A long-term follow-up study after medial patellofemoral ligament reconstruction using the transferred semitendinosus tendon for patellar dislocation

Abstract

The management of patellar dislocation syndrome has traditionally been difficult. There are no golden standard methods for patellar dislocations probably due to the many etiologies. However, it is known that medial patellofemoral ligament (MPFL) is damaged when the patella is dislocated. The purpose of this study is to examine whether our method of MPFL reconstruction is useful for the treatment of dislocated patellae and unstable patellae. Forty-six knees (43 patients) of 68 knees (65 patients) that were operated on using our surgical procedure for MPFL reconstruction with the advancement of the vastus medialis or the MPFL reconstruction with Insall's procedure were followed up for at least 5 years. The patient age ranged from 6 to 43 years. These knees consisted of six habitual dislocation patellae, twenty-six recurrent dislocation patellae, ten traumatic dislocation patellae, and four unstable patellae. The patients were evaluated pre-operatively and more than three times post-operatively at 6, 12, 36, 60, or 120 months. No patient experienced patellar dislocation after surgery. Their post-operative Kujala's scores were significantly improved. On conventional X-ray and on stress X-ray evaluations, the mean values for congruence angle, tilting angle, lateral shift ratio, medial stress shift ratio, and lateral stress shift ratio at the final follow-up (60 or 120 months) were demonstrated to be within the normal range. We conclude that our MPFL reconstruction method with the advancement of the vastus medialis or with Insall's procedure might be recommended for the treatment of habitual, recurrent, and indeed any other type of patellar dislocation, as well as for unstable patellae.

Patellofemoral Joint Instability: A Review of Current Concepts

“…In a recent meta-analysis, a total of 1,065 MPFL reconstructions were identified in 31 studies, and it was found that autograft reconstructions were associated with greater postoperative improvements in Kujala scores when compared to allograft, and that double-limbed reconstructions were associated with both improved postoperative Kujala scores and lower failure rate [58]. Overall, in the absence of significant malalignment, MPFL reconstructions appear to provide long-term functional improvement with improved Kujala scores, low rate of redislocation, and decreases in apprehension and patellofemoral pain [59,60,61,62,63,64]. However, the current literature on MPFL outcomes has substantial methodological limitations with small sample sizes and limited follow-ups [65].…”

Modern management of patellar instability

“…A systematic review of the literature demonstrates no one technique to be superior. Despite this reconstruction of the MPFL has demonstrated excellent clinical results across a number of series, with low levels of re-dislocations [64,[78][79][80][81]. MPFL reconstruction offers an appropriate treatment modality in a chronic situation.…”

The Outcomes of Modified Fulkerson Osteotomy Procedure to Treat Habitual Patellar Dislocation Associated with High-Grade Trochlear Dysplasia

“…There is still much controversy associated with aetiological factors, pathological changes and treatment, especially in the choice of surgical method [1]. There are many traditional treatments, including proximal and distal realignment and soft tissue procedures, which lead to a high rate of recurrence and an increased incidence of osteoarthritis in the patellofemoral joint postoperatively at long-term follow-up [2]. Trochlear dysplasia is one of the most consistent anatomic factors that can lead to habitual patellar dislocations.…”