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Clinical Orthopaedics and Related Research®

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01-06-2008 | Original Article

Ligament Reconstruction versus Distal Realignment for Patellar Dislocation

Authors: Petri Sillanpää, MD, Ville M. Mattila, MD, PhD, Tuomo Visuri, MD, PhD, Heikki Mäenpää, MD, PhD, Harri Pihlajamäki, MD, PhD

Published in: Clinical Orthopaedics and Related Research® | Issue 6/2008

Abstract

Recently, medial patellofemoral ligament reconstruction has been emphasized for the treatment of patellar dislocation. This study compared the results of medial patellofemoral ligament reconstruction by adductor magnus tenodesis with distal patellar realignment in patients with recurrent patellar dislocation. Additionally, the development of patellofemoral osteoarthrosis was compared for these two procedures at a median 10-year followup. Between 1994 and 2000, 47 consecutive patients were treated for recurrent patellar dislocation by adductor magnus tenodesis (18 knees) or Roux-Goldthwait procedure (29 knees). Redislocations, subjective symptoms, and functional outcomes were evaluated. Magnetic resonance imaging was performed at followup. The incidence of patellar redislocation after surgery was 7% in the adductor magnus group and 14% in the Roux-Goldthwait group. Median Kujala scores were 88 for the adductor magnus group and 86 for the Roux-Goldthwait group. Magnetic resonance imaging revealed patellofemoral articular cartilage lesions in 22 knees (73.3%) at followup, including 14 (46.6%) with full-thickness cartilage loss. Radiographs revealed patellofemoral osteoarthritis in five patients in the Roux-Goldthwait group and in none of the patients in the adductor magnus group. Adductor magnus tenodesis is a reliable method to treat recurrent patellar dislocation. The medial patellofemoral ligament reconstruction seems to reduce the risk of osteoarthrosis compared with distal realignment surgery.

Level of Evidence: Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Aglietti P, Buzzi R, De Biase P, Giron F. Surgical treatment of recurrent dislocation of the patella. Clin Orthop Relat Res. 1994;308:8–17.PubMed

Aglietti P, Pisaneschi A, De Biase P. Recurrent dislocation of patella: three kinds of surgical treatment. Ital J Orthop Traumatol. 1992;18:25–36.PubMed

Ahlbäck S. Osteoarthrosis of the knee: a radiographic investigation. Acta Radiol Suppl. 1968;277:7–72.

Ahmad CS, Stein BE, Matuz D, Henry JH. Immediate surgical repair of the medial patellar stabilizers for acute patellar dislocation: a review of eight cases. Am J Sports Med. 2000;28:804–810.PubMed

Arnbjornsson A, Egund N, Rydling O, Stockerup R, Ryd L. The natural history of recurrent dislocation of the patella: long-term results of conservative and operative treatment. J Bone Joint Surg Br. 1992;74:140–142.PubMed

Avikainen VJ, Nikku RK, Seppanen-Lehmonen TK. Adductor magnus tenodesis for patellar dislocation: technique and preliminary results. Clin Orthop Relat Res. 1993;297:12–16.PubMed

Brattstroem H. Shape of the intercondylar groove normally and in recurrent dislocation of patella: a clinical and x-ray-anatomical investigation. Acta Orthop Scand Suppl. 1964;68(suppl 68):1–148.PubMed

Bredella MA, Tirman PF, Peterfy CG, Zarlingo M, Feller JF, Bost FW, Belzer JP, Wischer TK, Genant HK. Accuracy of T2-weighted fast spin-echo MR imaging with fat saturation in detecting cartilage defects in the knee: comparison with arthroscopy in 130 patients. AJR Am J Roentgenol. 1999;172:1073–1080.PubMed

Brittberg M, Winalski CS. Evaluation of cartilage injuries and repair. J Bone Joint Surg Am. 2003;85(suppl 2):58–69.PubMed

10.

Chrisman OD, Snook GA, Wilson TC. A long-term prospective study of the Hauser and Roux-Goldthwait procedures for recurrent patellar dislocation. Clin Orthop Relat Res. 1979;144:27–30.PubMed

11.

Conlan T, Garth WP Jr, Lemons JE. Evaluation of the medial soft-tissue restraints of the extensor mechanism of the knee. J Bone Joint Surg Am. 1993;75:682–693.PubMed

12.

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

13.

Disler DG, McCauley TR, Kelman CG, Fuchs MD, Ratner LM, Wirth CR, Hospodar PP. Fat-suppressed three-dimensional spoiled gradient-echo MR imaging of hyaline cartilage defects in the knee: comparison with standard MR imaging and arthroscopy. AJR Am J Roentgenol. 1996;167:127–132.PubMed

14.

Drez D Jr, Edwards TB, Williams CS. Results of medial patellofemoral ligament reconstruction in the treatment of patellar dislocation. Arthroscopy. 2001;17:298–306.PubMedCrossRef

15.

Ellera Gomes JL. Medial patellofemoral ligament reconstruction for recurrent dislocation of the patella: a preliminary report. Arthroscopy. 1992;8:335–340.PubMedCrossRef

16.

Gagliardi JA, Chung EM, Chandnani VP, Kesling KL, Christensen KP, Null RN, Radvany MG, Hansen MF. Detection and staging of chondromalacia patellae: relative efficacies of conventional MR imaging, MR arthrography, and CT arthrography. AJR Am J Roentgenol. 1994;163:629–636.PubMed

17.

Garth WP Jr, DiChristina DG, Holt G. Delayed proximal repair and distal realignment after patellar dislocation. Clin Orthop Relat Res. 2000;377:132–144.PubMedCrossRef

18.

Goldthwait JE. Slipping or recurrent dislocation of the patella: with the report of eleven cases. American Journal of Orthopedic Surgery, Vol 1, pp 293–308, 1903. J Bone Joint Surg Am. 2003;85:2489.

19.

Hampson WG, Hill P. Late results of transfer of the tibial tubercle for recurrent dislocation of the patella. J Bone Joint Surg Br. 1975;57:209–213.PubMed

20.

Han I, Chang CB, Lee S, Lee MC, Seong SC, Kim TK. Correlation of the condition of the patellar articular cartilage and patellofemoral symptoms and function in osteoarthritic patients undergoing total knee arthroplasty. J Bone Joint Surg Br. 2005;87:1081–1084.PubMedCrossRef

21.

Hautamaa PV, Fithian DC, Kaufman KR, Daniel DM, Pohlmeyer AM. Medial soft tissue restraints in lateral patellar instability and repair. Clin Orthop Relat Res. 1998;349:174–182.PubMedCrossRef

22.

Hughston JC. Subluxation of the patella. J Bone Joint Surg Am. 1968;50:1003–1026.PubMed

23.

Insall J, Salvati E. Patella position in the normal knee joint. Radiology. 1971;101:101–104.PubMed

24.

Iwano T, Kurosawa H, Tokuyama H, Hoshikawa Y. Roentgenographic and clinical findings of patellofemoral osteoarthrosis: with special reference to its relationship to femorotibial osteoarthrosis and etiologic factors. Clin Orthop Relat Res. 1990;252:190–197.PubMed

25.

Jalovaara P, Seppanen-Lehmonen T, Lindholm RV. Krogius and Roux-Goldthwait operations for recurrent patellar dislocation. Acta Orthop Belg. 1988;54:380–383.PubMed

26.

Juliusson R, Markhede G. A modified Hauser procedure for recurrent dislocation of the patella: a long-term follow-up study with special reference to osteoarthritis. Arch Orthop Trauma Surg. 1984;103:42–46.PubMedCrossRef

27.

Kawahara Y, Uetani M, Nakahara N, Doiguchi Y, Nishiguchi M, Futagawa S, Kinoshita Y, Hayashi K. Fast spin-echo MR of the articular cartilage in the osteoarthrotic knee: correlation of MR and arthroscopic findings. Acta Radiol. 1998;39:120–125.PubMedCrossRef

28.

Koskinen SK, Rantanen JP, Nelimarkka OI, Kujala UM. Effect of Elmslie-Trillat and Roux-Goldthwait procedures on patellofemoral relationships and symptoms in patients with patellar dislocations. Am J Knee Surg. 1998;11:167–173.PubMed

29.

Kujala UM, Jaakkola LH, Koskinen SK, Taimela S, Hurme M, Nelimarkka O. Scoring of patellofemoral disorders. Arthroscopy. 1993;9:159–163.PubMedCrossRef

30.

Laurin CA, Dussault R, Levesque HP. The tangential x-ray investigation of the patellofemoral joint: x-ray technique, diagnostic criteria and their interpretation. Clin Orthop Relat Res. 1979;144:16–26.PubMed

31.

Maenpaa H, Huhtala H, Lehto MU. Recurrence after patellar dislocation: redislocation in 37/75 patients followed for 6–24 years. Acta Orthop Scand. 1997;68:424–426.PubMed

32.

Maenpaa H, Lehto MU. Patellar dislocation. The long-term results of nonoperative management in 100 patients. Am J Sports Med. 1997;25:213–217.PubMedCrossRef

33.

Maenpaa H, Lehto MU. Patellofemoral osteoarthritis after patellar dislocation. Clin Orthop Relat Res. 1997;339:156–162.PubMedCrossRef

34.

Marcacci M, Zaffagnini S, Iacono F, Visani A, Petitto A, Neri NP. Results in the treatment of recurrent dislocation of the patella after 30 years’ follow-up. Knee Surg Sports Traumatol Arthrosc. 1995;3:163–166.PubMedCrossRef

35.

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

36.

Muneta T, Sekiya I, Tsuchiya M, Shinomiya K. A technique for reconstruction of the medial patellofemoral ligament. Clin Orthop Relat Res. 1999;359:151–155.PubMedCrossRef

37.

Nikku R, Nietosvaara Y, Aalto K, Kallio PE. Operative treatment of primary patellar dislocation does not improve medium-term outcome: a 7-year follow-up report and risk analysis of 127 randomized patients. Acta Orthop. 2005;76:699–704.PubMedCrossRef

38.

Niskanen RO, Paavilainen PJ, Jaakkola M, Korkala OL. Poor correlation of clinical signs with patellar cartilaginous changes. Arthroscopy. 2001;17:307–310.PubMedCrossRef

39.

Nomura E. Classification of lesions of the medial patello-femoral ligament in patellar dislocation. Int Orthop. 1999;23:260–263.PubMedCrossRef

40.

Nomura E, Inoue M, Kobayashi S. Long-term follow-up and knee osteoarthritis change after medial patellofemoral ligament reconstruction for recurrent patellar dislocation. Am J Sports Med. 2007;35:1851–1858.PubMedCrossRef

41.

Nomura E, Inoue M, Osada N. Anatomical analysis of the medial patellofemoral ligament of the knee, especially the femoral attachment. Knee Surg Sports Traumatol Arthrosc. 2005;13:510–515.PubMedCrossRef

42.

Nomura E, Inoue M, Osada N. Augmented repair of avulsion-tear type medial patellofemoral ligament injury in acute patellar dislocation. Knee Surg Sports Traumatol Arthrosc. 2005;13:346–351.PubMedCrossRef

43.

Rantanen J, Paananen M. Modified Hauser operation for patellar instability: immediate mobilization of 35 knees, a 5–8 year follow-up study. Acta Orthop Scand. 1996;67:455–458.PubMed

44.

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

45.

Schlenzka D, Schwesinger G. The height of the patella: an anatomical study. Eur J Radiol. 1990;11:19–21.PubMedCrossRef

46.

Spritzer CE, Courneya DL, Burk DL Jr, Garrett WE, Strong JA. Medial retinacular complex injury in acute patellar dislocation: MR findings and surgical implications. AJR Am J Roentgenol. 1997;168:117–122.PubMed

47.

Steensen RN, Dopirak RM, Maurus PB. A simple technique for reconstruction of the medial patellofemoral ligament using a quadriceps tendon graft. Arthroscopy. 2005;21:365–370.PubMedCrossRef

48.

Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res. 1985;198:43–49.PubMed

Title: Ligament Reconstruction versus Distal Realignment for Patellar Dislocation
Authors: Petri Sillanpää, MD
Ville M. Mattila, MD, PhD
Tuomo Visuri, MD, PhD
Heikki Mäenpää, MD, PhD
Harri Pihlajamäki, MD, PhD
Publication date: 01-06-2008
Publisher: Springer-Verlag
Published in: Clinical Orthopaedics and Related Research® / Issue 6/2008
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-008-0207-6

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