PDF herunterladen
J Knee Surg 2022; 35(03): 299-307
DOI: 10.1055/s-0040-1713898
Original Article

Effect of Isolated Medial Patellofemoral Ligament Reconstruction in Patellofemoral Instability Regardless of Predisposing Factors

Jae Ik Lee
1   Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
,
Mohd Shahrul Azuan Jaffar
2   Department of Orthopaedic Surgery and Traumatology, Sarawak General Hospital, Sarawak, Malaysia
,
Han Gyeol Choi
1   Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
,
Tae Woo Kim
3   Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Boramae Medical Center, Dongjak-gu, Seoul, South Korea
,
Yong Seuk Lee
1   Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
› Institutsangaben Funding None.
› Weitere Informationen
    Lizenzen und Reprints

Abstract

The purpose of this study was to evaluate the outcomes of isolated medial patellofemoral ligament (MPFL) reconstruction, regardless of the presence of predisposing factors. A total of 21 knees that underwent isolated MPFL reconstruction from March 2014 to August 2017 were included in this retrospective series. Radiographs of the series of the knee at flexion angles of 20, 40, and 60 degrees were acquired. The patellar position was evaluated using the patellar tilt angle, sulcus angle, congruence angle (CA), and Caton-Deschamps and Blackburne-Peel ratios. To evaluate the clinical outcome, the preoperative and postoperative International Knee Documentation Committee (IKDC) and Lysholm knee scoring scales were analyzed. To evaluate the postoperative outcomes based on the predisposing factors, the results were separately analyzed for each group. Regarding radiologic outcomes, 20-degree CA was significantly reduced from 10.37 ± 5.96° preoperatively to −0.94 ± 4.11° postoperatively (p = 0.001). In addition, regardless of the predisposing factors, delta values of pre- and postoperation of 20-degree CA were not significantly different in both groups. The IKDC score improved from 53.71 (range: 18–74) preoperatively to 94.71 (range: 86–100) at the last follow-up (p = 0.004), and the Lysholm score improved from 54.28 (range: 10–81) preoperatively to 94.14 (range: 86–100) at the last follow-up (p = 0.010). Isolated MPFL reconstruction provides a safe and effective treatment for patellofemoral instability, even in the presence of mild predisposing factors, such as trochlear dysplasia, increased patella height, increased TT–TG distance, or valgus alignment. This is a Level 4, case series study.

Keywords

patella - dislocation - patellofemoral instability - medial patellofemoral ligament - reconstruction

Ethical Approval

The article does not contain any studies with human participants or animals performed by any of the authors.




Publikationsverlauf

Eingereicht: 31. März 2020

Angenommen: 25. Mai 2020

Artikel online veröffentlicht:
13. Juli 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Nomura E, Inoue M, Kobayashi S. Generalized joint laxity and contralateral patellar hypermobility in unilateral recurrent patellar dislocators. Arthroscopy 2006; 22 (08) 861-865
    CrossrefPubMedSuche in Google Scholar
  • 2 Grana WA, Hinkley B, Hollingsworth S. Arthroscopic evaluation and treatment of patellar malalignment. Clin Orthop Relat Res 1984; (186) 122-128
    PubMedSuche in Google Scholar
  • 3 Deie M, Ochi M, Sumen Y, Adachi N, Kobayashi K, Yasumoto M. A long-term follow-up study after medial patellofemoral ligament reconstruction using the transferred semitendinosus tendon for patellar dislocation. Knee Surg Sports Traumatol Arthrosc 2005; 13 (07) 522-528
    CrossrefPubMedSuche in Google Scholar
  • 4 Chotel F, Bérard J, Raux S. Patellar instability in children and adolescents. Orthop Traumatol Surg Res 2014; 100 (Suppl. 01) S125-S137
    CrossrefPubMedSuche in Google Scholar
  • 5 Amis AA, Firer P, Mountney J, Senavongse W, Thomas NP. Anatomy and biomechanics of the medial patellofemoral ligament. Knee 2003; 10 (03) 215-220
    CrossrefPubMedSuche in Google Scholar
  • 6 Desio SM, Burks RT, Bachus KN. Soft tissue restraints to lateral patellar translation in the human knee. Am J Sports Med 1998; 26 (01) 59-65
    CrossrefPubMedSuche in Google Scholar
  • 7 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
    CrossrefPubMedSuche in Google Scholar
  • 8 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
    CrossrefPubMedSuche in Google Scholar
  • 9 Colvin AC, West RV. Patellar instability. J Bone Joint Surg Am 2008; 90 (12) 2751-2762
    CrossrefPubMedSuche in Google Scholar
  • 10 White BJ, Sherman OH. Patellofemoral instability. Bull NYU Hosp Jt Dis 2009; 67 (01) 22-29
    PubMedSuche in Google Scholar
  • 11 Blanke F, Watermann K, Haenle M, Feitenhansl A, Camathias C, Vogt S. Isolated medial patellofemoral ligament reconstruction can be an effective procedure in patellofemoral instability with risk factors. J Knee Surg 2020; 33 (10) 992-997
    Thieme ConnectPubMedSuche in Google Scholar
  • 12 Erickson BJ, Nguyen J, Gasik K, Gruber S, Brady J, Shubin Stein BE. Isolated medial patellofemoral ligament reconstruction for patellar instability regardless of tibial tubercle-trochlear groove distance and patellar height: outcomes at 1 and 2 years. Am J Sports Med 2019; 47 (06) 1331-1337
    CrossrefPubMedSuche in Google Scholar
  • 13 Howells NR, Barnett AJ, Ahearn N, Ansari A, Eldridge JD. Medial patellofemoral ligament reconstruction: a prospective outcome assessment of a large single centre series. J Bone Joint Surg Br 2012; 94 (09) 1202-1208
    CrossrefPubMedSuche in Google Scholar
  • 14 Nelitz M, Dreyhaupt J, Lippacher S. Combined trochleoplasty and medial patellofemoral ligament reconstruction for recurrent patellar dislocations in severe trochlear dysplasia: a minimum 2-year follow-up study. Am J Sports Med 2013; 41 (05) 1005-1012
    CrossrefPubMedSuche in Google Scholar
  • 15 Laugharne E, Bali N, Purushothamdas S, Almallah F, Kundra R. Variability of measurement of patellofemoral indices with knee flexion and quadriceps contraction: an MRI-based anatomical study. Knee Surg Relat Res 2016; 28 (04) 297-301
    CrossrefPubMedSuche in Google Scholar
  • 16 Dejour D, Ferrua P, Ntagiopoulos PG. et al; French Arthroscopy Society (SFA). The introduction of a new MRI index to evaluate sagittal patellofemoral engagement. Orthop Traumatol Surg Res 2013; 99 (Suppl. 08) S391-S398
    CrossrefPubMedSuche in Google Scholar
  • 17 Guilbert S, Chassaing V, Radier C. et al; French Arthroscopy Society (SFA). Axial MRI index of patellar engagement: a new method to assess patellar instability. Orthop Traumatol Surg Res 2013; 99 (Suppl. 08) S399-S405
    CrossrefPubMedSuche in Google Scholar
  • 18 Biedert RM, Tscholl PMJAJO. Patella alta: a comprehensive review of current knowledge. Am J Orthop 2017; 46 (06) 290-300
    Suche in Google Scholar
  • 19 Watson NA, Duchman KR, Grosland NM, Bollier MJ. Finite element analysis of patella alta: a patellofemoral instability model. Iowa Orthop J 2017; 37: 101-108
    PubMedSuche in Google Scholar
  • 20 Prakash J, Seon J-K, Woo S-H, Jin C, Song EK. Comparison of radiological parameters between normal and patellar dislocation groups in Korean population: a rotational profile CT-based study. Knee Surg Relat Res 2016; 28 (04) 302-311
    CrossrefPubMedSuche in Google Scholar
  • 21 Kim Y-M, Joo Y-B. Patellofemoral osteoarthritis. Knee Surg Relat Res 2012; 24 (04) 193-200
    CrossrefPubMedSuche in Google Scholar
  • 22 Iseki Y, Takahashi T, Takeda H. et al. Defining the load bearing axis of the lower extremity obtained from anterior-posterior digital radiographs of the whole limb in stance. Osteoarthritis Cartilage 2009; 17 (05) 586-591
    CrossrefPubMedSuche in Google Scholar
  • 23 Collins NJ, Misra D, Felson DT, Crossley KM, Roos EM. Measures of knee function: International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS), Knee Outcome Survey Activities of Daily Living Scale (KOS-ADL), Lysholm Knee Scoring Scale, Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Activity Rating Scale (ARS), and Tegner Activity Score (TAS). Arthritis Care Res (Hoboken) 2011; 63 (Suppl. 11) S208-S228
    Suche in Google Scholar
  • 24 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
    CrossrefPubMedSuche in Google Scholar
  • 25 Arendt EA, Fithian DC, Cohen E. Current concepts of lateral patella dislocation. Clin Sports Med 2002; 21 (03) 499-519
    CrossrefPubMedSuche in Google Scholar
  • 26 Balcarek P, Jung K, Ammon J. et al. Anatomy of lateral patellar instability: trochlear dysplasia and tibial tubercle-trochlear groove distance is more pronounced in women who dislocate the patella. Am J Sports Med 2010; 38 (11) 2320-2327
    CrossrefPubMedSuche in Google Scholar
  • 27 Balcarek P, Jung K, Frosch KH, Stürmer KM. Value of the tibial tuberosity-trochlear groove distance in patellar instability in the young athlete. Am J Sports Med 2011; 39 (08) 1756-1761
    CrossrefPubMedSuche in Google Scholar
  • 28 Lippacher S, Dreyhaupt J, Williams SR, Reichel H, Nelitz M. Reconstruction of the medial patellofemoral ligament: clinical outcomes and return to sports. Am J Sports Med 2014; 42 (07) 1661-1668
    CrossrefPubMedSuche in Google Scholar
  • 29 Buckens CF, Saris DB. Reconstruction of the medial patellofemoral ligament for treatment of patellofemoral instability: a systematic review. Am J Sports Med 2010; 38 (01) 181-188
    CrossrefPubMedSuche in Google Scholar
  • 30 Prakash J, Seon J-K, Woo S-H, Jin C, Song EK. Comparison of radiological parameters between normal and patellar dislocation groups in Korean population: a rotational profile CT-based study. Knee Surg Relat Res 2016; 28 (04) 302-311
    CrossrefPubMedSuche in Google Scholar