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Influence of rupture patterns of the medial patellofemoral ligament (MPFL) on the outcome after operative treatment of traumatic patellar dislocation

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

Abstract

Purpose

Patellar dislocation usually occurs to the lateral side, leading to ruptures of the medial patellofemoral ligament (MPFL) in about 90 % of all cases. Reliable prognostic factors for the stability of the patellofemoral joint after MPFL surgery and satisfaction of the patient have not been established as yet.

Methods

This multicentric study retrospectively included 40 patients with a mean age of 22.4 ± 8.1 years (range 9–48) from 5 German Trauma Departments with first-time traumatic patellar dislocation and operative treatment. Surgery was limited to soft tissue repairs, and a preoperative magnetic resonance imaging (MRI) was performed in all cases. Evaluation of the MRI included sulcus angle, dysplasia of the trochlea, depth and facet asymmetry of the trochlea, Insall-Salvati index, Tibial tuberosity to trochlear groove (TTTG) distance, and rupture patterns of the MPFL. Patients were interrogated after 2 years about recurrent dislocation, satisfaction, and the Kujala score.

Results

Trochlea facet asymmetry was significantly lower in patients with redislocation (23.5 ± 18.8) than in patients without redislocation (43.1 ± 16.5, p = 0.03). Patients with a patellar-based rupture were significantly younger (19.5 ± 7.2 years) than patients without patellar-based rupture (25.4 ± 8.1 years, p < 0.02). Patients with femoral-based ruptures were significantly older (25.7 ± 9.2 years) than patients without femoral-based rupture (19.7 ± 6.1 years, p < 0.02), and had a significantly higher TTTG distance (10.2 ± 6.9 vs. 4.5 ± 5.5, p < 0.02). Patients with incomplete ruptures of the MPFL had a significantly lower Insall-Salvati index (1.2 ± 0.2 vs. 1.4 ± 0.2, p = 0.05). The Kujala score in patients with redislocations was significantly lower (81.0 ± 10.5 points) than in patients without redislocation (91.9 ± 9.2 points, p < 0.02).

Conclusion

Younger patients more often sustain patellar-based ruptures following first-time traumatic patella dislocation, while older patients more often sustain femoral-based ruptures of the MPFL. Incomplete MPFL ruptures are correlated with lower Insall-Salvati indices. Low trochlear facet asymmetry is correlated with higher rates of redislocation. These results may be of relevance for the operative and postoperative treatment in the future.

Level of evidence

Prognostic study, Level IV.

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Acknowledgments

We greatly acknowledge funding of Ormed-DJO for this study.

Author information

Authors and Affiliations

  1. Trauma Department, Hannover Medical School (MHH), Carl-Neuberg-Straße 1, 30625, Hannover, Germany

    M. Petri, M. Broese, E. Liodakis, C. Krettek, C. Haasper & M. Jagodzinski

  2. Radiology Department, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Germany

    C. von Falck

  3. Trauma Department, University Hospital Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany

    P. Balcarek

  4. Trauma Department, University Hospital Freiburg, Hugstetter Str. 49, 79095, Freiburg, Germany

    P. Niemeyer

  5. Trauma Department, Traumacenter Murnau, Prof. Küntscher-Str. 8, 82418, Murnau, Germany

    M. Hofmeister

  6. Department of Trauma and Reconstructive Surgery, Friederikenstift Hospital Hannover, Humboldtstr. 5, 30169, Hannover, Germany

    C. Voigt & H. Lill

  7. Trauma Department, Johannes Wesling Hospital Minden, Hans-Nolte-Str. 1, 32429, Minden, Germany

    J. Zeichen

  8. Trauma Department, Asklepios Hospital St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Germany

    K. H. Frosch

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  1. M. Petri
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  2. C. von Falck
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  3. M. Broese
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  4. E. Liodakis
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  5. P. Balcarek
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  7. M. Hofmeister
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  9. C. Voigt
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  10. C. Haasper
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  11. J. Zeichen
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  12. K. H. Frosch
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  13. H. Lill
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  14. M. Jagodzinski
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Corresponding author

Correspondence to M. Petri.

Additional information

This is a study of the Committee TRAUMA of the AGA-Society for Arthroscopy and Joint Surgery. P. Balcarek, M. Hofmeister, C. Voigt, C. Haasper, J. Zeichen, K. H. Frosch and H. Lill are members of the Committee.

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Petri, M., von Falck, C., Broese, M. et al. Influence of rupture patterns of the medial patellofemoral ligament (MPFL) on the outcome after operative treatment of traumatic patellar dislocation. Knee Surg Sports Traumatol Arthrosc 21, 683–689 (2013). https://doi.org/10.1007/s00167-012-2037-z

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