J Knee Surg 2020; 33(10): 992-997
DOI: 10.1055/s-0039-1688917
Original Article

Isolated Medial Patellofemoral Ligament Reconstruction Can Be an Effective Procedure in Patellofemoral Instability with Risk Factors

Fabian Blanke
1   Department of Orthopedic Sports Medicine and Arthroscopic Surgery, Hessing Stiftung, Augsburg, Germany
,
Kathrin Watermann
1   Department of Orthopedic Sports Medicine and Arthroscopic Surgery, Hessing Stiftung, Augsburg, Germany
2   Department of Orthopedic Sports Medicine and Arthroscopic Surgery, Klinikum Rechts der Isar, Technische Universität München, München, Germany
,
Maximilian Haenle
1   Department of Orthopedic Sports Medicine and Arthroscopic Surgery, Hessing Stiftung, Augsburg, Germany
,
Andreas Feitenhansl
1   Department of Orthopedic Sports Medicine and Arthroscopic Surgery, Hessing Stiftung, Augsburg, Germany
,
Carlo Camathias
3   Department of Orthopedic Surgery, University Children's Hospital Basel, Basel, Switzerland
,
Stephan Vogt
1   Department of Orthopedic Sports Medicine and Arthroscopic Surgery, Hessing Stiftung, Augsburg, Germany
2   Department of Orthopedic Sports Medicine and Arthroscopic Surgery, Klinikum Rechts der Isar, Technische Universität München, München, Germany
› Author Affiliations

Abstract

Patellofemoral instability is a severe problem in young and active patients. This pathology is influenced by ligamentous, bony, and neuromuscular parameters. The reconstruction of the medial patellofemoral ligament (MPFL) evolved to a primary procedure, but combined procedures were more frequently performed in the past years. However, additional operative procedures are associated with increased morbidity and no absolute indication can be identified in the literature. This study is intended to clarify whether addressing only ligamentous influence factors (MPFL) in chronic patellofemoral instability is sufficient to produce good clinical outcomes, or whether other risk factors influence the results negatively and should also be treated at some point. In 52 patients with chronic patellofemoral instability patellar height according to Caton-Deschamps, trochlear dysplasia according to Dejour, the leg axis, the femoral antetorsion, tibial tubercle (TT)–trochlear groove, and TT–posterior cruciate ligament distance were evaluated. All patients were treated with isolated MPFL reconstruction. After a minimum follow-up period of 24 months (24–36 months), the clinical outcome results were calculated using the scoring system according to Lysholm and Tegner. Correlation between clinical outcome scores and anatomic risk factors were calculated. The analysis was performed using a standard statistical software package (JMP version 12, SAS Institute, Cary, NC). The average postoperative Lysholm score increased significantly from 57.23 ± 19.9 to 85.9 ± 17.2 points (p < 0.0001) after isolated MPFL reconstruction. Moreover, the Tegner and Lysholm scores significantly improved both in patients without and with different risk factors postoperative. There were no significant differences in the outcome sores between the groups. Even the degree of trochlear dysplasia (types I–III) did not influence the results. Finally, there was no significant correlation found between all collected risk factors and the postoperative outcome scores. Isolated MPFL reconstruction can be an effective procedure in patients with patellofemoral instability and mild to moderate risk factors.



Publication History

Received: 26 July 2018

Accepted: 05 April 2019

Article published online:
23 May 2019

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers
333 Seventh Avenue, New York, NY 10001, USA.

 
  • References

  • 1 Schneider DK, Grawe B, Magnussen RA. , et al. Outcomes after isolated medial patellofemoral ligament reconstruction for the treatment of recurrent lateral patellar dislocations: a systematic review and meta-analysis. Am J Sports Med 2016; 44 (11) 2993-3005
  • 2 Arendt EA, Fithian DC, Cohen E. Current concepts of lateral patella dislocation. Clin Sports Med 2002; 21 (03) 499-519
  • 3 Drez Jr D, Edwards TB, Williams CS. Results of medial patellofemoral ligament reconstruction in the treatment of patellar dislocation. Arthroscopy 2001; 17 (03) 298-306
  • 4 Farahmand F, Senavongse W, Amis AA. Quantitative study of the quadriceps muscles and trochlear groove geometry related to instability of the patellofemoral joint. J Orthop Res 1998; 16 (01) 136-143
  • 5 Senavongse W, Amis AA. The effects of articular, retinacular, or muscular deficiencies on patellofemoral joint stability: a biomechanical study in vitro. J Bone Joint Surg Br 2005; 87 (04) 577-582
  • 6 Camanho GL, Viegas AdeC, Bitar AC, Demange MK, Hernandez AJ. Conservative versus surgical treatment for repair of the medial patellofemoral ligament in acute dislocations of the patella. Arthroscopy 2009; 25 (06) 620-625
  • 7 Larsen E, Lauridsen F. Conservative treatment of patellar dislocations. Influence of evident factors on the tendency to redislocation and the therapeutic result. Clin Orthop Relat Res 1982; (171) 131-136
  • 8 Amis AA, Firer P, Mountney J, Senavongse W, Thomas NP. Anatomy and biomechanics of the medial patellofemoral ligament. Knee 2003; 10 (03) 215-220
  • 9 Conlan T, Garth Jr WP, Lemons JE. Evaluation of the medial soft-tissue restraints of the extensor mechanism of the knee. J Bone Joint Surg Am 1993; 75 (05) 682-693
  • 10 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
  • 11 Schöttle P, Schmeling A, Romero J, Weiler A. Anatomical reconstruction of the medial patellofemoral ligament using a free gracilis autograft. Arch Orthop Trauma Surg 2009; 129 (03) 305-309
  • 12 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
  • 13 Ahmad CS, Brown GD, Shubin Stein BE. The docking technique for medial patellofemoral ligament reconstruction: surgical technique and clinical outcome. Am J Sports Med 2009; 37 (10) 2021-2027
  • 14 Nomura E, Horiuchi Y, Kihara M. Medial patellofemoral ligament restraint in lateral patellar translation and reconstruction. Knee 2000; 7 (02) 121-127
  • 15 Nomura E, Inoue M. Surgical technique and rationale for medial patellofemoral ligament reconstruction for recurrent patellar dislocation. Arthroscopy 2003; 19 (05) E47
  • 16 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
  • 17 Tompkins MA, Arendt EA. Patellar instability factors in isolated medial patellofemoral ligament reconstructions--what does the literature tell us? A systematic review. Am J Sports Med 2015; 43 (09) 2318-2327
  • 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 Yeung M, Leblanc MC, Ayeni OR. , et al. Indications for medial patellofemoral ligament reconstruction: a systematic review. J Knee Surg 2016; 29 (07) 543-554
  • 20 Ruwe PA, Gage JR, Ozonoff MB, DeLuca PA. Clinical determination of femoral anteversion. A comparison with established techniques. J Bone Joint Surg Am 1992; 74 (06) 820-830
  • 21 Yue RA, Arendt EA, Tompkins MA. Patellar height measurements on radiograph and magnetic resonance imaging in patellar instability and control patients. J Knee Surg 2017; 30 (09) 943-950
  • 22 Dejour H, Walch G, Nove-Josserand L, Guier C. Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 1994; 2 (01) 19-26
  • 23 Dejour D, Reynaud P, Lecoultre B. Doulerurs et instabilite rotulienne: Essai de classification. Med Hyg (Geneve) 1998; 56: 1466-1471
  • 24 Brady JM, Sullivan JP, Nguyen J. , et al. The tibial tubercle-to-trochlear groove distance is reliable in the setting of trochlear dysplasia, and superior to the tibial tubercle-to-posterior cruciate ligament distance when evaluating coronal malalignment in patellofemoral instability. Arthroscopy 2017; 33 (11) 2026-2034
  • 25 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
  • 26 Bicos J, Fulkerson JP, Amis A. Current concepts review: the medial patellofemoral ligament. Am J Sports Med 2007; 35 (03) 484-492
  • 27 Schöttle PB, Scheffler SU, Schwarck A, Weiler A. Arthroscopic medial retinacular repair after patellar dislocation with and without underlying trochlear dysplasia: a preliminary report. Arthroscopy 2006; 22 (11) 1192-1198
  • 28 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 (08) 1254-1261
  • 29 Wagner D, Pfalzer F, Hingelbaum S, Huth J, Mauch F, Bauer G. The influence of risk factors on clinical outcomes following anatomical medial patellofemoral ligament (MPFL) reconstruction using the gracilis tendon. Knee Surg Sports Traumatol Arthrosc 2013; 21 (02) 318-324
  • 30 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
  • 31 Neyret P, Robinson AH, Le Coultre B, Lapra C, Chambat P. Patellar tendon length--the factor in patellar instability?. Knee 2002; 9 (01) 3-6
  • 32 Ward SR, Terk MR, Powers CM. Patella alta: association with patellofemoral alignment and changes in contact area during weight-bearing. J Bone Joint Surg Am 2007; 89 (08) 1749-1755
  • 33 Daynes J, Hinckel BB, Farr J. Tibial tuberosity-posterior cruciate ligament distance. J Knee Surg 2016; 29 (06) 471-477
  • 34 Schoettle PB, Zanetti M, Seifert B, Pfirrmann CW, Fucentese SF, Romero J. The tibial tuberosity-trochlear groove distance; a comparative study between CT and MRI scanning. Knee 2006; 13 (01) 26-31
  • 35 Seitlinger G, Scheurecker G, Högler R, Labey L, Innocenti B, Hofmann S. Tibial tubercle-posterior cruciate ligament distance: a new measurement to define the position of the tibial tubercle in patients with patellar dislocation. Am J Sports Med 2012; 40 (05) 1119-1125
  • 36 Palmu S, Kallio PE, Donell ST, Helenius I, Nietosvaara Y. Acute patellar dislocation in children and adolescents: a randomized clinical trial. J Bone Joint Surg Am 2008; 90 (03) 463-470