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Clinical outcomes of medial patellofemoral ligament repair in recurrent (chronic) lateral patella dislocations

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The specific aim of this project was to review a homogenous group of patients who had chosen to undergo medial patellofemoral ligament (MPFL) repair to stabilize their patella after repeat (chronic) patellofemoral dislocations and to record the success of this procedure in stabilizing the patella against further lateral dislocations.

Methods

This is a retrospective study of 55 knees in 48 patients who underwent a repair of the medial patellofemoral ligament by a single surgeon over a 4-year period. The endpoint of the study was a documented patellofemoral dislocation or a minimum 2-year follow-up.

Results

Fifty-five knees in 48 patients underwent a MPFL repair/reattachment. Patella alta, as defined by the Insall–Salvati (I/S) ratio, was within normal limits in 6 (14%). The I/S ratio was greater than 1.2 in 38 patients (86%) and greater than 1.4 in 23 patients (52%). Trochlear dysplasia as defined by a positive crossing sign on a true lateral radiograph and/or a sulcus angle on axial view of greater than 145 was present in 45/47 (96%). Successful management of the knee as defined by no further patella dislocation occurred in 22 knees. Nineteen knees sustained a redislocation event (46%).

Conclusions

The surgical procedure of operative repair (reattachment) of the MPFL to its femoral attachment had a significantly high rate of failure in this patient group of chronic (repeat) lateral patellar dislocators.

Level of evidence

IV.

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References

  1. Ahmad CS, Stein BE, Matuz D, Henry JH (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 

  2. Arendt E (2010) Medial side patellofemoral anatomy: surgical implications in patellofemoral instability. In: Zaffagnini S, Dejour D, Arendt E (eds) Patellofemoral pain, instability and arthritis. Heidelberg, Springer, Berlin, pp 149–152

    Chapter  Google Scholar 

  3. Atkin DM, Fithian DC, Marangi KS, Stone ML, Dobson BE, Mendelsohn C (2000) Characteristics of patients with primary acute lateral patellar dislocation and their recovery within the first 6 months of injury. Am J Sports Med 28:472–479

    PubMed  CAS  Google Scholar 

  4. Buchner M, Baudendistel B, Sabo D, Schmitt H (2005) Acute traumatic primary patellar dislocation: long-term results comparing conservative and surgical treatment. Clin J Sport Med 15:62–66

    Article  PubMed  Google Scholar 

  5. Camanho GL, Viegas Ade C, Bitar AC, Demange MK, Hernandez AJ (2009) Conservative versus surgical treatment for repair of the medial patellofemoral ligament in acute dislocations of the patella. Arthroscopy 25:620–625

    Article  PubMed  Google Scholar 

  6. Christiansen SE, Jakobsen BW, Lund B, Lind M (2008) Isolated repair of the medial patellofemoral ligament in primary dislocation of the patella: a prospective randomized study. Arthroscopy 24:881–887

    Article  PubMed  Google Scholar 

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

    Google Scholar 

  8. 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

    Article  PubMed  Google Scholar 

  9. Dejour D, Le Coultre B (2007) Osteotomies in patello-femoral instabilities. Sports Med Arthrosc 15:39–46

    Article  PubMed  Google Scholar 

  10. DeJour H, Bonnin M (1994) Tibial translation after anterior cruciate ligament rupture. Two radiographic tests compared. J Bone Joint Surg (BR) 76:745–749

    CAS  Google Scholar 

  11. Dejour H, Walch G, Nove-Josserand L, Guier CH (1994) Patellar problems: factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 2:19–26

    Article  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 26:59–65

    PubMed  CAS  Google Scholar 

  13. Elias DA, White LM, Fithian DC (2002) Acute lateral patellar dislocation at MR imaging: injury patterns of medial patellar soft-tissue restraints and osteochondral injuries of the inferomedial patella. Radiology 225:736–743

    Article  PubMed  Google Scholar 

  14. Feller JA, Lind M, Nelson J, Diduch D, Arendt E (2011) Repair and reconstruction of the medial patellofemoral ligament for treatment of lateral patellar dislocations: Surgical techniques and clinical results. In: Scott WN (ed) Insall scott—surgery of the knee, 5th Edn. Elsevier, Philadelphia (in press)

  15. Fithian DC, Paxton EW, Stone ML, Silva P, Davis DK, Elias DA, White LM (2004) Epidemiology and natural history of acute patellar dislocation. Am J Sports Med 32:1114–1121

    Article  PubMed  Google Scholar 

  16. Guerrero P, Li X, Patel K, Brown M, Busconi B (2009) Medial patellofemoral ligament injury patterns and associated pathology in lateral patella dislocation: an MRI study. Sports Med Arthrosc Rehabil Ther Technol 1:17

    Article  PubMed  Google Scholar 

  17. Insall J, Salvati E (1971) Patella position in the normal knee joint. Radiology 101:101–104

    PubMed  CAS  Google Scholar 

  18. Kolowich PA, Paulos LE, Rosenberg TD (1990) Lateral release of the patella: indications and contraindications. Am J Sports Med 18:359–365

    Article  PubMed  CAS  Google Scholar 

  19. Laurin CA, Dussault R, Levesque HP (1979) The tangential X-ray investigation of the patellofemoral joint: X-ray technique, diagnostic criteria and their interpretation. Clin Orthop 144:16–26

    PubMed  Google Scholar 

  20. Laurin CA, Levesque HP, Dussault RG, Labelle H, Peides JP (1978) The abnormal lateral patellofemoral angle. J Bone Joint Surg [Am] 60:55–60

    CAS  Google Scholar 

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

    PubMed  Google Scholar 

  22. Nikku R, Nietosvaara Y, Aalto K, Kallio P (2005) Operative treatment of primary patellar dislocation does not improve medium-term outcome. Acta Orthopaedica 76:699–704

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  24. Nomura E, Horiuchi Y, Inoue M (2002) Correlation of MR imaging findings and open exploration of medial patellofemoral ligament injuries in acute patellar dislocations. Knee 9:139–143

    Article  PubMed  CAS  Google Scholar 

  25. Sallay PI (1996) Acute dislocation of the patella. A correlative pathoanatomic study. Am J Sports Med 24:52–60

    Article  PubMed  CAS  Google Scholar 

  26. Schottle PB, Scheffler SU, Schwarck A, Weiler A (2006) Arthroscopic medial retinacular repair after patellar dislocation with and without underlying trochlear dysplasia: a preliminary report. Arthroscopy 22:1192–1198

    Article  PubMed  Google Scholar 

  27. Spritzer CE, Courneya DL, Burk DLJ, Garrett WE, Strong JA (1997) Medial retinacular complex injury in acute patellar dislocation: MR findings and surgical implications. Am J Roentgenol 168:117–122

    CAS  Google Scholar 

  28. Stefancin J, Parker R (2007) First-time traumatic patellar dislocation: a systematic review. Clin Orthop Rel Res 455:93–101

    Article  Google Scholar 

  29. Tuxoe JI, Teir M, Winge S, Nielsen PL (2002) The medial patellofemoral ligament: a dissection study. Knee Surg Sports Traumatol Arthrosc 10:138–140

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Av., Suite R200, Minneapolis, MN, 55454, USA

    Elizabeth A. Arendt, Amy Moeller & Julie Agel

Authors
  1. Elizabeth A. Arendt
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  2. Amy Moeller
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  3. Julie Agel
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Corresponding author

Correspondence to Julie Agel.

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Arendt, E.A., Moeller, A. & Agel, J. Clinical outcomes of medial patellofemoral ligament repair in recurrent (chronic) lateral patella dislocations. Knee Surg Sports Traumatol Arthrosc 19, 1909–1914 (2011). https://doi.org/10.1007/s00167-011-1516-y

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  • DOI: https://doi.org/10.1007/s00167-011-1516-y

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