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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 5/2012

01-05-2012 | Knee

Effects of medial patellofemoral ligament reconstruction on patellar tracking

Authors: Keisuke Kita, Shuji Horibe, Yukiyoshi Toritsuka, Norimasa Nakamura, Yoshinari Tanaka, Yasukazu Yonetani, Tatsuo Mae, Ken Nakata, Hideki Yoshikawa, Konsei Shino

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 5/2012

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Abstract

Purpose

Medial patellofemoral ligament (MPFL) reconstruction has been performed to treat recurrent patellar dislocation. However, the effects on patellar tracking have not been well documented, particularly in patients. The purpose of this study is to compare patellar tracking pattern and chondral status at MPFL reconstruction with those at second-look arthroscopy.

Methods

Between 1999 and 2008, 71 patients with recurrent patellar dislocation underwent MPFL reconstruction using a double-looped semitendinosus tendon. Of these, 25 knees in 24 patients underwent second-look arthroscopy (at 6–26 months after initial surgery), forming the subject for the present study. No other surgical procedures such as tibial tuberosity transfer, lateral release, or osteotomy were performed in any patients. To assess the patellar tracking pattern, the position of the patella on femoral groove was evaluated arthroscopically during passive knee motion through lateral suprapatellar portal.

Results

Before MPFL reconstruction, the patella in all patients was shifted laterally throughout the entire range of knee motion. Immediately after MPFL reconstruction, patellar malalignment was corrected in all cases. On second-look arthroscopy, two different patellar tracking patterns were observed. In 9 knees, the patella was located on the center of the femoral groove throughout the range of motion. Meanwhile, in the remaining 16 knees, the patella was shifted laterally at knee extension and migrated to the center of femoral groove with increased knee flexion. No significant deteriorations in chondral status were seen on second-look arthroscopy.

Conclusion

The present study revealed that not all improved patellar trackings after MPFL reconstruction remained intact at follow-up. Chondral status in patellofemoral joint was not aggravated by MPFL reconstruction.

Level of evidence

Therapeutic studies, Level IV.
Literature
1.
Abramowitch SD, Zhang X, Curran M, Kilger R (2010) A comparison of the quasi-static mechanical and non-linear viscoelastic properties of the human semitendinosus and gracilis tendons. Clin Biomech (Bristol, Avon) 25(4):325–331
2.
Arendt EA (2009) MPFL reconstruction for PF instability The soft (tissue) approach. Orthop Traumatol Surg Res 95(8 Suppl 1):S97–S100PubMedCrossRef
3.
Balcarek P, Ammon J, Frosch S, Walde TA, Schuttrumpf JP, Ferlemann KG, Lill H, Sturmer KM, Frosch KH (2010) Magnetic resonance imaging characteristics of the medial patellofemoral ligament lesion in acute lateral patellar dislocations considering trochlear dysplasia, patella alta, and tibial tuberosity-trochlear groove distance. Arthroscopy 26(7):926–935PubMedCrossRef
4.
Beck P, Brown NA, Greis PE, Burks RT (2007) Patellofemoral contact pressures and lateral patellar translation after medial patellofemoral ligament reconstruction. Am J Sports Med 35(9):1557–1563PubMedCrossRef
5.
Bicos J, Fulkerson JP, Amis A (2007) Current concepts review: the medial patellofemoral ligament. Am J Sports Med 35(3):484–492PubMedCrossRef
6.
Brossmann J, Muhle C, Bull CC, Schroder C, Melchert UH, Zieplies J, Spielmann RP, Heller M (1994) Evaluation of patellar tracking in patients with suspected patellar malalignment: cine MR imaging vs arthroscopy. AJR Am J Roentgenol 162(2):361–367PubMed
7.
Burks RT, Desio SM, Bachus KN, Tyson L, Springer K (1998) Biomechanical evaluation of lateral patellar dislocations. Am J Knee Surg 11(1):24–31PubMed
8.
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
9.
Conlan T, Garth WP Jr, Lemons JE (1993) Evaluation of the medial soft-tissue restraints of the extensor mechanism of the knee. J Bone Joint Surg Am 75(5):682–693PubMed
10.
Dandy DJ (1996) Chronic patellofemoral instability. J Bone Joint Surg Br 78(2):328–335PubMed
11.
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(7):522–528PubMedCrossRef
12.
Dejour H, Walch G, Nove-Josserand L, Guier C (1994) Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 2(1):19–26PubMedCrossRef
13.
Delaunay C, Kapandji T (1998) Effect of arthroscopic fluid inflow on the femoro-patellar tracking Comparative study of the dry and fluid filled knee. Rev Chir Orthop Reparatrice Appar Mot 84(4):346–349PubMed
14.
Elias JJ, Cosgarea AJ (2006) Technical errors during medial patellofemoral ligament reconstruction could overload medial patellofemoral cartilage: a computational analysis. Am J Sports Med 34(9):1478–1485PubMedCrossRef
15.
Feller JA, Amis AA, Andrish JT, Arendt EA, Erasmus PJ, Powers CM (2007) Surgical biomechanics of the patellofemoral joint. Arthroscopy 23(5):542–553PubMedCrossRef
16.
Fithian DC, Paxton EW, Stone ML, Silva P, Davis DK, Elias DA, White LM (2004) Epidemiology and natural history of acute patellar dislocation. Am J Sports Med 32(5):1114–1121PubMedCrossRef
17.
Hautamaa PV, Fithian DC, Kaufman KR, Daniel DM, Pohlmeyer AM (1998) Medial soft tissue restraints in lateral patellar instability and repair. Clin Orthop Relat Res 349:174–182PubMedCrossRef
18.
Horibe S, Shino K, Nagano J, Nakamura H, Tanaka M, Ono K (1990) Replacing the medial collateral ligament with an allogenic tendon graft. An experimental canine study. J Bone Joint Surg Br 72(6):1044–1049PubMed
19.
Insall J, Goldberg V, Salvati E (1972) Recurrent dislocation and the high-riding patella. Clin Orthop Relat Res 88:67–69PubMedCrossRef
20.
Kepler CK, Bogner EA, Hammoud S, Malcolmson G, Potter HG, Green DW (2011) Zone of injury of the medial patellofemoral ligament after acute patellar dislocation in children and adolescents. Am J Sports Med 39(7):1444–1449
21.
Kolowich PA, Paulos LE, Rosenberg TD, Farnsworth S (1990) Lateral release of the patella: indications and contraindications. Am J Sports Med 18(4):359–365PubMedCrossRef
22.
Kujala UM, Jaakkola LH, Koskinen SK, Taimela S, Hurme M, Nelimarkka O (1993) Scoring of patellofemoral disorders. Arthroscopy 9(2):159–163PubMedCrossRef
23.
LeGrand AB, Greis PE, Dobbs RE, Burks RT (2007) MPFL reconstruction. Sports Med Arthrosc 15(2):72–77PubMedCrossRef
24.
Mae T, Shino K, Matsumoto N, Natsu-Ume T, Yoneda K, Yoshikawa H, Yoneda M (2010) Anatomic double-bundle anterior cruciate ligament reconstruction using hamstring tendons with minimally required initial tension. Arthroscopy 26(10):1289–1295PubMedCrossRef
25.
Maeno S, Hashimoto D, Otani T, Masumoto K, Fukui Y, Nishiyama M, Ishikawa M, Fujita N, Kanagawa H (2010) Medial patellofemoral ligament reconstruction with hanger lifting procedure. Knee Surg Sports Traumatol Arthrosc 18(2):157–160PubMedCrossRef
26.
Melegari TM, Parks BG, Matthews LS (2008) Patellofemoral contact area and pressure after medial patellofemoral ligament reconstruction. Am J Sports Med 36(4):747–752PubMedCrossRef
27.
Merchant AC, Mercer RL, Jacobsen RH, Cool CR (1974) Roentgenographic analysis of patellofemoral congruence. J Bone Joint Surg Am 56(7):1391–1396PubMed
28.
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(1):36–40PubMed
29.
Nomura E (1999) Classification of lesions of the medial patello-femoral ligament in patellar dislocation. Int Orthop 23(5):260–263PubMedCrossRef
30.
Nomura E, Inoue M, Kobayashi S (2006) Generalized joint laxity and contralateral patellar hypermobility in unilateral recurrent patellar dislocators. Arthroscopy 22(8):861–865PubMedCrossRef
31.
Nomura E, Inoue M, Kobayashi S (2007) Long-term follow-up and knee osteoarthritis change after medial patellofemoral ligament reconstruction for recurrent patellar dislocation. Am J Sports Med 35(11):1851–1858PubMedCrossRef
32.
Ostermeier S, Holst M, Bohnsack M, Hurschler C, Stukenborg-Colsman C, Wirth CJ (2007) In vitro measurement of patellar kinematics following reconstruction of the medial patellofemoral ligament. Knee Surg Sports Traumatol Arthrosc 15(3):276–285PubMedCrossRef
33.
Ostermeier S, Stukenborg-Colsman C, Hurschler C, Wirth CJ (2006) In vitro investigation of the effect of medial patellofemoral ligament reconstruction and medial tibial tuberosity transfer on lateral patellar stability. Arthroscopy 22(3):308–319PubMedCrossRef
34.
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(3):345–349PubMed
35.
Schottle PB, Hensler D, Imhoff AB (2010) Anatomical double-bundle MPFL reconstruction with an aperture fixation. Knee Surg Sports Traumatol Arthrosc 18(2):147–151PubMedCrossRef
36.
Schottle 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(1):26–31CrossRef
37.
Shea KG, Grimm NL, Belzer J, Burks RT, Pfeiffer R (2010) The relation of the femoral physis and the medial patellofemoral ligament. Arthroscopy 26(8):1083–1087PubMedCrossRef
38.
Smith TO, Walker J, Russell N (2007) Outcomes of medial patellofemoral ligament reconstruction for patellar instability: a systematic review. Knee Surg Sports Traumatol Arthrosc 15(11):1301–1314PubMedCrossRef
39.
Toritsuka Y, Amano H, Mae T, Uchida R, Hamada M, Ohzono K, Shino K (2010) Dual tunnel medial patellofemoral ligament reconstruction for patients with patellar dislocation using a semitendinosus tendon autograft. Knee 18(4):214–219PubMedCrossRef
40.
Yamada Y, Toritsuka Y, Horibe S, Sugamoto K, Yoshikawa H, Shino K (2007) In vivo movement analysis of the patella using a three-dimensional computer model. J Bone Joint Surg Br 89(6):752–760PubMedCrossRef
41.
Yamada Y, Toritsuka Y, Yoshikawa H, Sugamoto K, Horibe S, Shino K (2007) Morphological analysis of the femoral trochlea in patients with recurrent dislocation of the patella using three-dimensional computer models. J Bone Joint Surg Br 89(6):746–751PubMedCrossRef
42.
Zaffagnini S, De Pasquale V, Marchesini Reggiani L, Russo A, Agati P, Bacchelli B, Marcacci M (2007) Neoligamentization process of BTPB used for ACL graft: histological evaluation from 6 months to 10 years. Knee 14(2):87–93PubMedCrossRef
Metadata
Title
Effects of medial patellofemoral ligament reconstruction on patellar tracking
Authors
Keisuke Kita
Shuji Horibe
Yukiyoshi Toritsuka
Norimasa Nakamura
Yoshinari Tanaka
Yasukazu Yonetani
Tatsuo Mae
Ken Nakata
Hideki Yoshikawa
Konsei Shino
Publication date
01-05-2012
Publisher
Springer-Verlag
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 5/2012
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-011-1609-7

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