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Medial patellofemoral ligament reconstruction as an isolated or combined procedure for recurrent patellar instability

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

Abstract

Purpose

The principal aim of this study was to report the outcomes of medial patellofemoral ligament (MPFL) reconstruction, used as either an isolated procedure or in combination with another stabilization procedure, for the primary treatment of recurrent patellar instability.

Methods

Between 2007 and 2012, 45 patients with recurrent patellar instability and no prior stabilization surgery had an MPFL reconstruction by a single surgeon, either as an isolated procedure or in combination with another stabilization procedure. Questionnaires detailing patellar instability since surgery, knee pain, ability to negotiate stairs, and sports participation were completed, and data regarding examination and radiological findings were collected from the medical record.

Results

A total of 36 (80 %) patients completed the questionnaire at a mean of 3.1 years (minimum 1 year), whilst a further 11 % had clinical follow-up of greater than 1 year. Four patients were excluded due to lack of adequate follow-up. Thirty-one patients had an isolated MPFL reconstruction and none had further patellar instability. Of the ten patients who had a combined procedure, one experienced recurrent instability. Return to sport rates were 81 and 57 % for the isolated and combined groups, respectively, with the majority returning to strenuous sport (81 and 57 %, respectively). Most patients (96 and 80 %) could negotiate stairs without difficulty, whilst 38 and 40 % reported some degree of anterior knee pain.

Conclusions

This study shows that satisfactory results can be obtained using MPFL reconstruction either in isolation or in combination to treat recurrent patellar instability. Whether the indications for an isolated MPFL can be extended further remains unclear.

Level of evidence

III.

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References

  1. Ahmad CS, Brown GD, Stein BS (2009) The docking technique for medial patellofemoral ligament reconstruction: surgical technique and clinical outcome. Am J Sports Med 37:2021–2027

    Article  PubMed  Google Scholar 

  2. Arendt EA, Dejour D (2012) Patella instability: building bridges across the ocean a historic review. Knee Surg Sports Traumatol Arthrosc 21:279–293

    Article  PubMed  Google Scholar 

  3. Bernageau J, Goutallier D, Debeyre J, Ferrané J (1975) New exploration technic of the patellofemoral joint. Relaxed axial quadriceps and contracted quadriceps. Rev Chir Orthop Reparatrice Appar Mot 61(Suppl 2):286–290

    PubMed  Google Scholar 

  4. Biedert RM, Albrecht S (2006) The patellotrochlear index: a new index for assessing patellar height. Knee Surg Sports Traumatol Arthrosc 14:707–712

    Article  PubMed  Google Scholar 

  5. Bitar AC, Howells NR, Demange MK, Barnett AJ, D’Elia CO, Ahearn N, Camanho GL, Ansari A, Eldridge JD (2012) Medial patellofemoral ligament reconstruction: a prospective outcome assessment of a large single centre series. J Bone Joint Surg Br 94:1202–1208

    Google Scholar 

  6. Cossey AJ, Paterson R (2005) A new technique for reconstructing the medial patellofemoral ligament. Knee 12:93–98

    Article  PubMed  CAS  Google Scholar 

  7. Deie M, Ochi M, Adachi N, Shibuya H, Nakamae A (2011) Medial patellofemoral ligament reconstruction fixed with a cylindrical bone plug and a grafted semitendinosus tendon at the original femoral site for recurrent patellar dislocation. Am J Sports Med 39:140–145

    Article  PubMed  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 H, Walch G, Nove-Josserand L, Guier C (1994) Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 2:19–26

    Article  PubMed  CAS  Google Scholar 

  10. Dopirak R, Adamany D, Bickel B, Steensen R (2008) Reconstruction of the medial patellofemoral ligament using a quadriceps tendon graft: a case series. Orthopedics 31:217

    PubMed  Google Scholar 

  11. Ellera Gomes JL, Stigler Marczyk LR, César de César P, Jungblut CF (2004) Medial patellofemoral ligament reconstruction with semitendinosus autograft for chronic patellar instability: a follow-up study. Arthroscopy 20:147–151

    Article  PubMed  Google Scholar 

  12. Fernandez E, Caton JH, Sala D, Dejour D, Castejon M, Castejon M (2005) Reconstruction of the medial patellofemoral ligament for patellar instability using a semitendinosus autograft. Acta Orthop Belg 71:303–308

    PubMed  Google Scholar 

  13. Fisher B, Nyland J, Brand E, Curtin B (2010) Medial patellofemoral ligament reconstruction for recurrent patellar dislocation: a systematic review including rehabilitation and return-to-sports efficacy. Arthroscopy 26:1384–1394

    Article  PubMed  Google Scholar 

  14. Gomes JE (2008) Comparison between a static and a dynamic technique for medial patellofemoral ligament reconstruction. Arthroscopy 24:430–435

    Article  PubMed  Google Scholar 

  15. Gomes JLE (2008) Medial patellofemoral ligament reconstruction with half width (hemi tendon) semitendinosus graft. Orthopedics 31:322–326

    Article  PubMed  Google Scholar 

  16. Goyal D (2013) Medial patellofemoral ligament reconstruction: the superficial quad technique. Am J Sports Med 41:1022–1029

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  18. Kang H, Cao J, Yu D, Zheng Z, Wang F (2013) Comparison of 2 different techniques for anatomic reconstruction of the medial patellofemoral ligament: a prospective randomized study. Am J Sports Med 41:1013–1021

    Article  PubMed  Google Scholar 

  19. Koëter S, Horstmann WG, Wagenaar F-CBM, Huysse W, Wymenga AB, Anderson PG (2007) A new CT scan method for measuring the tibial tubercle trochlear groove distance in patellar instability. Knee 14:128–132

    Article  PubMed  Google Scholar 

  20. Kohn LM, Meidinger G, Beitzel K, Banke IJ, Hensler D, Imhoff AB, Schottle PB (2013) Isolated and combined medial patellofemoral ligament reconstruction in revision surgery for patellofemoral instability: a prospective study. Am J Sports Med 41:2128–2135

    Article  PubMed  Google Scholar 

  21. Labelle H, Peides JP, Levesque HP, Fauteux P, Laurin CA (1976) Evaluation of patellar position by tangential X-ray visualization. Union Med Can 105:870–873

    PubMed  CAS  Google Scholar 

  22. Lustig S, Servien E, Ait Si Selmi T, Neyret P (2006) Factors affecting reliability of TT-TG measurements before and after medialization: a CT-scan study. Rev Chir Orthop Reparatrice Appar Mot 92:429–436

    Article  PubMed  CAS  Google Scholar 

  23. Matthews JJ, Schranz P (2009) Reconstruction of the medial patellofemoral ligament using a longitudinal patellar tunnel technique. Int Orthop 34:1321–1325

    Article  PubMed  PubMed Central  Google Scholar 

  24. Mikashima Y, Mikashima Y, Kimura M, Kimura M, Kobayashi Y, Kobayashi Y, Miyawaki M, Miyawaki M, Tomatsu T, 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 

  25. Mulford JS, Wakeley CJ, Eldridge JDJ (2007) Assessment and management of chronic patellofemoral instability. J Bone Joint Surg Br 89:709–716

    Article  PubMed  CAS  Google Scholar 

  26. Nomura E, Nomura E, Horiuchi Y, Horiuchi Y, Kihara M, Kihara M (2000) A mid-term follow-up of medial patellofemoral ligament reconstruction using an artificial ligament for recurrent patellar dislocation. Knee 7:211–215

    Article  PubMed  Google Scholar 

  27. Noyes FR, Stabler CL (1989) A system for grading articular cartilage lesions at arthroscopy. Am J Sports Med 17:505–513

    Article  PubMed  CAS  Google Scholar 

  28. Pandit S, Frampton C, Stoddart J, Lynskey T (2011) Magnetic resonance imaging assessment of tibial tuberosity–trochlear groove distance: normal values for males and females. Int Orthop 35:1799–1803

    Article  PubMed  PubMed Central  Google Scholar 

  29. Panni AS, Alam M, Cerciello S, Vasso M, Maffulli N (2011) Medial patellofemoral ligament reconstruction with a divergent patellar transverse 2-tunnel technique. Am J Sports Med 39:2647–2655

    Article  PubMed  Google Scholar 

  30. Phillips CL, Silver DAT, Schranz PJ, Mandalia V (2010) The measurement of patellar height: a review of the methods of imaging. J Bone Joint Surg Br 92:1045–1053

    Article  PubMed  CAS  Google Scholar 

  31. Saudan M, Fritschy D (2000) AT-TG (anterior tuberosity-trochlear groove): interobserver variability in CT measurements in subjects with patellar instability. Rev Chir Orthop Reparatrice Appar Mot 86:250–255

    PubMed  CAS  Google Scholar 

  32. Schoettle PB, Zanetti M, Seifert B, Pfirrmann CWA, Fucentese SF, Romero J (2006) The tibial tuberosity–trochlear groove distance; a comparative study between CT and MRI scanning. Knee 13:26–31

    Article  PubMed  Google Scholar 

  33. Shah JN, Howard JS, Flanigan DC, Brophy RH, Carey JL, Lattermann C (2012) A systematic review of complications and failures associated with medial patellofemoral ligament reconstruction for recurrent patellar dislocation. Am J Sports Med 40:1916–1923

    Article  PubMed  PubMed Central  Google Scholar 

  34. Siebold R, Borbon CAV (2012) Arthroscopic extraarticular reconstruction of the medial patellofemoral ligament with gracilis tendon autograft—surgical technique. Knee Surg Sports Traumatol Arthrosc 20:1245–1251

    Article  PubMed  Google Scholar 

  35. Slenker NR, Tucker BS, Pepe MD, Marchetto PA, Cohen SB (2013) Short-/intermediate-term outcomes after medial patellofemoral ligament reconstruction in the treatment of chronic lateral patellofemoral instability. Phys Sportsmed 41:26–33

    Article  PubMed  Google Scholar 

  36. Tecklenburg K, Feller JA, Whitehead TS, Webster KE, Elzarka A (2010) Outcome of surgery for recurrent patellar dislocation based on the distance of the tibial tuberosity to the trochlear groove. J Bone Joint Surg Br 92:1376–1380

    Article  PubMed  CAS  Google Scholar 

  37. Wagner D, Pfalzer F, Hingelbaum S, Huth J, Mauch F, Bauer G (2012) The influence of risk factors on clinical outcomes following anatomical medial patellofemoral ligament (MPFL) reconstruction using the gracilis tendon. Knee Surg Sports Traumatol Arthrosc 21:318–324

    Article  PubMed  Google Scholar 

  38. Zhao J, Huangfu X, He Y (2012) The role of medial retinaculum plication versus medial patellofemoral ligament reconstruction in combined procedures for recurrent patellar instability in adults. Am J Sports Med 40:1355–1364

    Article  PubMed  Google Scholar 

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Correspondence to Julian A. Feller.

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Feller, J.A., Richmond, A.K. & Wasiak, J. Medial patellofemoral ligament reconstruction as an isolated or combined procedure for recurrent patellar instability. Knee Surg Sports Traumatol Arthrosc 22, 2470–2476 (2014). https://doi.org/10.1007/s00167-014-3132-0

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  • DOI: https://doi.org/10.1007/s00167-014-3132-0

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