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Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

01-10-2014 | Knee

Anatomic medial patellofemoral ligament reconstruction using patellar suture anchor fixation for recurrent patellar instability

Authors: Si Young Song, In Sung Kim, Ho Geun Chang, Jae-Hyuk Shin, Hyung Jin Kim, Young-Jin Seo

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 10/2014

Abstract

Purpose

The purpose of this study was to prospectively evaluate clinical and radiographic outcomes following anatomic medial patellofemoral ligament (MPFL) reconstruction using patellar suture anchor fixation for recurrent patellar instability.

Methods

Twenty patients (20 knees) were enrolled in this study. The median age was 21 years, and the median follow-up was 34.5 months. Reconstruction was performed using a hamstring autograft fixed with two suture anchors at native patellar site of the MPFL. No patient had undergone additional medial tibial tuberosity transfer. Clinical scores (Kujala, Lysholm, and Tegner score) and apprehension test were completed preoperatively and at the follow-up. Preoperative and follow-up radiographic assessments included modified Insall-Salvati ratio, congruence angle, and lateral patellofemoral angle.

Results

The preoperative Kujala and Lysholm scores were 52.6 ± 12.4 and 49.2 ± 10.7, and at follow-up visits, corresponding values were 90.9 ± 4.5 (p < 0.001) and 90.9 ± 5.2 (p < 0.001). Tegner score increased from 3.0 (range 1–4) to 5.0 (range 4–7) (p < 0.001). The apprehension test was positive in all patients preoperatively, but only positive in one patient at follow-up. All radiographic assessments were significantly improved; modified Insall-Salvati index (from 1.75 to 1.65) (p = 0.002), congruence angle (from 6.3° to −7.0°) (p < 0.001), and lateral patellofemoral angle (from 2.1° to 4.9°) (p = 0.008). No patient experienced a patellar fracture or redislocation.

Conclusion

These results are comparable to those of bone tunnel techniques reported in the literature. This study shows that anatomic MPFL reconstruction using two suture anchors is a reliable treatment option.

Level of evidence

Case series with no comparison group, Level IV.

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

Amis AA, Firer P, Mountney J, Senavongse W, Thomas NP (2003) Anatomy and biomechanics of the medial patellofemoral ligament. Knee 10:215–220PubMedCrossRef

Anbari A, Cole BJ (2008) Medial patellofemoral ligament reconstruction: a novel approach. J Knee Surg 21:241–245PubMedCrossRef

Arendt EA (2009) MPFL reconstruction for PF instability. The soft (tissue) approach. Orthop Traumatol Surg Res 95:S97–S100PubMedCrossRef

Beasley LS, Vidal AF (2004) Traumatic patellar dislocation in children and adolescents: treatment update and literature review. Curr Opin Pediatr 16:29–36PubMedCrossRef

Christiansen SE, Jacobsen BW, Lund B, Lind M (2008) Reconstruction of the medial patellofemoral ligament with gracilis tendon autograft in transverse patellar drill holes. Arthroscopy 24(1):82–87PubMedCrossRef

Deakin M, Stubbs D, Bruce W, Goldberg J, Gillies RM, Walsh WR (2005) Suture strength and angle of load application in a suture anchor eyelet. Arthroscopy 21:1447–1451PubMedCrossRef

Deie M, Ochi M, Adachi N, Shibuya H, Nakamae (2011) A 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 39:140–145PubMedCrossRef

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

10.

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 225:736–743PubMedCrossRef

11.

Farr J, Schepsis AA (2006) Reconstruction of the medial patellofemoral ligament for recurrent patellar instability. J Knee Surg 19:307–316PubMedCrossRef

12.

Grelsamer RP, Meadows S (1992) The modified Insall-Salvati ratio for assessment of patellar height. Clin Orthop Relat Res Sep: 170–176

13.

Han H, Xia Y, Yun X, Wu M (2011) Anatomical transverse patella double tunnel reconstruction of medial patellofemoral ligament with a hamstring tendon autograft for recurrent patellar dislocation. Arch Orthop Trauma Surg 131:343–351PubMedCrossRef

14.

Hapa O, Aksahin E, Ozden R, Pepe M, Yanat AN, Dogramaci Y, Bozdag E, Sunbuloglu E (2012) Aperture fixation instead of transverse tunnels at the patella for medial patellofemoral ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 20:322–326PubMedCrossRef

15.

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 Relat Res 144:16–26PubMed

16.

Matsumoto A, Yoshiya S, Muratsu H, Matsui N, Yagi M, Kuroda R, Kurosaka M (2006) Mechanical evaluation of a soft tissue interference screw with a small diameter: significance of graft/bone tunnel cross-sectional area ratio. Knee Surg Sports Traumatol Arthrosc 14:330–334PubMedCrossRef

17.

Merchant AC, Mercer RL, Jacobsen RH, Cool CR (1974) Roentgenographic analysis of patellofemoral congruence. J Bone Joint Surg Am 56:1391–1396PubMed

18.

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 72:65–71PubMed

19.

Mountney J, Senavongse W, Amis AA, Thomas NP (2005) Tensile strength of the medial patellofemoral ligament before and after repair or reconstruction. J Bone Joint Surg Br 87:36–40PubMed

20.

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 9:139–143PubMedCrossRef

21.

Nomura E, Horiuchi Y, Kihara M (2000) Medial patellofemoral ligament restraint in lateral patellar translation and reconstruction. Knee 7:121–127PubMedCrossRef

22.

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 39:2647–2655PubMedCrossRef

23.

Ronga M, Oliva F, Longo UG, Testa V, Capasso G, Maffulli N (2009) Isolated medial patellofemoral ligament reconstruction for recurrent patellar dislocation. Am J Sports Med 37:1735–1742PubMedCrossRef

24.

Sanders TG, Morrison WB, Singleton BA, Miller MD, Cornum KG (2001) Medial patellofemoral ligament injury following acute transient dislocation of the patella: MR findings with surgical correlation in 14 patients. J Comput Assist Tomogr 25:957–962PubMedCrossRef

25.

Sandmeier RH, Burks RT, Bachus KN, Billings A (2000) The effect of reconstruction of the medial patellofemoral ligament on patellar tracking. Am J Sports Med 28:345–349PubMed

26.

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

27.

Schottle P, Schmeling A, Romero J, Weiler A (2009) Anatomical reconstruction of the medial patellofemoral ligament using a free gracilis autograft. Arch Orthop Trauma Surg 129:305–309PubMedCrossRef

28.

Schottle PB, Fucentese SF, Romero J (2005) Clinical and radiological outcome of medial patellofemoral ligament reconstruction with a semitendinosus autograft for patella instability. Knee Surg Sports Traumatol Arthrosc 13:516–521PubMedCrossRef

29.

Schottle PB, Hensler D, Imhoff AB (2010) Anatomical double-bundle MPFL reconstruction with an aperture fixation. Knee Surg Sports Traumatol Arthrosc 18:147–151PubMedCrossRef

30.

Schottle PB, Schmeling A, Rosenstiel N, Weiler A (2007) Radiographic landmarks for femoral tunnel placement in medial patellofemoral ligament reconstruction. Am J Sports Med 35:801–804PubMedCrossRef

31.

Smirk C, Morris H (2003) The anatomy and reconstruction of the medial patellofemoral ligament. Knee 10:221–227PubMedCrossRef

32.

Steiner TM, Torga-Spak R, Teitge RA (2006) Medial patellofemoral ligament reconstruction in patients with lateral patellar instability and trochlear dysplasia. Am J Sports Med 34:1254–1261PubMedCrossRef

33.

Thaunat M, Erasmus PJ (2008) Recurrent patellar dislocation after medial patellofemoral ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 16:40–43PubMedCrossRef

34.

Toritsuka Y, Amano H, Mae T, Uchida R, Hamada M, Ohzono K, Shino K (2011) Dual tunnel medial patellofemoral ligament reconstruction for patients with patellar dislocation using a semitendinosus tendon autograft. Knee 18:214–219PubMedCrossRef

Title: Anatomic medial patellofemoral ligament reconstruction using patellar suture anchor fixation for recurrent patellar instability
Authors: Si Young Song
In Sung Kim
Ho Geun Chang
Jae-Hyuk Shin
Hyung Jin Kim
Young-Jin Seo
Publication date: 01-10-2014
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 10/2014
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-013-2730-6

At a glance: The STEP trials

Springer Medicine

Anatomic medial patellofemoral ligament reconstruction using patellar suture anchor fixation for recurrent patellar instability

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

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