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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 8/2019

01-08-2019 | KNEE

Reconstruction of the medial patellofemoral ligament and reinforcement of the medial patellotibial ligament is an effective treatment for patellofemoral instability with patella alta

Authors: Yimeng Yang, Qiang Zhang

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 8/2019

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Abstract

Purpose

To evaluate the clinical outcome of the combined reconstruction of the medial patellofemoral ligament (MPFL) and medial patellotibial ligament (MPTL) for patellar instability with patella alta.

Methods

A total of 108 patients underwent a combined reconstruction of the MPFL and MPTL, and 58 patients were included in this study. The clinical results were evaluated and compared using the International Knee Documentation Committee (IKDC) scores, Kujala scores, and visual analogue scale (VAS) scores. The tibial tuberosity–trochlear groove (TT–TG) distance, three indices of patellar height (Insall–Salvati ratio, modified Insall–Salvati ratio, and Caton–Deschamps index), and patellar shift and tilt were defined preoperatively and at the 12- and 24-month follow-up visits.

Results

At the 12- and 24-month follow-up visits, 86.2% (50/58) and 87.9% (51/58) of the subjective outcomes were excellent, 5/58 (8.6%) and 4/58 (6.9%) were good, 1/58 (1.7%) and 2/58 (3.4%) were fair, and 2/58 (3.4%) and 1/58 (1.7%) were poor. There were significant improvements in the IKDC scores, from 51.9 ± 13.8 preoperatively to 80 ± 19.2 (P < 0.05) at 12 months and 85 ± 13.9 (P < 0.05) at 24 months; Kujala scores, from 55.1 ± 15.2 preoperatively to 82.6 ± 14.9 (P < 0.05) at 12 months and 89.5 ± 10.2 (P < 0.05) at 24 months; and VAS scores, from 58 ± 11 preoperatively to 12 ± 5 (P < 0.05) at 12 months and 11 ± 4 (P < 0.05) at 24 months. The patellar tilt, patellar shift, Insall–Salvati ratio, modified Insall–Salvati ratio, Caton–Deschamps index, and TT–TG distance all decreased significantly compared with the preoperative values, and there were no significant differences between the values at the 12- and 24-month follow-ups.

Conclusion

The results of this study show that a combined reconstruction of the MPFL and MPTL is an effective treatment for patellar instability with patella alta. This article emphasizes the combined effect of MPFL and MPTL instead of MPFL alone and provides an effective option for the treatment of recurrent patellar dislocation with patella alta.

Level of evidence

Case series, Level IV.
Appendix
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Literature
1.
2.
Amis AA (2007) Current concepts on anatomy and biomechanics of patellar stability. Sports Med Arthrosc 15:48–56CrossRefPubMed
3.
Aulisa AG, Falciglia F, Giordano M, Savignoni P, Guzzanti V (2012) Galeazzi’s modified technique for recurrent patella dislocation in skeletally immature patients. J Orthop Sci 17:148–155CrossRefPubMed
4.
Balcarek P, Ammon J, Frosch S, Walde TA, Schuttrumpf JP, Ferlemann KG et al (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 26:926–935CrossRefPubMed
5.
Baumann C, Pratte E, Sherman S, Arendt E, Hinckel B (2018) Reconstruction of the medial patellotibial ligament results in favorable clinical outcomes: a systematic review. Knee Surg Sports Traumatol Arthrosc 26:2920–2933CrossRefPubMed
6.
Beaconsfield T, Pintore E, Maffulli N, Petri GJ (1994) Radiological measurements in patellofemoral disorders. A review. Clin Orthop Relat Res 18–28
7.
Bitar AC, Demange MK, D’Elia CO, Camanho GL (2012) Traumatic patellar dislocation: nonoperative treatment compared with MPFL reconstruction using patellar tendon. Am J Sports Med 40:114–122CrossRefPubMed
8.
Buckens CF, Saris DB (2010) Reconstruction of the medial patellofemoral ligament for treatment of patellofemoral instability: a systematic review. Am J Sports Med 38:181–188CrossRefPubMed
9.
Chia SL, Merican AM, Devadasan B, Strachan RK, Amis AA (2009) Radiographic features predictive of patellar maltracking during total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 17:1217–1224CrossRefPubMed
10.
11.
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 75:682–693CrossRefPubMed
12.
Crosby EB, Insall J (1976) Recurrent dislocation of the patella. Relation of treatment to osteoarthritis. J Bone Joint Surg Am 58:9–13CrossRefPubMed
13.
Dejour H, Walch G, Nove-Josserand L, Guier C (1994) Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 2:19–26CrossRefPubMed
14.
Desio SM, Burks RT, Bachus KN (1998) Soft tissue restraints to lateral patellar translation in the human knee. Am J Sports Med 26:59–65CrossRefPubMed
15.
Elias JJ, Cech JA, Weinstein DM, Cosgrea AJ (2004) Reducing the lateral force acting on the patella does not consistently decrease patellofemoral pressures. Am J Sports Med 32:1202–1208CrossRefPubMed
16.
Elias JJ, Cosgarea AJ (2006) Technical errors during medial patellofemoral ligament reconstruction could overload medial patellofemoral cartilage: a computational analysis. Am J Sports Med 34:1478–1485CrossRefPubMed
17.
Elias JJ, Wilson DR, Adamson R, Cosgarea AJ (2004) Evaluation of a computational model used to predict the patellofemoral contact pressure distribution. J Biomech 37:295–302CrossRefPubMed
18.
Fabricant PD, Ladenhauf HN, Salvati EA, Green DW (2014) Medial patellofemoral ligament (MPFL) reconstruction improves radiographic measures of patella alta in children. Knee 21:1180–1184CrossRefPubMed
19.
Farahmand F, Naghi Tahmasbi M, Amis A (2004) The contribution of the medial retinaculum and quadriceps muscles to patellar lateral stability—an in-vitro study. Knee 11:89–94CrossRefPubMed
20.
Feller JA, Amis AA, Andrish JT, Arendt EA, Erasmus PJ, Powers CM (2007) Surgical biomechanics of the patellofemoral joint. Arthroscopy 23:542–553CrossRefPubMed
21.
Garth WP Jr, Connor GS, Futch L, Belarmino H (2011) Patellar subluxation at terminal knee extension: isolated deficiency of the medial patellomeniscal ligament. J Bone Joint Surg Am 93:954–962CrossRefPubMed
22.
Grelsamer RP, Meadows S (1992) The modified Insall-Salvati ratio for assessment of patellar height. Clin Orthop Relat Res 280:170–176
23.
Hensler D, Sillanpaa PJ, Schoettle PB (2014) Medial patellofemoral ligament: anatomy, injury and treatment in the adolescent knee. Curr Opin Pediatr 26:70–78CrossRefPubMed
24.
Hinckel BB, Gobbi RG, Bonadio MB, Demange MK, Pecora JR, Camanho GL (2016) Reconstruction of medial patellofemoral ligament using quadriceps tendon combined with reconstruction of medial patellotibial ligament using patellar tendon: initial experience. Rev Bras Ortop 51:75–82CrossRefPubMedPubMedCentral
25.
Hinckel BB, Gobbi RG, Demange MK, Bonadio MB, Pecora JR, Camanho GL (2016) Combined reconstruction of the medial patellofemoral ligament with quadricipital tendon and the medial patellotibial ligament with patellar tendon. Arthrosc Tech 5:e79–e84CrossRefPubMedPubMedCentral
26.
27.
Irrgang JJ, Anderson AF, Boland AL, Harner CD, Kurosaka M, Neyret P et al (2001) Development and validation of the international knee documentation committee subjective knee form. Am J Sports Med 29:600–613CrossRefPubMed
28.
Kujala UM, Jaakkola LH, Koskinen SK, Taimela S, Hurme M, Nelimarkka O (1993) Scoring of patellofemoral disorders. Arthroscopy 9:159–163CrossRefPubMed
29.
Lippacher S, Dejour D, Elsharkawi M, Dornacher D, Ring C, Dreyhaupt J et al (2012) Observer agreement on the Dejour trochlear dysplasia classification: a comparison of true lateral radiographs and axial magnetic resonance images. Am J Sports Med 40:837–843CrossRefPubMed
30.
Mani S, Kirkpatrick MS, Saranathan A, Smith LG, Cosgarea AJ, Elias JJ (2011) Tibial tuberosity osteotomy for patellofemoral realignment alters tibiofemoral kinematics. Am J Sports Med 39:1024–1031CrossRefPubMedPubMedCentral
31.
Nomura E, Inoue M, Osada N (2005) Anatomical analysis of the medial patellofemoral ligament of the knee, especially the femoral attachment. Knee Surg Sports Traumatol Arthrosc 13:510–515CrossRefPubMed
32.
Papachristou G, Nikolaou V, Efstathopoulos N, Sourlas J, Lazarettos J, Frangia K et al (2007) ACL reconstruction with semitendinosus tendon autograft without detachment of its tibial insertion: a histologic study in a rabbit model. Knee Surg Sports Traumatol Arthrosc 15:1175–1180CrossRefPubMed
33.
Philippot R, Boyer B, Testa R, Farizon F, Moyen B (2012) The role of the medial ligamentous structures on patellar tracking during knee flexion. Knee Surg Sports Traumatol Arthrosc 20:331–336CrossRefPubMed
34.
Rillmann P, Dutly A, Kieser C, Berbig R (1998) Modified Elmslie-Trillat procedure for instability of the patella. Knee Surg Sports Traumatol Arthrosc 6:31–35CrossRefPubMed
35.
Rodeo SA, Arnoczky SP, Torzilli PA, Hidaka C, Warren RF (1993) Tendon-healing in a bone tunnel. A biomechanical and histological study in the dog. J Bone Joint Surg Am 75:1795–1803CrossRefPubMed
36.
Scuderi G, Cuomo F, Scott WN (1988) Lateral release and proximal realignment for patellar subluxation and dislocation. A long-term follow-up. J Bone Joint Surg Am 70:856–861CrossRefPubMed
37.
Servien E, Verdonk PC, Neyret P (2007) Tibial tuberosity transfer for episodic patellar dislocation. Sports Med Arthrosc 15:61–67CrossRefPubMed
38.
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 40:1916–1923CrossRefPubMedPubMedCentral
39.
Stephen JM, Dodds AL, Lumpaopong P, Kader D, Williams A, Amis AA (2015) The ability of medial patellofemoral ligament reconstruction to correct patellar kinematics and contact mechanics in the presence of a lateralized tibial tubercle. Am J Sports Med 43:2198–2207CrossRefPubMed
40.
Thevenin-Lemoine C, Ferrand M, Courvoisier A, Damsin JP, Ducou le Pointe H, Vialle R (2011) Is the Caton-Deschamps index a valuable ratio to investigate patellar height in children? J Bone Joint Surg Am 93:e35CrossRefPubMed
41.
Ward SR, Terk MR, Powers CM (2007) Patella alta: association with patellofemoral alignment and changes in contact area during weight-bearing. J Bone Joint Surg Am 89:1749–1755PubMed
42.
Watanabe T, Muneta T, Ikeda H, Tateishi T, Sekiya I (2008) Visual analog scale assessment after medial patellofemoral ligament reconstruction: with or without tibial tubercle transfer. J Orthop Sci 13:32–38CrossRefPubMed
43.
Weber AE, Nathani A, Dines JS, Allen AA, Shubin-Stein BE, Arendt EA et al (2016) An algorithmic approach to the management of recurrent lateral patellar dislocation. J Bone Joint Surg Am 98:417–427CrossRefPubMed
44.
Zaffagnini S, Golano P, Farinas O, Depasquale V, Strocchi R, Cortecchia S et al (2003) Vascularity and neuroreceptors of the pes anserinus: anatomic study. Clin Anat 16:19–24CrossRefPubMed
45.
Zaffagnini S, Grassi A, Marcheggiani Muccioli GM, Luetzow WF, Vaccari V, Benzi A et al (2014) Medial patellotibial ligament (MPTL) reconstruction for patellar instability. Knee Surg Sports Traumatol Arthrosc 22:2491–2498CrossRefPubMed
Metadata
Title
Reconstruction of the medial patellofemoral ligament and reinforcement of the medial patellotibial ligament is an effective treatment for patellofemoral instability with patella alta
Authors
Yimeng Yang
Qiang Zhang
Publication date
01-08-2019
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 8/2019
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-018-5281-z

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