Subscribe to RSS
DOI: 10.1055/s-0038-1636913
Long-Term Clinical Results of Double Bundle Reconstruction of the Medial Patellofemoral Ligament for Patellar Instability
Publication History
28 August 2017
28 January 2018
Publication Date:
07 March 2018 (online)
Abstract
Medial patellofemoral ligament (MPFL) reconstruction is a satisfactory technique for patellar instability, and the anatomical double bundle variant is recommended for better clinical results. However, long-term outcomes are still uncharacterized. This study aimed to assess the effectiveness of double bundle reconstruction of the MPFL for patellar instability by means of established scores. A total of 68 patients with chronic patellar instability who underwent surgery from May 2005 to February 2010 were included prospectively. Anatomical double reconstruction of the MPFL with the semitendinosus tendon was conducted. Tegner Activity Scale (TAS), Kujala score, Lysholm knee score, and objective physical examination were assessed during follow-up. Median follow-up time for the patients was 8 (range, 6–10) years. Eight patients were lost to follow-up after 2 years. Preoperative mean TAS was 2.85 ± 0.78, increased to 4.91 ± 0.84 at 6 months and 7.26 ± 0.78 at 2 years postoperatively, and was 7.82 ± 0.89 at last follow-up. At last follow-up, pain free at rest was achieved in all patients; and 8 patients had knee pain in activities of daily living. Mean Kujala score was 57.53 ± 8.59 preoperatively, and increased to 61.22 ± 6.46, 89.51 ± 3.90, and 88.92 ± 3.84 at 6 months, 2 years postoperatively, and at last follow-up, respectively. Lysholm scores were also increased from preoperative values of 43.53 ± 10.20 to 58.22 ± 6.80, 89.37 ± 4.38, and 89.67 ± 4.13 at 6 months, 2 years postoperatively, and at last follow-up, respectively. Range of motion was 121.44 ± 12.69, 129.71 ± 6.39, 130.93 ± 5.67, and 130.78 ± 5.80 at preoperative point, 6 months, 2 years postoperatively, and at last follow-up, respectively. Long-term clinical results of double bundle reconstruction of the MPFL for patellar instability were encouraging.
-
References
- 1 Amis AA, Firer P, Mountney J, Senavongse W, Thomas NP. Anatomy and biomechanics of the medial patellofemoral ligament. Knee 2003; 10 (03) 215-220
- 2 Tanaka MJ. The anatomy of the medial patellofemoral complex. Sports Med Arthrosc Rev 2017; 25 (02) e8-e11
- 3 Trinh TQ, Ferrel JR, Bentley JC, Steensen RN. The anatomy of the medial patellofemoral ligament. Orthopedics 2017; 40 (04) e583-e588
- 4 Dragoo JL, Nguyen M, Gatewood CT, Taunton JD, Young S. Medial patellofemoral ligament repair versus reconstruction for recurrent patellar instability: two-year results of an algorithm-based approach. Orthop J Sports Med 2017; 5 (03) 2325967116689465
- 5 Fink C, Veselko M, Herbort M, Hoser C. MPFL reconstruction using a quadriceps tendon graft: part 2: operative technique and short term clinical results. Knee 2014; 21 (06) 1175-1179
- 6 Andrish J. Surgical options for patellar stabilization in the skeletally immature patient. Sports Med Arthrosc Rev 2017; 25 (02) 100-104
- 7 Tanaka MJ, Voss A, Fulkerson JP. The anatomic midpoint of the attachment of the medial patellofemoral complex. J Bone Joint Surg Am 2016; 98 (14) 1199-1205
- 8 Schöttle PB, Hensler D, Imhoff AB. Anatomical double-bundle MPFL reconstruction with an aperture fixation. Knee Surg Sports Traumatol Arthrosc 2010; 18 (02) 147-151
- 9 Schöttle PB, Fucentese SF, Romero J. Clinical and radiological outcome of medial patellofemoral ligament reconstruction with a semitendinosus autograft for patella instability. Knee Surg Sports Traumatol Arthrosc 2005; 13 (07) 516-521
- 10 Tang H, Xu YQ, Zheng TE. , et al. Anatomical double bundle reconstruction of medial patellofemoral ligament with allograft tendon in the treatment of patellar dislocations. Zhongguo Gu Shang 2015; 28 (03) 252-255
- 11 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 (01) 82-87
- 12 Grelsamer RP, Meadows S. The modified Insall-Salvati ratio for assessment of patellar height. Clin Orthop Relat Res 1992; (282) 170-176
- 13 Botchu R, Obaid H, Rennie WJ. Correlation between trochlear dysplasia and the notch index. J Orthop Surg (Hong Kong) 2013; 21 (03) 290-293
- 14 Singhal R, Rogers S, Charalambous CP. Double-bundle medial patellofemoral ligament reconstruction with hamstring tendon autograft and mediolateral patellar tunnel fixation: a meta-analysis of outcomes and complications. Bone Joint J 2013; 95-B (07) 900-905
- 15 Gobbi A, Whyte GP. One-stage cartilage repair using a hyaluronic acid-based scaffold with activated bone marrow-derived mesenchymal stem cells compared with microfracture: five-year follow-up. Am J Sports Med 2016; 44 (11) 2846-2854
- 16 Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 1985; (198) 43-49
- 17 Christoforakis J, Bull AM, Strachan RK, Shymkiw R, Senavongse W, Amis AA. Effects of lateral retinacular release on the lateral stability of the patella. Knee Surg Sports Traumatol Arthrosc 2006; 14 (03) 273-277
- 18 Longo UG, Berton A, Salvatore G. , et al. Medial patellofemoral ligament reconstruction combined with bony procedures for patellar instability: current indications, outcomes, and complications. Arthroscopy 2016; 32 (07) 1421-1427
- 19 Ambrožič B, Novak S. The influence of medial patellofemoral ligament reconstruction on clinical results and sports activity level. Phys Sportsmed 2016; 44 (02) 133-140
- 20 Houdek CG, Esquivel AO, Cracchiolo AM, Lemos SE. A biomechanical comparison of isometric and anatomic medial patellofemoral ligament reconstruction. J Knee Surg 2016; 29 (06) 522-526
- 21 Russo F, Doan J, Chase DC, Farnsworth CL, Pennock AT. Medial patellofemoral ligament reconstruction: fixation technique biomechanics. J Knee Surg 2016; 29 (04) 303-309
- 22 Siebold R, Chikale S, Sartory N, Hariri N, Feil S, Pässler HH. Hamstring graft fixation in MPFL reconstruction at the patella using a transosseous suture technique. Knee Surg Sports Traumatol Arthrosc 2010; 18 (11) 1542-1544
- 23 Kang HJ, Wang F, Chen BC, Su YL, Zhang ZC, Yan CB. Functional bundles of the medial patellofemoral ligament. Knee Surg Sports Traumatol Arthrosc 2010; 18 (11) 1511-1516
- 24 Wang Q, Huang W, Cai D, Huang H. Biomechanical comparison of single- and double-bundle medial patellofemoral ligament reconstruction. J Orthop Surg 2017; 12 (01) 29
- 25 Kita K, Tanaka Y, Toritsuka Y. , et al. Factors affecting the outcomes of double-bundle medial patellofemoral ligament reconstruction for recurrent patellar dislocations evaluated by multivariate analysis. Am J Sports Med 2015; 43 (12) 2988-2996
- 26 Pemmaraju G, Bassett J, Abbas R, Nagra G, Chugh S, Mughal E. Outcomes of combined tibial tuberosity transfer and medial patellofemoral ligament reconstruction for recurrent patellar instability. Acta Orthop Belg 2016; 82 (02) 365-371
- 27 Suganuma J, Mochizuki R, Shibata R. , et al. Reconstruction of the medial patellofemoral ligament with arthroscopic control of patellofemoral congruence using electrical stimulation of the quadriceps. Arthrosc Tech 2016; 5 (03) e649-e656
- 28 Valkering KP, Rajeev A, Caplan N, Tuinebreijer WE, Kader DF. An evaluation of the effectiveness of medial patellofemoral ligament reconstruction using an anatomical tunnel site. Knee Surg Sports Traumatol Arthrosc 2017; 25 (10) 3206-3212
- 29 Gobbi RG, Pereira CA, Sadigursky D. , et al. Evaluation of the isometry of different points of the patella and femur for medial patellofemoral ligament reconstruction. Clin Biomech (Bristol, Avon) 2016; 38: 8-12
- 30 Fulkerson JP, Edgar C. Medial quadriceps tendon-femoral ligament: surgical anatomy and reconstruction technique to prevent patella instability. Arthrosc Tech 2013; 2 (02) e125-e128
- 31 Mochizuki T, Nimura A, Tateishi T, Yamaguchi K, Muneta T, Akita K. Anatomic study of the attachment of the medial patellofemoral ligament and its characteristic relationships to the vastus intermedius. Knee Surg Sports Traumatol Arthrosc 2013; 21 (02) 305-310
- 32 Redler LH, Spang RC, Tepolt F, Davis EA, Kocher MS. Combined reconstruction of the medial patellofemoral ligament (MPFL) and medial quadriceps tendon-femoral ligament (MQTFL) for patellar instability in children and adolescents: surgical technique and outcomes. Orthop J Sports Med 2017; 5 (07) (Suppl. 06)
- 33 Sadigursky D, de Melo Laranjeira MS, Nunes M, Caneiro RJ, Colavolpe PO. Reconstruction of the medial patellofemoral ligament by means of the anatomical double-bundle technique using metal anchors. Rev Bras Ortop 2016; 51 (03) 290-297
- 34 Gonçaives MB, Júnior LH, Soares LF, Gonçaives TJ, Dos Santos RL, Pereira ML. Medial patellofemoral ligament reconstruction to treat recurrent patellar dislocation. Rev Bras Ortop 2015; 46 (02) 160-164
- 35 Kodkani PS. “Basket weave technique” for medial patellofemoral ligament reconstruction: clinical outcome of a prospective study. Indian J Orthop 2016; 50 (01) 34-42
- 36 Vavalle G, Capozzi M. Isolated reconstruction of the medial patellofemoral ligament with autologous quadriceps tendon. J Orthop Traumatol 2016; 17 (02) 155-162
- 37 Wang HD, Dong JT, Gao SJ. Medial patellofemoral ligament reconstruction using a bone groove and a suture anchor at patellar: a safe and firm fixation technique and 3-year follow-up study. J Orthop Surg 2016; 11 (01) 138
- 38 Wang CH, Ma LF, Zhou JW. , et al. Double-bundle anatomical versus single-bundle isometric medial patellofemoral ligament reconstruction for patellar dislocation. Int Orthop 2013; 37 (04) 617-624
- 39 Li J, Li Y, Wei J, Wang J, Gao S, Shen Y. A simple technique for reconstruction of medial patellofemoral ligament with bone-fascia tunnel fixation at the medial margin of the patella: a 6-year-minimum follow-up study. J Orthop Surg 2014; 9: 66