An anatomical study of the origin, structure and insertion of the medial patellofemoral ligament

Li, C.-H.; Ricketts, David; Wang, X.-S.; Yu, Tengbo; Qi, Chaorong; Zhu, Yong

doi:10.5603/fm.a2018.0028

Cited by 3 publications

(3 citation statements)

References 21 publications

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“…Indeed, in recent systematic reviews, failure rates vary from 1.2% to 6.6%. 14,21 Our failure rate appears to be higher than that in the Schneider et al 26 systematic review, which may be due to longer follow-up. 17 In the algorithmic approach to the treatment of recurrent lateral patellar dislocation, trochleoplasty is recommended in cases of severe trochlear dysplasia (ie, type B or D according to the Dejour classification).…”

Section: Discussioncontrasting

confidence: 55%

“…The graft was passed between the deep fascia and the capsule of the knee joint and out through a 2-cm longitudinal incision over the medial epicondyle. The 2 ends of the graft were secured into a 6-mm tunnel approximately 3 cm long, sited between the adductor tubercle and the proximal part of the superficial medial collateral ligament, 14 and guided by a transfemoral pin. The position of the femoral tunnel was verified with fluoroscopy.…”

Section: Surgical Proceduresmentioning

confidence: 99%

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Clinical Outcomes and Predictive Factors for Failure With Isolated MPFL Reconstruction for Recurrent Patellar Instability: A Series of 211 Reconstructions With a Minimum Follow-up of 3 Years

et al. 2019

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Background: Reconstruction of the medial patellofemoral ligament (MPFL) is widely acknowledged as an integral part of the current therapeutic armamentarium for recurrent patellar instability. The procedure is often performed with concomitant bony procedures, such as distalization of the tibial tuberosity or trochleoplasty in the case of patella alta or high-grade trochlear dysplasia, respectively. At the present time, few studies have evaluated the clinical effectiveness of MPFL reconstruction as an isolated intervention. Purpose: To report the clinical outcomes of isolated MPFL reconstruction in cases of patellar instability and to identify predictive factors for failure. Study Design: Case series; Level of evidence, 4. Methods: A retrospective analysis of prospectively collected data was performed, including all patients who had undergone isolated MPFL reconstruction between January 2008 and January 2014. Preoperative assessment included the Kujala score, assessment of patellar tracking (“J-sign”), and radiographic features, such as trochlear dysplasia according to Dejour classification, patellar height with the Caton-Deschamps index (CDI), tibial tubercle–trochlear groove distance, and patellar tilt. The Kujala score was assessed postoperatively. Failure was defined by a postoperative patellar dislocation or surgical revision for recurrent patellar instability. Results: A total of 239 MPFL reconstructions were included; 28 patients (11.7%) were uncontactable and considered lost to follow-up. Thus, 211 reconstructions were analyzed with a mean follow-up of 5.8 years (range, 3-9.3 years). The mean age at surgery was 20.6 years (range, 12-48 years), and 55% of patients were male. Twenty-seven percent of patients had a preoperative positive J-sign, and 93% of patients had trochlear dysplasia (A, 47%; B, 25%; C, 15%; D, 6%). The mean CDI was 1.2 (range, 1.0-1.7); mean tibial tubercle–trochlear groove distance, 15 mm (range, 5-30 mm); and mean patellar tilt, 23° (range, 9°-47°). The mean Kujala score improved from 56.1 preoperatively to 88.8 ( P < .001). Ten failures were reported that required surgical revision for recurrent patellar instability (4.7%). Uni- and multivariate analyses highlighted 2 preoperative risk factors for failure: patella alta (CDI ≥1.3; odds ratio, 4.9; P = .02) and preoperative positive J-sign (odds ratio, 3.9; P = .04). Conclusion: In cases of recurrent patellar instability, isolated MPFL reconstruction would appear to be a safe and efficient surgical procedure with a low failure rate. Preoperative failure risk factors identified in this study were patella alta with a CDI ≥1.3 and a preoperative positive J-sign.

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Section: Discussioncontrasting

confidence: 55%

Section: Surgical Proceduresmentioning

confidence: 99%

Clinical Outcomes and Predictive Factors for Failure With Isolated MPFL Reconstruction for Recurrent Patellar Instability: A Series of 211 Reconstructions With a Minimum Follow-up of 3 Years

et al. 2019

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“…Improved understanding of patellofemoral instability has led to the development of various different techniques of MPFL reconstruction as either an isolated or combined procedure [2, 20]. Recent anatomical and biomechanical studies have highlighted the complexity of the patellofemoral joint and the medial stabilisers of the patella [14, 16, 19]. Decision‐making with regard to treatment is dependent upon a thorough review of symptomatology, physical examination and assessment of associated osteochondral and soft‐tissue factors.…”

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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Editorial Commentary: Medial Patellofemoral Complex: Driving a Better Understanding of Medial Knee Anatomy

Sobhy¹

2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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An anatomical study of the origin, structure and insertion of the medial patellofemoral ligament

Abstract: Background: Repair and reconstruction of the medial patellofemoral ligament (MPFL) has

Cited by 3 publications

References 21 publications

Clinical Outcomes and Predictive Factors for Failure With Isolated MPFL Reconstruction for Recurrent Patellar Instability: A Series of 211 Reconstructions With a Minimum Follow-up of 3 Years

Clinical Outcomes and Predictive Factors for Failure With Isolated MPFL Reconstruction for Recurrent Patellar Instability: A Series of 211 Reconstructions With a Minimum Follow-up of 3 Years

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

Editorial Commentary: Medial Patellofemoral Complex: Driving a Better Understanding of Medial Knee Anatomy

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