Isolated Medial Patellofemoral Ligament Reconstruction with Semitendinosus Tendon Allograft

Ridley, Taylor J.; Macalena, Jeffrey A.; Arendt, Elizabeth A.

doi:10.2106/jbjs.st.17.00033

Cited by 5 publications

(5 citation statements)

References 8 publications

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“…Trochlear dysplasia, torsional deformity, patella height and patellofemoral arthritis need to be considered before proceeding to isolated MPFL reconstruction [8, 20, 23]. A wide variety of techniques have been described with numerous graft sources and graft fixation type, with anatomic double‐bundle reconstruction using hamstring autograft with aperture fixation, becoming a popular technique recently [3, 4, 7, 18, 20, 22, 27, 28, 31, 32, 35]. Good‐to‐excellent clinical results, associated with low redislocation rates, have been reported after isolated MPFL reconstruction [11, 13, 21, 25, 29, 35].…”

Section: Introductionmentioning

confidence: 99%

Isolated medial patellofemoral ligament reconstruction significantly improved quality of life in patients with recurrent patella dislocation

Bouras

Edmond

Brown

et al. 2019

Knee Surg Sports Traumatol Arthrosc

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Purpose The purpose of this study was to measure the improvement in quality of life (QoL) following isolated anatomical double-bundle medial patellofemoral ligament reconstruction. Methods This is a single-centre, prospective study of 56 consecutive patients (57 knees) who underwent isolated MPFL reconstruction between 2014 and 2017. Functional outcome and QoL were assessed with the Kujala score and the EQ-5D-3L questionnaire, respectively. Objective outcomes were obtained through clinical examination at the latest follow-up assessing redislocation rate, patella apprehension test, patellar tilt, pain and range of motion. ResultsThe median Kujala score increased from 60 (range 31-96) to 92 (range 34-100) at latest follow-up (p < 0.001). The median EQ-5D index also increased, from 0.69 (range 0.10-1) at baseline to 1 (range 0.16-1) at latest follow-up (p < 0.001), as well as the median EQ-5D VAS from 75 (range 20-95) to 92 (range 40-100) (p < 0.001). Four dimensions of the EQ-5D were signiicantly improved except for the anxiety/depression scores. Female patients reported lower scores at baseline and at latest follow-up, for all three outcomes (Kujala, EQ-5D index, EQ-5D VAS), however there was no evidence that gender negatively impacted on the beneit of surgery. The re-dislocation rate was 0%. Apprehension and patellar tilt test were negative in all patients and no lexion deicit was identiied at latest follow-up. Two patients had tenderness along the reconstruction requiring femoral screw removal in one of them. Conclusions Isolated anatomical double-bundle aperture MPFL reconstruction, ofered signiicantly improved short-term QoL along with excellent functional outcome. Female patients scored lower, but this did not afect the overall outcome. Including QoL tools in the assessment of ligament reconstruction operations, such as the MPFL, can provide more accurate understanding of the overall patient beneit. Level of evidence II.

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Section: Introductionmentioning

confidence: 99%

Isolated medial patellofemoral ligament reconstruction significantly improved quality of life in patients with recurrent patella dislocation

Bouras

Edmond

Brown

et al. 2019

Knee Surg Sports Traumatol Arthrosc

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“…An anteromedial approach was used to harvest semitendinosus autografts which was used for femoral testing. This has previously been described for MPFLr with satisfactory results [12,27]. Once the tendons had been fixed and the bone fully prepared, specimens were stored at À20 °C and thawed at room temperature for 24 h prior to testing.…”

Section: Specimen Preparationmentioning

confidence: 99%

What is the best fixation method in medial patellofemoral ligament reconstruction? A biomechanical comparison of common methods for femoral graft attachment

Vezole,

Gunst,

Gras

et al. 2024

SICOT-J

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Introduction: A variety of techniques have been described for femoral fixation in medial patellofemoral ligament reconstruction (MPFLr). The aim of this study was to compare the biomechanical performance of the most used methods for graft fixation in the femur using human cadaveric tissue. We wondered what is the best fixation method for femoral fixation in MPFL reconstruction? Hypothesis: A suspensory fixation device provides the best femoral fixation. Material and method: Twenty cadaveric knees were tested. Four femoral fixation methods were compared (5 knees per group): interference fixation with a Biosure© RG 5 mm and a 7 mm, suture anchor (Healicoil Regenesorb 4.75 mm ©) and suspensory fixation with the Ultrabutton©. The testing was divided in preconditioning, cyclic loading and load to failure. Load to failure, elongation, stiffness and mode of failure were recorded and compared. Results: The Ultrabutton© had the highest mean ultimate load (427 ± 215 N (p = 0.5)), followed by Healicoil anchor © (308 ± 44 N (p > 0.05)) and the interference screw of 7 mm (255 ± 170 N (p > 0.05)). Mean stiffness was similar in the Ultrabutton© and 4.75 mm. Healicoil anchor © groups (111 ± 21 N/mm and 119 ± 20 N/mm respectively), and lowest in 7 mm Biosure© screw fixation group (90 ± 5 N/mm). The Biosure© 5 mm RG screw presented 100% of premature rupture because of tendon slippage. The Ultrabutton© presented the lowest premature rupture (40%). Discussion: A suspensory fixation for the femur had the lowest number of graft failures and highest load to failure. This study has implications for surgeons’ choice of graft fixation in MPFLr. It is the first study to test the most commonly femoral used fixation methods, allowing direct comparisons between each method.

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“…25,31,32 Graft placement on the patella has been consistent, with many groups recommending a broad attachment along the medial border of the patella. 33,34 Avoiding large patellar drill tunnels can reduce the risk of patella fracture. 35 There appear to many good graft choices, including autograft quadriceps and hamstring, as well as allograft choices.…”

Section: Unique Anatomic Considerations For Mpfl Reconstruction In Sk...mentioning

confidence: 99%

Recurrent Pediatric Patellofemoral Instability-Beyond the MPFL

Lin

Mackie

Aitchison

et al. 2020

Journal of the Pediatric Orthopaedic Society of North America

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Pediatric patellofemoral instability is an increasingly common and debilitating problem. In recent years, there has been an improvement in diagnostic capabilities and greater knowledge of unique pediatric patellofemoral anatomy and pathophysiology. The spectrum of disease varies from a single traumatic dislocation, to recurrent dislocation, to obligatory dislocation in flexion or even fixed dislocation in severe or syndrome-associated cases. When treating pediatric patellofemoral instability, it is important to understand the benefits and limitations of nonoperative management. It is important to recognize the challenges imparted by the anatomy of the skeletally immature knee, specifically with regards to the physis, when considering surgical treatment. One must have a thorough understanding of common anatomic and pathophysiologic contributors to patellofemoral instability, such as coronal or axial plane malalignment, and concomitant osteochondral injury. For the very severe cases such as obligatory dislocation in flexion, special techniques may be required to achieve stability of the patellofemoral joint.

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Isolated Medial Patellofemoral Ligament Reconstruction with Semitendinosus Tendon Allograft

Cited by 5 publications

References 8 publications

Isolated medial patellofemoral ligament reconstruction significantly improved quality of life in patients with recurrent patella dislocation

Isolated medial patellofemoral ligament reconstruction significantly improved quality of life in patients with recurrent patella dislocation

What is the best fixation method in medial patellofemoral ligament reconstruction? A biomechanical comparison of common methods for femoral graft attachment

Recurrent Pediatric Patellofemoral Instability-Beyond the MPFL

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