PubMed  Google Scholar 

  19. Schutzer SF, Ramsby GR, Fulkerson JP (1986) The evaluation of patellofemoral pain using computerized tomography. A preliminary study. Clin Orthop 204:286–293

    PubMed  Google Scholar 

  20. Sasaki T, Yagi T (1986) Subluxation of the patella. Investigation by computerized tomography. Int Orthop 10:115–120

    Article  PubMed  CAS  Google Scholar 

  21. Delgado-Martínez AD, Estrada C, Rodríguez-Merchán EC et al (1996) CT scanning of the patello-femoral joint. The quadriceps relaxed or contracted? Int Orthop 20:159–162

    Article  PubMed  Google Scholar 

  22. Kujala UM, Jaakkola LH, Koskinen SK et al (1993) Scoring of patellofemoral disorders. Arthroscopy 9(2):159–163

    Article  PubMed  CAS  Google Scholar 

  23. Drez D Jr, Edwards TB, Williams CS (2001) Results of medial patellofemoral ligament reconstruction in the treatment of patellar dislocation. Arthroscopy 17(3):298–306

    Article  PubMed  Google Scholar 

  24. Amis AA, Firer P, Mountney J et al (2003) Anatomy and biomechanics of the medial patellofemoral ligament. Knee 10(3):215–220

    Article  PubMed  CAS  Google Scholar 

  25. Satterfield WH, Johnson DL (2005) Arthroscopic patellar “bankart” repair after acute dislocation. Arthroscopy 21(5):627.e1–627.e5

    Article  Google Scholar 

  26. Marteau E, Burdin P, Brilhault JM (2011) Gracilis tendon transfer associated with distal alignment for patella alta with recurrent dislocations: an original surgical technique. Orthop Traumatol Surg Res 97(4):S5–S11

    Article  PubMed  CAS  Google Scholar 

  27. Mikashima Y, Kimura M, Kobayashi Y et al (2006) Clinical results of isolated reconstruction of the medial patellofemoral ligament for recurrent dislocation and subluxation of the patella. Acta Orthop Belg 72(1):65–71

    PubMed  Google Scholar 

  28. 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):516–521

    Article  PubMed  Google Scholar 

  29. Toritsuka Y, Amano H, Uchida R et al (2011) Dual tunnel medial patellofemoral ligament reconstruction for patients with patellar dislocation using a semitendinosus tendon autograft. Knee 18(4):214–219

    Article  PubMed  Google Scholar 

  30. Matthews JJ, Schranz P (2010) Reconstruction of the medial patellofemoral ligament using a longitudinal patellar tunnel technique. Int Orthop 34(8):1321–1325

    Article  PubMed  Google Scholar 

  31. Christiansen SE, Jacobsen BW, Lund B et al (2008) Reconstruction of the medial patellofemoral ligament with gracilis tendon autograft in transverse patellar drill holes. Arthroscopy 24(1):82–87

    Article  PubMed  Google Scholar 

  32. 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(10):2021–2027

    Article  PubMed  Google Scholar 

  33. Smirk C, Morris H (2003) The anatomy and reconstruction of the medial patellofemoral ligament. Knee 10(3):221–227

    Article  PubMed  Google Scholar 

  34. Aragão JA, Reis FP, de Vasconcelos DP et al (2008) Metric measurements and attachments levels of the medial patellofemoral ligament: an anatomical study in cadavers. Clinics 63(4):541–544

    Article  PubMed  Google Scholar 

  35. Panagiotopoulos E, Strzelczyk P, Herrmann M et al (2006) Cadaveric study on static medial patellar stabilizers: the dynamizing role of the vastus medialis obliquus on medial patellofemoral ligament. Knee Surg Sports Tarumatol Arthrosc 14(1):7–12

    Article  Google Scholar 

  36. Mountney J, Senavongse W, Amis AA et al (2005) Tensile strength of the medial patellofemoral ligament before and after repair or reconstruction. J Bone Joint Surg Br 87(1):36–40

    PubMed  CAS  Google Scholar 

  37. Hamner DL, Brown CH Jr, Steiner ME et al (1999) Hamstring tendon grafts for reconstruction of the anterior cruciate ligament: biomechanical evaluation of the use of multiple strands and tensioning techniques. J Bone Joint Surg Am 81(4):549–557

    PubMed  CAS  Google Scholar 

  38. Clancy WG Jr, Nelson DA, Reider B et al (1982) Anterior cruciate ligament reconstruction using one-third of the patellar ligament augmented by extra-articular tendon transfers. J Bone Joint Surg Am 64(3):352–359

    PubMed  Google Scholar 

  39. Steensen RN, Dopirak RM, Maurus PB (2005) A simple technique for reconstruction of the medial patellofemoral ligament using a quadriceps tendon graft. Arthroscopy 21(3):365–370

    Article  PubMed  Google Scholar 

  40. Heegaard J, Leyvraz PF, Van Kampen A et al (1994) Influence of soft structures on patellar three- dimensional tracking. Clin Orthop Relat Res 299:235–243

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Joint Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China

    Cheng-hai Wang, Long-fei Ma, Jian-wei Zhou, Gang Ji, Hao-yu Wang, Fei Wang & Juan Wang

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  1. Cheng-hai Wang
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  2. Long-fei Ma
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  3. Jian-wei Zhou
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  4. Gang Ji
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  5. Hao-yu Wang
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  6. Fei Wang
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  7. Juan Wang
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Correspondence to Fei Wang.

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Level of evidence: Therapeutic studies, level III.

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Wang, Ch., Ma, Lf., Zhou, Jw. et al. Double-bundle anatomical versus single-bundle isometric medial patellofemoral ligament reconstruction for patellar dislocation. International Orthopaedics (SICOT) 37, 617–624 (2013). https://doi.org/10.1007/s00264-013-1788-6

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  • DOI: https://doi.org/10.1007/s00264-013-1788-6

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