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Dynamic medial patellofemoral ligament reconstruction in recurrent patellar instability

A surgical technique

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Abstract

The medial patellofemoral ligament (MPFL) is the primary stabilizer of the patellofemoral joint; its reconstruction has been recommended in adults over the past decade after recurrent patellar instability. However, there has been no standardized technique for reconstruction, therefore, ideal graft and technique for reconstruction are yet undetermined. However, dynamic MPFL reconstruction studies claim to be superior to other procedures as it is more anatomical. This preliminary study aims at assessing the outcomes of MPFL reconstruction in a dynamic pattern using hamstring graft. We performed this procedure in four consecutive patients with chronic patellar instability following trauma. MPFL reconstruction was done with hamstring tendons detached distally and secured to patellar periosteum after being passed through a bony tunnel in the patella without an implant and using the medial collateral ligament as a pulley. In all 4 knees, the MPFL reconstruction was isolated and was not associated with any other realignment procedures. No recurrent episodes of dislocation or subluxation were reported at 24 months followup.

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References

  1. Hawkins RJ, Bell RH, Anisette G. Acute patellar dislocations. The natural history. Am J Sports Med 1986;14:117–20.

    Article  CAS  Google Scholar 

  2. Desio SM, Burks RT, Bachus KN. Soft tissue restraints to lateral patellar translation in the human knee. Am J Sports Med 1998;26:59–65.

    Article  CAS  Google Scholar 

  3. Nomura E. Classification of lesions of the medial patello-femoral ligament in patellar dislocation. Int Orthop 1999;23:260–3.

    Article  CAS  PubMed  Google Scholar 

  4. Sallay PI, Poggi J, Speer KP, Garrett WE. Acute dislocation of the patella. A correlative pathoanatomic study. Am J Sports Med 1996;24:52–60.

    Article  CAS  Google Scholar 

  5. Heegaard J, Leyvraz PF, Van Kampen A, Rakotomanana L, Rubin PJ, Blankevoort L. Influence of soft structures on patellar three-dimensional tracking. Clin Orthop Relat Res 1994;299:235–43.

    Google Scholar 

  6. Rünow A. The dislocating patella. Etiology and prognosis in relation to generalized joint laxity and anatomy of the patellar articulation. Acta Orthop Scand Suppl 1983;201:1–53.

    Article  Google Scholar 

  7. Tuxøe JI, Teir M, Winge S, Nielsen PL. The medial patellofemoral ligament: A dissection study. Knee Surg Sports Traumatol Arthrosc 2002;10:138–40.

    Article  Google Scholar 

  8. Amis AA, Firer P, Mountney J, Senavongse W, Thomas NP. Anatomy and biomechanics of the medial patellofemoral ligament. Knee 2003;10:215–20.

    Article  CAS  Google Scholar 

  9. Burks RT, Desio SM, Bachus KN, Tyson L, Springer K. Biomechanical evaluation of lateral patellar dislocations. Am J Knee Surg 1998;11:24–31.

    CAS  Google Scholar 

  10. Dainer RD, Barrack RL, Buckley SL, Alexander AH. Arthroscopic treatment of acute patellar dislocations. Arthroscopy 1988;4:267–71.

    Article  CAS  Google Scholar 

  11. Small NC, Glogau AI, Berezin MA. Arthroscopically assisted proximal extensor mechanism realignment of the knee. Arthroscopy 1993;9:63–7.

    Article  CAS  Google Scholar 

  12. Panagopoulos A, van Niekerk L, Triantafillopoulos IK. MPFL reconstruction for recurrent patella dislocation: A new surgical technique and review of the literature. Int J Sports Med 2008;29:359–65.

    Article  CAS  Google Scholar 

  13. Erasmus PJ, Thaunat M. MPFL reconstruction: Principles and complications. In: Sanchis-Alfonso V, editor. Anterior Knee Pain and Patellar Instability. 2nd ed. London: Springer-Verlag Limited; 2011. p. 389–90.

    Chapter  Google Scholar 

  14. Reddy KR, Reddy NS. Trochleoplasty and medial patellofemoral ligament reconstruction for recurrent patellar dislocation. Indian J Orthop 2012;46:242–5.

    Article  PubMed  Google Scholar 

  15. Hamner DL, Brown CH Jr, Steiner ME, Hecker AT, Hayes WC. Hamstring tendon grafts for reconstruction of the anterior cruciate ligament: Biomechanical evaluation of the use of multiple strands and tensioning techniques. J Bone Joint Surg Am 1999;81:549–57.

    Article  CAS  Google Scholar 

  16. Amis A, Arendt EA, Deehan D, Defoort KC, Dejour D, Fink C, et al. The medial patellofemoral ligament. In: Zaffagnini S, Becker R, Kerkhoffs GM, Espregueira-Mendes J, Van Dijk CN, editors. ESSKA Instructional Course Lecture Book. London, New York, Dordrecht: Springer Heidelberg; 2014. p. 114–23.

    Google Scholar 

  17. Park SY, Oh H, Park S, Lee JH, Lee SH, Yoon KH. Factors predicting hamstring tendon autograft diameters and resulting failure rates after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2013;21:1111–8.

    Article  Google Scholar 

  18. Goh JC, Lee PY, Bose K. A cadaver study of the function of the oblique part of vastus medialis. J Bone Joint Surg Br 1995;77:225–31.

    Article  CAS  Google Scholar 

  19. Thaunat M, Erasmus PJ. Management of overtight medial patellofemoral ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2009;17:480–3.

    Article  Google Scholar 

  20. Deie M, Ochi M, Sumen Y, Yasumoto M, Kobayashi K, Kimura H. Reconstruction of the medial patellofemoral ligament for the treatment of habitual or recurrent dislocation of the patella in children. J Bone Joint Surg Br 2003;85:887–90.

    Article  CAS  PubMed  Google Scholar 

  21. Fink C, Veselko M, Herbort M, Hoser C. Minimally invasive reconstruction of the medial patellofemoral ligament using quadriceps tendon. Arthrosc Tech 2014;3:e325–9.

    Article  Google Scholar 

  22. Ochid M, Okada Y, Manabe H, Mochiduki Y, Sasashige Y, Jitsuiki Z, et al. The medial tenodesis for patellar dislocation–From the view points of the isometry. Hiza 1989;15:45–50.

    Google Scholar 

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

    Google Scholar 

  24. Crosby EB, Insall J. Recurrent dislocation of the patella. Relation of treatment to osteoarthritis. J Bone Joint Surg Am 1976;58:9–13.

    Article  CAS  Google Scholar 

  25. Kujala UM, Jaakkola LH, Koskinen SK, Taimela S, Hurme M, Nelimarkka O. Scoring of patellofemoral disorders. Arthroscopy 1993;9:159–63.

    Article  CAS  PubMed  Google Scholar 

  26. Zelle BA, Lattermann C, Chhabra A, Fu FH, Huard J. Biological considerations of tendon graft incorporation within the bone tunnel. Oper Tech Orthop 2005;15:36–42.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedics, ASHRAM, Eluru, Andhra Pradesh, India

    I. Muni Srikanth

  2. Department of Orthopaedics, Apolo Hospitals, Chennai, Tamil Nadu, India

    Lenin Chinnusamy

  3. Department of Radiodiagnosis, TIME Hospitals, Vijayawada, Andhra Pradesh, India

    K. Deepti

  4. Department of Orthopaedics, Dr. PSIMS and RF, Chinoutpalli, Vijayawada, Andhra Pradesh, India

    Kopuri Ravi Kiran

Authors
  1. Kopuri Ravi Kiran
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  2. I. Muni Srikanth
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  3. Lenin Chinnusamy
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  4. K. Deepti
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Correspondence to Kopuri Ravi Kiran.

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Kiran, K.R., Srikanth, I.M., Chinnusamy, L. et al. Dynamic medial patellofemoral ligament reconstruction in recurrent patellar instability. IJOO 49, 630–636 (2015). https://doi.org/10.4103/0019-5413.168768

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  • DOI: https://doi.org/10.4103/0019-5413.168768

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