Aperture fixation instead of transverse tunnels at the patella for medial patellofemoral ligament reconstruction

Hapa, Onur; Akşahin, Ertuğrul; Özden, Raif; Pepe, Murad; Yanat, Ahmet Nedim; Doğramacı, Yunus; Bozdağ, Ergün; Sünbüloğlu, Emin

doi:10.1007/s00167-011-1582-1

Cited by 53 publications

(62 citation statements)

References 23 publications

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“…While some studies have observed increased rates of postoperative patellar fracture after the use of bone tunnels for graft fixation, there has been a trend toward techniques that avoid utilization of tunnels. 15,35 Finally, our analysis also found that postoperative infections requiring surgical intervention are a rare (1.2%) complication after patellar instability surgery, which is consistent with previous studies. 33,38,49 …”

Section: Discussionsupporting

confidence: 92%

Operative Management of Patellar Instability in the United States

Arshi

Cohen

Wang

et al. 2016

Orthopaedic Journal of Sports Medicine

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Background:Treatment of patellofemoral instability has evolved as our understanding of the relevant pathoanatomy has improved. In light of these developments, current practice patterns and management trends have likely changed to reflect these advancements; however, this has not been evaluated in a formal study.Purpose:To determine nationwide patient demographics, surgical trends, and postoperative complications associated with the operative management of patellar instability surgery.Study Design:Descriptive epidemiological study.Methods:A large private-payer database (PearlDiver) comprising patients covered by Humana and United Healthcare insurance policies was retrospectively reviewed using Current Procedural Terminology (CPT) codes to identify patients who underwent surgery for patellar instability. The study cohort was established by querying for patients billed under CPT codes 27420, 27422, or 27427 while satisfying the diagnostic requirement of patellar instability (International Classification of Diseases–9th Revision codes 718.36, 718.86, or 836.3). Patient demographics, surgical trends, concomitant procedures, and postoperative complications were determined.Results:A total of 6190 patients underwent surgical management for patellar instability. Adolescents (age range, 10-19 years) represented 51.5% of cases, and 59.6% were female. The number of patellar instability procedures increased annually over the study period in both the Humana (P = .004, R 2 = 0.76) and United Healthcare (P = .097, R 2 = 0.54) cohorts. The most common concomitant procedures were lateral retinacular release (43.7%), chondroplasty (31.1%), tibial tubercle osteotomy (13.1%), removal of loose bodies (10.5%), osteochondral grafting (9.5%), and microfracture surgery (9.5%). Manipulation under anesthesia was required in 4.6% of patients within 1 year. Patellar fracture within 1 year and infection within 30 days occurred in 2.1% and 1.2% of patients, respectively.Conclusion:Patellar instability surgery has increased over the past decade. This finding may be attributed to growing clinical evidence to support these procedures as well as increased surgeon familiarity and comfort with these specific techniques. We observed an unexpectedly high rate of concomitant lateral retinacular release. Overall, the rates of commonly recognized complications (stiffness, patellar fracture, and postoperative infection) were similar to those observed in smaller case series.

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Section: Discussionsupporting

confidence: 92%

Operative Management of Patellar Instability in the United States

Arshi

Cohen

Wang

et al. 2016

Orthopaedic Journal of Sports Medicine

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“…Even in the study of Hapa et al 17 there have been no differences between the two techniques. However, there was a MPFL lower stiffness in the suture anchor group with respect to the bone tunnel group.…”

Section: Discussionmentioning

confidence: 84%

Medial patello-femoral ligament (MPFL) reconstruction using suture anchors fixation: preliminary results

Calanna

Pulici

Carimati

et al. 2016

MLTJ

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SummaryPurpose: several surgical techniques have been described for the MPFL reconstruction, using many femoral and patellar fixation techniques and different grafts (autograft, allograft, synthetic). The goal of our study is to evaluate the safety and efficacy of MPFL reconstruction using Juggerknot™ (BIOMET, Warsaw, Indiana) suture anchors fixation with a clinical evaluation pre/post surgery of our patients with objective patellofemoral (PF) instability.

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“…With the double-over semitendinosus graft yielding a tensile strength of approximately 2300 N and a stiffness of approximately 470 N/mm [36], the limiting factor in the construct is clearly the fixation. The 3.5-mm metal anchor used in this technique was found to have a pull-out strength of 295 N in a porcine model [37], in comparison, the pull-out strength of interference screw fixation in the setting of MPFL reconstruction have yielded slightly inferior results, with through-tunnel fixation failing at 195 N and aperture fixation failing at between 126 and 241 N [35,38]. Second, patellar fractures, the most serious complication after double-bundled MPFL reconstruction, have been reported only in procedures with patellar-bone tunnel fixation [24,28,29,39], for bone tunnels may act as stress risers whereas suture anchor fixation, sparing of bone drilling, such complication may be minimised.…”

Section: Discussionmentioning

confidence: 92%

The double-pulley technique for anatomical double-bundled medial patellofemoral ligament reconstruction

Lin

Renn

2015

Injury

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Aperture fixation instead of transverse tunnels at the patella for medial patellofemoral ligament reconstruction

Abstract: Aperture fixation techniques, especially interference screw fixation, were as strong as the technique utilizing tunnels in the patella for MPFL reconstruction.

Cited by 53 publications

References 23 publications

Operative Management of Patellar Instability in the United States

Operative Management of Patellar Instability in the United States

Medial patello-femoral ligament (MPFL) reconstruction using suture anchors fixation: preliminary results

The double-pulley technique for anatomical double-bundled medial patellofemoral ligament reconstruction

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