BACKGROUND: When undertaking patellofemoral ligament reconstruction, there are various methods of getting the proper tension for the graft, and the choice of the finest method remains controversial.Previously, a digital tensiometer was used to simulate knee structure, and a tension of approximately 2 N was quantified to restore patellofemoral track[11], but it is unclear whether a tension of 2 N restores patellofemoral tracks during the operation. The purpose of this study was to verify the tension of the graft using a digital tensiometer for medial patellofemoral ligament reconstruction and to perform an mid-term follow-up.Methods: Thirty-nine patients with recurrent patellar dislocation were included in the study. Patellar instability and patellar tilt angle and Patellar congruence angle were confirmed preoperatively by computed tomography (CT) and X-ray, history of dislocation and patellar apprehension test. Knee function was assessed by preoperative and postoperative Lysholm and Kujala scoresResults: 39 knees (39 cases),including 22 female and 17 male individuals with an average age of 21.10±7.26 , were included.39 people have been followed up by telephone or face-to-face questionnaires and have been followed up for at least 24 months.Preoperative history of ≥2 patellar dislocation, none of which was treated surgically. Intraoperatively, all underwent isolated MPFL reconstruction and release of the Lateral retinacular. Mean Kujala and Lysholm scores were 91.28±4.90,and 90.67±5.15, respectively.Mean The patellar tilt angle (PTA) the patellar congruence angle (PCA)were 11.5±2.63,and 2.38±3.58, respectively.39 people did not undergo reoperation during the follow-up period.In general,36patients (36/39;92.31%) were absolutely painless when Completing daily activities at the last follow-up.CONCLUSION: We conclude that the graft tension required to restore a normal patellofemoral relationship in clinical practice is approximately 24N and that the use of 2N tension is too low. Reconstruction of the patellofemoral ligament using a tensiometer is a more accurate and reliable surgical procedure for the treatment of recurrent patellar dislocation. Level of Evidence: Level IV—case series.
During medial patellofemoral ligament (MPFL) reconstruction, fluoroscopic determination of the femoral tunnel point is the most common method. However, there is a decrease in tunnel position accuracy due to rotation of the femur during fluoroscopy, as well as the damage to the operator from multiple fluoroscopies, whereas the 3D-printed individualized navigation template is not affected by this factor. This study focuses on the accuracy and early clinical efficacy of 2 different ways to determine the femoral tunnel (Schöttle point) for double-bundle isometric MPFL reconstruction. This is a retrospective study, conducted between 2016 and 2019, in which 60 patients with recurrent patellar dislocation were divided into 2 groups: 30 with MPFL reconstruction at the Schöttle point determined by 3D-printed individualized navigation template (group A) and 30 with MPFL reconstruction at the Schöttle point determined by fluoroscopic guidance (group B). The changes in patella congruence angle and patella tilt angle before and after surgery were assessed using computed tomography scans of the knee, knee function was assessed using the Kujala knee score and the international knee documentation committee (IKDC) score, and the 2 approaches were compared for the intraoperative establishment of the femoral tunnel position at a distance from Schöttle point. At a minimum of 3 years follow-up, patella tilt angle and patella congruence angle returned to normal levels and were statistically different from the preoperative range, with no significant differences between the 2 groups at the same period, and Kujala and IKDC scores of knee function were significantly improved in both groups after surgery. The mean Kujala and IKDC scores were statistically different between groups A and B at 3 and 6 months postoperatively. No statistically significant differences were seen between the 2 groups at the final follow-up. Both femoral tunnel localization approaches for double-bundle isometric MPFL reconstruction resulted in good knee function. At no < 3 years of follow-up, the use of a 3D-printed individualized navigation template did result in more accurate isometric points and higher knee function scores in the early postoperative period.
Purpose The optimal method for achieving proper graft tension during patellofemoral ligament reconstruction is a topic of debate. In the past, a digital tensiometer was used to simulate the knee structure, and a tension of approximately 2N was identified as suitable for restoring the patellofemoral track. However, it is unclear whether this tension level is sufficient during the actual surgery. The objective of this study was to verify the efficacy of graft tension using a digital tensiometer for medial patellofemoral ligament (MPFL) reconstruction and to conduct a mid-term follow-up. Methods The study enrolled 39 patients who had experienced recurrent patellar dislocation. Preoperative computed tomography scans and X-rays confirmed patellar instability, patellar tilt angle patellar congruence angle and the history of dislocation and patellar apprehension test. Knee function was evaluated using preoperative and postoperative Lysholm and Kujala scores. Results The study included 39 knees, comprising 22 females and 17 males, with an average age of 21.10 ± 7.26. The patients were followed up for at least 24 months through telephone or face-to-face questionnaires. All patients had a preoperative history of ≥2 patellar dislocations, none of which were surgically treated. During surgery, all patients underwent isolated MPFL reconstruction and lateral retinacula release. The mean Kujala and Lysholm scores were 91.28 ± 4.90 and 90.67 ± 5.15, respectively. The mean PTA and PCA were 11.5 ± 2.63 and 2.38 ± 3.58, respectively. The study found that a tension of approximately 27.39 ± 5.57N (14.3–33.5N) was required to restore the patellofemoral track in patients with recurrent patellar dislocation. No patients required reoperation during the follow-up period. Overall, 36 out of 39 patients (92.31%) reported no pain when completing daily activities at the last follow-up. Conclusion In conclusion, a tension level of approximately 27.39 ± 5.57N is necessary to restore normal patellofemoral relationships during clinical practice, which indicates that using a tension of 2N is too low. The use of a tensiometer during patellofemoral ligament reconstruction is a more accurate and reliable surgical procedure for treating recurrent patellar dislocation.
Purpose: Medial patellofemoral ligament (MPFL) reconstruction combined with lateral retinacular release (LRR) has become a common treatment for recurrent patellar dislocation, but it has not been feasible to find a reliable and definitive figure to compare the change in soft tissue tension on both sides of the patella before and after LRR. The aim of this study was to verify the change in graft tension by means of a digital tensiometer. Methods: Fifty patients, aged 18-40 years, were included in this study, treated with MPFL reconstruction simplely and no other osteopathic surgery. After the graft had passed through the femoral tunnel, graft tension was measured by connecting a digital tensiometer, and the change in graft tension was analysed before and after LRR, together with pre- and post-operative knee function scores ( Lysholm score and kujala score) and radiographic angle (patellar congruence angle,PCA;PTA patellar tilt angle,PTA). RESULTS: All 50 patients (52 knees) underwent MPFL reconstruction combined with LRR, with statistically significant differences in graft tension from 35.61±4.25N to 24.00±4.23N before and after LRR as measured by a digital tensiometer, and Kujala score and Lysholm score from 51.40±14.39 to 92.23± 4.74 and from 48.17±9.52 to 91.88±5.07, respectively, and PCA and PTA from 16.51±5.97° to 2.34±3.37° and from 25.43±4.53° to 11.62±2.54°, respectively, with statistically significant differences.There were no significant post-operative complications, with the exception of three patients who experienced slight discomfort at the patellar end when the weather became colder.At a mean follow-up of 53 months, there were 7 (14%) complications and no postoperative redislocations were observed.94% of the patients were satisfied with the results of the operation. CONCLUSION: LRR is meaningful for patients with recurrent patellar dislocation and is effective in reducing tension on reconstruction grafts.
Objective:In order to treat and improve recurrent patellar dislocation (RPD), autologous partial peroneal long tendon (PLT) or autologous partial semitendinosus tendon (ST) were taken to reconstruct the medial patellofemoral ligament (MPFL) respectively. The postoperative effects of the two methods were compared.Method:Patients with RPD in the Department of orthopedics of the Sixth Affiliated Hospital of Xinjiang Medical University were selected, and underwent MPFL reconstruction from February 2018 to February 2021. There were 65 cases, including 20 male patients and 45 female patients. The grafts were autologous PLT or ST, including 32 cases in PLT group and 33 cases in ST group. The evaluation indexes include: postoperative complications: patellar fracture, patellar subluxation, knee pain, knee stiffness, lower limb skin paresthesia, patellar tilt angle, patellar concentration angle, Kujala score and kofoed score of ankle. The functional improvement and complications of patella and knee joint before and after operation were compared, and the curative effect of PLT and ST reconstruction of MPFL was analyzed.Results:The follow-up time was 12-15 months. There were 7 cases of knee pain and 5 cases of knee stiffness in PLT group and 5 cases of knee pain and 3 cases of knee stiffness in ST group. There was no significant difference in postoperative pain and stiffness between the two groups (P > 0.05). There were 18 cases of infrapatellar branch of saphenous nerve (IPBSN) injury in ST group, but no IPBSN injury was found in PLT group (P < 0.05). The IPBSN injury in ST group was positively correlated with the incision length of tendon extraction (P < 0.05). In the last follow-up, there was no significant difference in patellar tilt angle, patellar convergence angle and Kujala score between the two groups (P > 0.05). The kofoed score of ankle joint in both groups was excellent.Conclusions:Autologous PLT and ST reconstruction of MPFL can effectively treat RPD, significantly improve patellar tilt angle and patellar concentration angle, improve Kujala score, improve knee function and clinical symptoms. Both are effective ways to treat RPD, but ST group will lead to IPBSN injury and sensory impairment of anterolateral skin of lower leg.
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