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
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.
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This work was supported by JSPS KAKENHI (grant number 18K10752).
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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.
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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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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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DOI: https://doi.org/10.1007/s00264-020-04765-w