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Clinical outcomes after medial patellofemoral ligament reconstruction: an analysis of changes in the patellofemoral joint alignment

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Abstract

Purpose

Medial patellofemoral ligament (MPFL) reconstruction using the hamstring tendon is widely performed to treat recurrent patellar dislocation. MPFL reconstruction includes a post-operative process of necrosis and reperfusion of the hamstring tendon graft. We hypothesise that the patella gradually shifts laterally because of this process, ultimately affecting the patellofemoral joint alignment. This study aimed to analyse the chronological changes in the patellofemoral joint alignment and the outcomes of MPFL reconstruction.

Methods

In this retrospective case-series study, the Knee Society, Lysholm, and Kujala scores were evaluated in 24 consecutive patients (27 knees). To evaluate patellar tracking defects, radiographic indices including the tilting angle, the lateral shift ratio, and the congruence angle were measured before, immediately after, and three, 12, and 36 months after MPFL reconstruction.

Results

Post-operative Kujala, Knee Society, and Lysholm scores for the study population significantly improved relative to the pre-operative scores. The tilting and congruence angles at three months after the operation significantly increased relative to those recorded immediately after the operation. The tilting and congruence angles were not significantly different at three, 12, and 36 months after the operation.

Conclusions

The post-operative outcomes of MPFL reconstruction for recurrent patellar dislocation were favourable. Insufficient union between the bone tunnel and tendon graft, along with an elongation of the necrotic tendon graft, may change the alignment of the patellofemoral joint within three months after the operation. Therefore, we believe it is necessary to refrain from knee rotation that places lateral stress on the patella until three months after the operation.

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Notes

  1. ACL: anterior cruciate ligament; MPFL: medial patellofemoral ligament; MRA: magnetic resonance angiography; PF: patellofemoral

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Acknowledgments

We would like to thank Editage (www.editage.com) for English language editing.

Funding

This work was supported by JSPS KAKENHI (grant number 18K10752).

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Authors and Affiliations

  1. Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan

    Yuta Fujii, Hiroaki Inoue & Kenta Kaihara

  2. Department of Sports and Para-Sports Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajiicho 465, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan

    Shuji Nakagawa & Yuji Arai

  3. Department of Orthopaedics, Kyoto Interdisciplinary Institute Hospital of Community Medicine, Kyoto, Japan

    Hiroyuki Kan & Manabu Hino

  4. Department of Rehabilitation Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan

    Yasuo Mikami

Authors
  1. Yuta Fujii
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  2. Shuji Nakagawa
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  4. Hiroaki Inoue
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Yuta Fujii, Shuji Nakagawa, and Yuji Arai. The first draft of the manuscript was written by Yuta Fujii, and all authors commented on subsequent versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Yuji Arai.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study design was approved by the appropriate ethics review board (ERB-C-268-3).

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Informed consent was obtained from all individual participants included in the study.

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Fujii, Y., Nakagawa, S., Arai, Y. et al. Clinical outcomes after medial patellofemoral ligament reconstruction: an analysis of changes in the patellofemoral joint alignment. International Orthopaedics (SICOT) 45, 1215–1222 (2021). https://doi.org/10.1007/s00264-020-04765-w

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