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Reconstruction of medial patellofemoral ligament for chronic patellar instability

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Background

Disruption of the capsule, medial patellar retinaculum, and/or vastus medialis obliqus has been associated with recurrent patellar instability. Biomechanical studies have shown that the medial patellofemoral ligament (MPFL) is the main restraint against lateral patella displacement and reconstruction of the MPFL has become an accepted surgical technique to restore patellofemoral stability in patients having recurrent patellar dislocation. We report a prospective series of patients of chronic patellar instability treated by reconstruction of medial patellofemoral ligament.

Materials and Methods

Twelve patients (15 knees) with recurrent dislocation of patella, were operated between January 2006 and December 2008. All patients had generalised ligament laxity with none had severe grade of patella alta or trochlear dysplasia. The MPFL was reconstructed with doubled semitendinosus tendon. Patients were followed up with subjective criteria, patellar inclination angle, and Kujala score.

Results

The mean duration of followup after the operative procedures was an average of 42 months (range 24–60 months). 10 knees showed excellent results, 3 knees gave good results, and 2 knees had a fair result. The average patellar inclination angle decreased from 34.3° to 18.6°. The average preoperative Kujala functional score was 44.8 and the average postoperative score was 91.9.

Conclusion

MPFL reconstruction using the semitendinosus tendon gives good results in patients with chronic patellar instability without predisposing factors like severe patella alta and high-grade trochlear dysplasia, and for revision cases.

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References

  1. Fulkerson JP. Evaluation of the peripatellar soft tissue and retinaculum in patients with patellofemoral pain. Clin Sports Med 1989;8:197–202.

    CAS  PubMed  Google Scholar 

  2. Heegaard J, Leyvraz PF, Van Kampen A, Rakotomanana L, Rubin PJ, Blankevoort L. Influence of soft tissue structures on patellar three dimensional tracking. Clin Orthopaedics Relat Res 1994;299:235–43.

    Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  4. Conlan T, Garth WP, Lemons JE. Evaluation of the medial soft tissue restraints of the extensor mechanism of the knee. J Bone Joint Surg 1993;75:682–93.

    Article  CAS  PubMed  Google Scholar 

  5. Sandmeier RH, Burks RT, Bachus KN, Billings A. The effect of reconstruction of the patellofemoral ligament on patella tracking. Am J Sports Med 2000;28:345–9.

    Article  CAS  PubMed  Google Scholar 

  6. Garth WP, Garth WP Jr, DiChristina DG, Holt G. Delayed proximal repair and distal realignment after patellar dislocation. Clin Orthop 2000;377:132–44.

    Article  Google Scholar 

  7. Sallay PI, Poggi J, Speer KP, Garrett WE. Acute dislocation of the patella. A correlative patho-anatomic study. Am J Sports Med 1996;24:52–60.

    Article  CAS  PubMed  Google Scholar 

  8. Andrish J. The management of recurrent patellar dislocation. Orthop Clin North Am 2008;39:313–27.

    Article  PubMed  Google Scholar 

  9. Nikku R, Nietosvaara Y, Aalto K, Kallio PE. Operative treatment of primary patellar dislocation does not improve medium term outcome. Acta Orthop 2005;76:699–704.

    Article  PubMed  Google Scholar 

  10. Buchner M, Baudendistel B, Sabo D, Schmitt H. Acute traumatic primary patellar dislocation: Long term results comparing conservative and surgical treatment. Clin J Sport Med 2005;15:62–6.

    Article  PubMed  Google Scholar 

  11. Huberti HH, Hayes WC. Patellofemoral contact pressures: The influence of Q-angle and tendofemoral contact. J Bone Joint Surg Am 1984;66:715–24.

    Article  CAS  PubMed  Google Scholar 

  12. Ahmed AM, Burke DL, Hyder A. Force analysis of the patellar mechanism. J Orthop Res 1987;5:69–85.

    Article  CAS  PubMed  Google Scholar 

  13. Pidoriano AJ, Weinstein RN, Buuck DA, Fulkerson JP. Correlation of patellar articular lesions with results from anteromedialtibial tubercle transfer. Am J Sports Med 1997;25:533–7.

    Article  CAS  PubMed  Google Scholar 

  14. Nomura E, Inoue M, Kobayashi S. Long-term followup and knee osteoarthritis change after medial patello-femoral ligament reconstruction for recurrent patellar dislocation. Am Sports Med 2007;35:1851–8.

    Article  Google Scholar 

  15. Goutallier D, Bernageau J, Leucudonnec B. The measurement of the Tibial tuberosity. Patellar groove distanced technique and results. Rev Chir Orthop Reparatrice Appar Mot 1978;64:423–8.

    CAS  PubMed  Google Scholar 

  16. David D, Bertrand LC. Osteotomies in patellofemoral instabilities. Sports Med Arthrosc 2007;15:39–46.

    Article  Google Scholar 

  17. Caton J, Deschamps G, Chambat P, Lerat JL, Dejour H. Patella infera. Apropos of 128 cases. Rev Chir Orthop Reparatrice Appar Mot 1982;68:317–25.

    CAS  PubMed  Google Scholar 

  18. Grahame R. The revised (Brighton 1998) criteria for the diagnosis of benign joint hypermobility syndrome (BJHS). J Rheumatol 2000;27:1777–9.

    CAS  PubMed  Google Scholar 

  19. Kujala UM, Jaakkola LH, Koskinen SK, Taimela S, Hurme M, Nelimarkka O. Scoring of patellofemoral disorders. Arthroscopy 1993;9:159–63.

    Article  CAS  PubMed  Google Scholar 

  20. Erasmus PJ. Reconstruction of the medial patellofemoral ligament in recurrent dislocation of the patella. Arthroscopy Supplement 1998;14:42.

    Google Scholar 

  21. Paessler HH, Mastrokalos DS. Anterior cruciate ligament reconstruction using semitendinosus and gracilis tendons, bone patellar tendon, or quadriceps tendon-graft with press-fit fixation without hardware. A new and innovative procedure. Orthop Clin North Am 2003;34:49–64.

    Article  PubMed  Google Scholar 

  22. Mikashima Y, Kimura M, Kobayashi Y, Miyawaki M, Tomatsu T. Clinical reults of isolated reconstruction of the medial patello-femoral ligament for recurrent dislocation and subluxation of the patella. Acta Orthop Belg 2006; 72:65–71.

    PubMed  Google Scholar 

  23. Ostemeier S, Stukenborg-Colsman C, Hurschler C, Wirth CJ. In vitro investigation of the effect of medial patellofemoral ligament reconstruction and medial tibial tuberosity transfer on lateral patella stability. Arthroscopy 2006;22:308–19.

    Article  Google Scholar 

  24. Smith TO, Walker J, Russell N. Outcomes of medial patellofemoral ligament reconstruction for patellar instability: A systematic review. Knee Surg Sports Traumatol Arthrosc 2007;15:1301–14.

    Article  PubMed  Google Scholar 

  25. Panagopoulos A, van Niekerk L, Triantafillopoulos IK. MPFL reconstruction for recurrent patella dislocation: A new surgical technique and review of the literature. Int J Sports Med 2008;29:359–65.

    Article  CAS  PubMed  Google Scholar 

  26. Avikainen VJ, Nikku RK, Seppanen-Lehmonen TK. Adductor magnustenodesis for patellar dislocation: Technique and preliminary results. Clin Orthop Relat Res 1993;297:12–6.

    Google Scholar 

  27. Steensen RN, Dopirak RM, McDonald WG 3rd. The anatomy and isometry of the medial patellofemoral ligament. Am J Sports Med 2004;32:1509–13.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  29. Ellera Gomes JL. Medial patellofemoral ligament reconstruction for recurrent dislocation of the patella: A preliminary report. Arthroscopy 1992;8:335–40.

    Article  Google Scholar 

  30. Muneta T, Sekiya I, Tsuchiya M, Shinomiya K. A technique for reconstruction of the medial patellofemoral ligament. Clin Orthop Relat Res 1999;359:151–5.

    Article  Google Scholar 

  31. Neyret P, Robinson AH, Le Coultre B, Lapra C, Chambat P. Patellar tendon length-the factor in patellar instability? Knee 2002;9:3–6.

    Article  PubMed  Google Scholar 

  32. Nikku R. Operative versus closed treatment of primary dislocation of the patella. Acta Orthop Scand 1997;68:419–23.

    Article  CAS  PubMed  Google Scholar 

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

    Article  Google Scholar 

  34. Hamner DL, Brown CH Jr, Steiner ME, Hecker AT, Hayes WC. Hamstring tendon grafts for reconstruction of the anterior cruciate ligament: Biomechanical evaluation of the use of multiple strands and tensioning techniques. J Bone Joint Surg Am 1999;81:549–57.

    Article  CAS  PubMed  Google Scholar 

  35. Mologne TS, Friedman MJ. Arthroscopic anterior cruciate ligament reconstruction with hamstring tendons: Indications, surgical technique and complications and their treatment. In Surgery of the knee 4th ed. In: Scott WN, Editor. $$$Philadelphia: Churchill Livingstone; 2006. p. 648–51.

    Google Scholar 

  36. Elias JJ, Cosgarea AJ. Technical errors during medial patellofemoral ligament reconstruction could overload the medial patellofemoral cartilage: A computational analysis. Am J Sports Med 2006;34:1478–85.

    Article  PubMed  Google Scholar 

  37. Beck P, Brown NA, Greis PE, Burks RT. Patellofemoral contact pressures and lateral patellar translation after medial patellofemoral ligament reconstruction. Am J Sports Med 2007;35:1557–63.

    Article  PubMed  Google Scholar 

  38. Fernandez E, Sala D, Castejon M. Reconstruction of the medial patellofemoral ligament for patellar instability using a semitendinosus autograft. Octaorthop Belgica 2005;71:303–8.

    Google Scholar 

  39. Arendt EA, Fithian DC, Cohen E. Current concepts of lateral patella dislocation. Clin Sports Med 2002;21:499–519.

    Article  PubMed  Google Scholar 

  40. Thaunat M, Erasmus PJ. Recurrent patellar dislocation after medial patellofemoral ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2008;16:40–3.

    Article  PubMed  Google Scholar 

  41. Larson RL Cabaud HE, Slocum DB, James SL, Keenan T, Hutchinson T. The patellar compression syndrome: Surgical treatment by lateral retinacular release. Clin Orthop 1978;134:158–67.

    Google Scholar 

  42. Hughston JC, Deese M. Medial subluxation of the patella as a complication of lateral retinacular release. Am J Sports Med 1988;16:383–8.

    Article  CAS  PubMed  Google Scholar 

  43. Teitge RA. Treatment of complications of patellofemoral joint surgery. Oper Tech Sports Med 1994;2:317–34.

    Google Scholar 

  44. Fithian DC, Paxton EW, Cohen AB. Indications in the treatment of patellar instability. J Knee Surg 2004;17:47–56.

    Article  PubMed  Google Scholar 

  45. Senavongse W, Farahmand F, Jones J, Andersen H, Bull AM, Amis AA. Quantitative measurement of patellofemoral joint stability: Force-displacement behavior of the human patella in vitro. J Orthop Res 2003;21:780–6.

    Article  CAS  PubMed  Google Scholar 

  46. Schöttle PB, Fucentese SF, Romero J. Clinical and radiological outcome of medial patello-femoral ligament reconstruction with a semitendinosus autograft for patella instability. Knee Surg Sports Traumatol Arthrosc 2005;13:516–21.

    Article  PubMed  Google Scholar 

  47. Christiansen SE, Jacobsen BW, Lund B, Lind M. Reconstruction of the medial patellofemoral ligament with gracilis tendon autograft in transverse patellar drill holes. Arthroscopy 2008;24:82–7.

    Article  PubMed  Google Scholar 

  48. Steiner TM, Torga-Spak R, Teitge RA. Medial patellofemoral ligament reconstruction in patients with lateral patellar instability and trochlear dysplasia. Am J Sports Med 2006;34:1254–61.

    Article  PubMed  Google Scholar 

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Correspondence to Raghuveer Reddy K.

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K, R.R., Mishra, C.B. Reconstruction of medial patellofemoral ligament for chronic patellar instability. IJOO 46, 447–454 (2012). https://doi.org/10.4103/0019-5413.97259

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