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Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 13, Issue 7, pp 516–521 | Cite as

Clinical and radiological outcome of medial patellofemoral ligament reconstruction with a semitendinosus autograft for patella instability

  • PB Schöttle
  • SF Fucentese
  • J RomeroEmail author
Knee

Abstract

Background: Recurrent patellar instability is a common problem after dislocation. The medial patellofemoral ligament (MPFL) contributes 40–80% of the total medial restraining forces. This study assessed the clinical and radiological outcome after a follow-up of 4 years after linear MPFL reconstruction using an ipsilateral Semitendinosus tendon autograft. Study design and methods: 15 knees in 12 patients were examined with a mean of 47 months after linear reconstruction of the MPFL at a mean age of 30 years. 3 knees underwent previous surgery. 3 patients had mild trochlear dysplasia grade I or II, according to the classification of Dejour. If preoperative tibial tuberosity-trochlear groove distance (TTTG) was more than 15 mm, patients underwent additional medialisation of the tibial tuberosity (n=8) creating a similar postoperative situation for all patients. All patients were available for a postoperative evaluation, which consisted of a subjective questionnaire, the Kujala score, and the recording of potential patellar redislocation and apprehension. Patellar height and tilt was measured on plain radiographs. Postoperative CT scans were performed in patients with an additional tibial tuberosity-transfer. Results: Postoperatively, one patient reported on recurrent bilateral redislocation. Physical examination however revealed no findings. Three knees presented with persistent patellar apprehension. Thirteen knees had improved subjectively after surgery. The mean Kujala score improved significantly from 55.0 to 85.7 points. The patellar tilt decreased significantly from 11.3° to 9.2°. Four knees had patella alta preoperatively, but only two at the latest follow-up visit. Previous surgery or additional trochlear dysplasia had no influence on the clinical outcome. Conclusion: MPFL reconstruction improves clinical symptoms, reduces the patellar tilt substantially, and may correct patella alta. Additional mild trochlear dysplasia did not compromise the outcome; however, this fact needs further attention in a larger study group.

Keywords

Patella instability Medial patellofemoral ligament TTTG Reconstruction Tibial tuberosity 

References

  1. 1.
    Aglietti P, Buzzi R, De Biase P, Giron F (1994) Surgical treatment of recurrent dislocation of the patella. Clin Orthop 308:8–17PubMedGoogle Scholar
  2. 2.
    Avikainen VJ, Nikku RK, Seppanen-Lehmonen TK (1993) Adductor magnus tenodesis for patellar dislocation. Technique and preliminary results. Clin Orthop 297:12–16PubMedGoogle Scholar
  3. 3.
    Beaconsfield T, Pintore E, Maffulli N, Petri GJ (1994) Radiological measurements in patellofemoral disorders. A review. Clin Orthop 308:18–28PubMedGoogle Scholar
  4. 4.
    Betz RR, Magill JT III, Lonergan RP (1987) The percutaneous lateral retinacular release. Am J Sports Med 15:477–482Google Scholar
  5. 5.
    Blauth W, Mann M (1977) [Medial-and simultaneous anterior-transfer of the tibial tuberosity (author’s transl)]. Z Orthop Ihre Grenzgeb 115:252–255PubMedGoogle Scholar
  6. 6.
    Brown DE, Alexander AH, Lichtman DM (1984) The Elmslie-Trillat procedure: evaluation in patellar dislocation and subluxation. Am J Sports Med 12:104–109PubMedGoogle Scholar
  7. 7.
    Burks RT, Desio SM, Bachus KN, Tyson L, Springer K (1998) Biomechanical evaluation of lateral patellar dislocations. Am J Knee Surg 11:24–31PubMedGoogle Scholar
  8. 8.
    Caton J, Deschamps G, Chambat P, Lerat JL, Dejour H (1982) Les rotules basses. A propos de 128 observations. Rev Chir Orthop Reparatrice Appar Mot 68:317–325PubMedGoogle Scholar
  9. 9.
    Caton J, Deschamps G, Chambat P, Lerat JL, Dejour H (1982) [Patella infera. Apropos of 128 cases]. Rev Chir Orthop Reparatrice Appar Mot 68:317–325PubMedGoogle Scholar
  10. 10.
    Cerullo G, Puddu G, Conteduca, Ferretti A, Mariani PP (1988) Evaluation of the results of extensor mechanism reconstruction. Am J Sports Med 16:93–96PubMedGoogle Scholar
  11. 11.
    Cofield RH, Bryan RS (1977) Acute dislocation of the patella: results of conservative treatment. J Trauma 17:526–531PubMedGoogle Scholar
  12. 12.
    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 75:682–693PubMedGoogle Scholar
  13. 13.
    Cox JS (1982) Evaluation of the Roux-Elmslie-Trillat procedure for knee extensor realignment. Am J Sports Med 10:303–310PubMedGoogle Scholar
  14. 14.
    Crosby EB, Insall J (1976) Recurrent dislocation of the patella. Relation of treatment to osteoarthritis. J Bone Joint Surg Am 58:9–13PubMedGoogle Scholar
  15. 15.
    Davies AP, Costa ML, Shepstone L, Glasgow MM, Donell S, Donnell ST (2000) The sulcus angle and malalignment of the extensor mechanism of the knee. J Bone Joint Surg Br 82:1162–1166CrossRefPubMedGoogle Scholar
  16. 16.
    Davis DK, Fithian DC (2002) Techniques of medial retinacular repair and reconstruction. Clin Orthop 402:38–52PubMedGoogle Scholar
  17. 17.
    Dejour H, Walch G, Neyret P, Adeleine P (1990) [Dysplasia of the femoral trochlea]. Rev Chir Orthop Reparatrice Appar Mot 76:45–54PubMedGoogle Scholar
  18. 18.
    Dejour H, Walch G, Nove-Josserand L, Guier C (1994) Factors off patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 2:19–26CrossRefPubMedGoogle Scholar
  19. 19.
    Desio SM, Burks RT, Bachus KN (1998) Soft tissue restraints to lateral patellar translation in the human knee. Am J Sports Med 26:59–65PubMedGoogle Scholar
  20. 20.
    Drez D Jr, Edwards TB, Williams CS (2001) Results of medial patellofemoral ligament reconstruction in the treatment of patellar dislocation. Arthroscopy 17:298–306PubMedGoogle Scholar
  21. 21.
    Ellera Gomes JL, Stigler Marczyk LR, Cesar de Cesar P, Jungblut CF (2004) Medial patellofemoral ligament reconstruction with semitendinosus autograft for chronic patellar instability: a follow-up study. Arthroscopy 20:147–151PubMedGoogle Scholar
  22. 22.
    Erasmas PJ (1998) Reconstruction of the medial patellofemoral ligament in recurrent traumatic patellar dislocation. Arthroscopy 14:S42 (suppl., abstract)Google Scholar
  23. 23.
    Fithian DC, Mishra DK, Balen PF, Stone ML, Daniel DM (1995) Instrumented measurement of patellar mobility. Am J Sports Med 23:607–615PubMedGoogle Scholar
  24. 24.
    Fithian DC, Paxton EW, and Cohen AB (2004) Indications in the treatment of patellar instability. J Knee Surg 17:47–56PubMedGoogle Scholar
  25. 25.
    Garth WP Jr, DiChristina DG, Holt G (2000) Delayed proximal repair and distal realignment after patellar dislocation. Clin Orthop 377:132–144CrossRefPubMedGoogle Scholar
  26. 26.
    Goldwaith JE (1904) Slipping or recurrent dislocation of the patella. Boston Med Surg J :169–174Google Scholar
  27. 27.
    Gomes JL (1992) Medial patellofemoral ligament reconstruction for recurrent dislocation of the patella: a preliminary report. Arthroscopy 8:335–340PubMedGoogle Scholar
  28. 28.
    Goutallier D, Bernageau J, Lecudonnec B (1978) [The measurement of the tibial tuberosity. Patella groove distanced technique and results (author’s transl)]. Rev Chir Orthop Reparatrice Appar Mot 64:423–428PubMedGoogle Scholar
  29. 29.
    Hautamaa PV, Fithian DC, Kaufman KR, Daniel DM, Pohlmeyer AM (1998) Medial soft tissue restraints in lateral patellar instability and repair. Clin Orthop 349:174–182PubMedGoogle Scholar
  30. 30.
    Hawkins RJ, Bell RH, Anisette G (1986) Acute patellar dislocations. The natural history. Am J Sports Med 14:117–120PubMedGoogle Scholar
  31. 31.
    Hughston JC (1972) Reconstruction of the extensor mechanism for subluxating patella. Am J Sports Med 1:6–13Google Scholar
  32. 32.
    Kolowich PA, Paulos LE, Rosenberg TD, Farnsworth S (1990) Lateral release of the patella: indications and contraindications. Am J Sports Med 18:359–365PubMedGoogle Scholar
  33. 33.
    Kujala UM, Jaakkola LH, Koskinen SK, Taimela S, Hurme M, Nelimarkka O (1993) Scoring of patellofemoral disorders. Arthroscopy 9:159–163PubMedGoogle Scholar
  34. 34.
    Kujala UM, Osterman K, Kvist M, Aalto T, Friberg O (1986) Factors predisposing to patellar chondropathy and patellar apicitis in athletes. Int Orthop 10:195–200CrossRefPubMedGoogle Scholar
  35. 35.
    Muneta T, Sekiya I, Tsuchiya M, Shinomiya K (1999) A technique for reconstruction of the medial patellofemoral ligament. Clin Orthop 339:151–155CrossRefGoogle Scholar
  36. 36.
    Nomura E (1999) Classification of lesions of the medial patello-femoral ligament in patellar dislocation. Int Orthop 23:260–263CrossRefPubMedGoogle Scholar
  37. 37.
    Nomura E, Horiuchi Y, Kihara M (2000) A mid-term follow-up of medial patellofemoral ligament reconstruction using an artificial ligament for recurrent patellar dislocation. Knee 7:211–215CrossRefPubMedGoogle Scholar
  38. 38.
    Nomura E, Horiuchi Y, Kihara M (2000) Medial patellofemoral ligament restraint in lateral patellar translation and reconstruction. Knee 7:121–127CrossRefPubMedGoogle Scholar
  39. 39.
    Sallay PI, Poggi J, Speer KP, Garrett WE (1996) Acute dislocation of the patella. A correlative pathoanatomic study. Am J Sports Med 24:52–60PubMedGoogle Scholar
  40. 40.
    Scuderi G, Cuomo F, Scott WN (1988) Lateral release and proximal realignment for patellar subluxation and dislocation. A long-term follow-up. J Bone Joint Surg Am 70:856–861PubMedGoogle Scholar
  41. 41.
    Trillat A, Dejour H, Couette A (1964) [Diagnosis and treatment of recurrent dislocations of the patella]. Rev Chir Orthop Reparatrice Appar Mot 50:813–824PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  1. 1.Orthopedic DepartmentUniversity Hospital Balgrist ZurichZurichSwitzerland

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