An evaluation of the effectiveness of medial patellofemoral ligament reconstruction using an anatomical tunnel site

Abstract

PurposeMedial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability has gained popularity and anatomical and biomechanical studies have recently altered our operative techniques. The aim of this study was to report the clinical outcome of this new anatomical MPFL reconstructive technique and investigate whether correlating factors could be identified. MethodsBetween 2009 and 2012, a total of 31 consecutive patients underwent MPFL reconstruction using an autologous gracilis graft and anatomical tunnel placement.Pre-and post-operative data were collected as a part of routine clinical practice. The preoperative assessment included a rotational profile CT scan of the lower extremity according to the Lyon protocol with TT-TG distance measurement. Outcomes were evaluated with the Kujala and Norwich patella instability (NPI) scores preoperatively and at follow-up (1.5-5.1 years). ResultsA significant improvement of both the Kujala (p<0.001) and NPI (p=0.012) scores was recorded. A medium and large negative correlation were found between TT-TG distance and Kujala score improvement (rho=-0.48, p=0.020) and NPI score improvement (rho=-0.83, p=0.042), respectively. Multiple regression analysis identified TT-TG distance, Beighton score and BMI as factors explaining the variance of Kujala score improvement. ConclusionAnatomical MPFL reconstruction with the gracilis autograft for patellar instability resulted in good outcome. This underlines the importance of anatomical tunnel placement in MPFL reconstruction. With a precise preoperative work-up, factors can be identified that may guide selecting the optimal operative strategy and improve counseling of the patient.

Long-Term Clinical Results of Double Bundle Reconstruction of the Medial Patellofemoral Ligament for Patellar Instability

“…This seems to provide a higher stability during flexion, decreasing patellar rotation, unlike the techniques where only a single-point fixation is performed. [26][27][28][29] In the most recent research, the medial quadriceps tendon-femoral This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.…”

“…In this prospective study, 68 patients with patellar instability were evaluated before and after surgical treatment, which was performed from May 2005 to February 2010. They included 22 male and 46 female patients with a mean age of 21 years (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32) at first admission. Median duration of preoperative patellar instability was 12 months (range from 6 months to 3 years).…”

Return-to-Play Guidelines After Medial Patellofemoral Ligament Surgery for Recurrent Patellar Instability: A Systematic Review

“…The previous literature has described functional outcomes regarding the ability to complete daily tasks but has not assessed the return to preinjury levels of play. 53,66 Both the Kujala and Lysholm scores have been utilized to report outcomes and evaluate functional impairment after MPFL reconstruction. While both are extremely valuable objective criteria, neither of these scoring systems validates return to play in athletes.…”

Why Do Patellofemoral Stabilization Procedures Fail? Keys to Success

“…In patients with TT-TG distances up to 15 mm, MPFL reconstruction can restore patellofemoral kinematics and mechanics, However, for patients with TT-TG distance more than 20 mm, isolated MPFL reconstruction is less likely to correct the problem and a tibial tubercle osteotomy (TTO) may be indicated (14). In fact, patients with lower TT-TG have been shown to have better outcomes in terms of Kujala score compared to those with higher TT-TG following MPFL reconstruction using an anatomic femoral tunnel site (15).…”