Abstract
Purpose
Recurrent patellar dislocation is defined as a dislocation occurring more than once. There is no consensus as to the choice of operative technique for recurrent dislocation in adolescents. Recently, great importance has been attributed to MPFL reconstruction. The aim of this study is to evaluate the value of MPFL reconstruction (group A) in adolescents by comparing MPFL reconstruction with combined soft tissue proximal and distal alignment (group B).
Methods
MPFL reconstruction by means of Avikainen’s technique was performed on 32 knees. Another 33 knees were subject to the techniques combining retinacular plasty, vastus medialis advancement, and Roux-Goldthwait procedure. The results were assed clinically (Lyscholm scale and the Kujala Anterior Knee Pain Scale) and using X-rays (axial and lateral knee view). Isokinetic assessment of the quadriceps and hamstring was performed.
Results
No statistically significant differences between the two groups were observed regarding the Lyscholm and Kujala scales, the presence of redislocation (9.3 % for group A versus 12.1 % for group B), apprehension test, abnormal patellofemoral angle, abnormal Caton index (p > 0.05). A statistically significant difference between the groups was observed regarding the rate of pain complaints, the incidence of an abnormal congruence angle, patellar medialization and deficits in the peak torque of the hamstring between the two angular velocities (p < 0.05).
Conclusions
The redislocation rates risk is similar in both groups. However, a lower incidence of pain complaints in the group of patients with MPFL reconstruction favours the use of MPFL reconstruction as the first choice technique.
Level of evidence: III
Similar content being viewed by others
References
Colvin AC, West RV (2008) Patellar instability. J Bone Joint Surg Am 90:2751–2762
Crosby EB, Insall J (1976) Recurrent dislocation of the patella. Relation of treatment to osteoarthritis. J Bone Joint Surg Am 58:9–13
Hughston JC, Walsh WM (1979) Proximal and distal reconstruction of the extensor mechanism for patellar subluxation. Clin Orthop Relat Res 144:36–42
Fondren FB, Goldner JL, Bassett FH 3rd (1985) Recurrent dislocation of the patella treated by the modified Roux-Goldthwait procedure. A prospective study of forty-seven knees. J Bone Joint Surg Am 67:993–1005
Deie M, Ochi M, Sumen Y, Yasumoto M, Kobayashi K, Kimura H (2003) Reconstruction of the medial patellofemoral ligament for the treatment of habitual or recurrent dislocation of the patella in children. J Bone Joint Surg (Br) 85:887–890
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 13:522–528
Sillanpää P, Mattila VM, Visuri T, Mäenpää H, Pihlajamäki H (2008) Ligament reconstruction versus distal realignment for patellar dislocation. Clin Orthop Relat Res 466:1475–1484
Avikainen VJ, Nikku RK, Seppänen-Lehmonen TK (1993) Adductor magnus tenodesis for patellar dislocation. Technique and preliminary results. Clin Orthop Relat Res 297:12–16
Becher C, Kley K, Lobenhoffer P, Ezechieli M, Smith T, Ostermeier S (2014) Dynamic versus static reconstruction of the medial patellofemoral ligament for recurrent lateral patellar dislocation. Knee Surg Sports Traumatol Arthrosc 22:2452–2457
Ostermeier S, Holst M, Bohnsack M, Hurschler C, Stukenborg-Colsman C, Wirth CJ (2007) In vitro measurement of patellar kinematics following reconstruction of the medial patellofemoral ligament. Knee Surg Sports Traumatol Arthrosc 15:276–285
Luhmann SJ, O’Donnell JC, Fuhrhop S (2011) Outcomes after patellar realignment surgery for recurrent patellar instability dislocations: a minimum 3-year follow-up study of children and adolescents. J Pediatr Orthop 31:65–71
Grelsamer RP, Stein DA (2006) Patellofemoral arthritis. J Bone Joint Surg Am 88:1849–1860
Sillanpää PJ, Mattila VM, Visuri T, Mäenpää H, Pihlajamäki H (2011) Patellofemoral osteoarthritis in patients with operative treatment for patellar dislocation: a magnetic resonance-based analysis. Knee Surg Sports Traumatol Arthrosc 19:230–235
Smith TO, Davies L, Chester R, Clark A, Donell ST (2010) Clinical outcomes of rehabilitation for patients following lateral patellar dislocation: a systematic review. Physiotherapy 96:269–281
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 26:1384–1394
Ronga M, Oliva F, Longo UG, Testa V, Capasso G, Maffulli N (2009) Isolated medial patellofemoral ligament reconstruction for recurrent patellar dislocation. Am J Sports Med 37:1735–1742
Kellis E, Katis A (2007) Quantification of functional knee flexor to extensor moment ratio using isokinetics and electromyography. J Athl Train 42:477–485
Goldthwait JEV (1899) Permanent dislocation of the patella. The report of a case of twenty years’ duration, successfully treated by transplantation of the patella tendons with the tubercle of the tibia. Ann Surg 29:62–68
Beighton P, Solomon L, Soskolne CL (1973) Articular mobility in an African population. Ann Rheum Dis 32:413–418
Merchant AC (2001) Patellofemoral imaging. Clin Orthop Relat Res 389:15–21
Beaconsfield T, Pintore E, Maffulli N, Petri GJ (1994) Radiological measurements in patellofemoral disorders. A review. Clin Orthop Relat Res 308:18–28
Berg EE, Mason SL, Lucas MJ (1996) Patellar height ratios. A comparison of four measurement methods. Am J Sports Med 24:218–221
Caton JH, Dejour D (2010) Tibial tubercle osteotomy in patello-femoral instability and in patellar height abnormality. Int Orthop 34:305–309
Freedson PS, Gilliam TB, Mahoney T, Maliszewski AF, Kastango K (1993) Industrial torque levels by age group and gender. Isokinet Exerc Sci 3:34–42
Wiggin MM, Jackson R (2005) Quadricep and hamstring peak torque norms in children 6 through 13 years. Pediatr Phys Ther 17:65
Acknowledgments
The authors are grateful to Daniel Cybula (Strzeminski Academy of Fine Arts Lodz) for preparing pictures.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Funding
This work was sponsored by the Polish Ministry of Science & Higher Education, Polish Mother’s Memorial Hospital Research Institute Young Researcher Internal Grant No. 2012/59-MN.
Conflict of interest
The authors declare that there is no conflict of interests regarding the publication of this paper.
Rights and permissions
About this article
Cite this article
Malecki, K., Fabis, J., Flont, P. et al. Preliminary results of two surgical techniques in the treatment of recurrent patellar dislocation. International Orthopaedics (SICOT) 40, 1869–1874 (2016). https://doi.org/10.1007/s00264-016-3119-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00264-016-3119-1