Complications of medial patellofemoral ligament reconstruction using two transverse patellar tunnels

Schiphouwer, Loes; Rood, Akkie; Tigchelaar, Siebren; Koëter, Sander

doi:10.1007/s00167-016-4245-4

Cited by 66 publications

(83 citation statements)

References 32 publications

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“…bundle MPFL reconstruction has been used for the treatment of recurrent patella dislocation. [5][6][7][8][9][10][11][12][13][14][15][16] The methods vary with patellar fixation and each method has its advantages and disadvantages. For patellar tunnel fixation, graft was passed through the patellar tunnels and the free ends of the graft were fixed in the femoral tunnel.…”

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confidence: 99%

“…6,9,11,13,15 Postoperative patella fractures were frequently reported due to significant bone loss or poor tunnel position. 9,11 In case series of 179 patients (192 knees) that had an MPFL reconstruction using two transverse patellar tunnels, seven patients (3.6%) sustained a patellar fracture without adequate trauma. 9 For suture anchor fixation, reconstruction was performed using a graft fixed with two suture anchors at the medial patellar edge.…”

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confidence: 99%

“…9,11 In case series of 179 patients (192 knees) that had an MPFL reconstruction using two transverse patellar tunnels, seven patients (3.6%) sustained a patellar fracture without adequate trauma. 9 For suture anchor fixation, reconstruction was performed using a graft fixed with two suture anchors at the medial patellar edge. 5,14,16 The lack of tendon-bone healing and risk for patella fracture should be taken into consideration.…”

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confidence: 99%

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Anatomical Medial Patellofemoral Ligament Reconstruction for Recurrent Patella Dislocation: Two-Strand Grafts versus Four-Strand Grafts

Niu

Lin

et al. 2019

J Knee Surg

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The purpose of this study was to describe two anatomical medial patellofemoral ligament (MPFL) reconstruction methods: reconstruction with two-strand grafts and reconstruction with four-strand grafts and to evaluate the clinical and radiological results. From January 2010 to January 2013, patients who sustained recurrent patella dislocation and met inclusion criteria were included in the study and divided into two groups randomly to undergo MPFL reconstruction either by two-strand grafts (T group) or four-strand grafts (F group). Patients were followed up 1 month, 1 year, 2 years, and 3 years postoperatively. The apprehension test was applied to test patella stability. The Kujala score, Lysholm score, and Crosby–Insall grading were used to evaluate the function of the affected knee. The patellar congruence and patellar tilt angle were used to measure the morphology of the patellofemoral joint. In addition, patients' subjective assessments and complications were recorded. Thirty-eight patients in T group and 38 patients in F group were followed for at least 36 months. The apprehension test was positive in all patients preoperatively but was negative at follow-up. The Kujala score, Lysholm score, patellar congruence angle, and the patellar tilt angle of patients in both groups improved significantly at 36-month follow-up when compared with those assessed preoperatively. However, patients in the F group achieved better clinical results in terms of Kujala score, patellar congruence angle, patellar tilt angle, and Crosby–Insall grading when compared with those in the T group 3 years after the operation. Most patients (92% of patients in the T group and 97% of patients in the F group) were satisfied with the surgery. The anatomical MPFL reconstruction with two-strand grafts or four-strand grafts were both safe techniques for recurrent patella dislocation with satisfactory clinical outcomes. The anatomical fixation with four-strand grafts achieved better clinical and radiographic results in the follow-up, which may be a better reconstruction method.

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Anatomical Medial Patellofemoral Ligament Reconstruction for Recurrent Patella Dislocation: Two-Strand Grafts versus Four-Strand Grafts

Niu

Lin

et al. 2019

J Knee Surg

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“…Several studies report an incidence varying between 0.9 and 3.6%. 16,29,30 The fractures mostly occurred within the 1st year after index surgery. These fractures were mainly connected to techniques using transpatellar tunnels for fixation.…”

Section: Discussionmentioning

confidence: 99%

“…These fractures were mainly connected to techniques using transpatellar tunnels for fixation. [29][30][31] However, they were also described after using suture anchors. 17,32 The two observed cases of an intraoperatively insufficient patellar tunnel resulted from an incorrect positioning of the aiming device with soft tissue interposed between the device and patella, resulting in a smaller cortical bridge.…”

Section: Discussionmentioning

confidence: 99%

Midterm Results after Implant-Free Patellar Fixation Technique for Medial Patellofemoral Ligament Reconstruction

Mayer¹,

Schuster

Schlumberger³

et al. 2019

J Knee Surg

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Problems and complications concerning the patellar fixation in medial patellofemoral ligament reconstruction (MPFLR) have been reported. The purpose of this retrospective study was to systematically analyze the surgical technique for MPFLR with a V-shaped patellar bonetunnel for implant-free fixation of an autologous gracilis tendon, allowing early functional rehabilitation, regarding restoration of the patellofemoral stability, patient satisfaction, return to sports, and technique-specific complications. In 2010, 128 cases of consecutive isolated MPFLR were performed. All these cases were included. After a minimum follow-up of 3 years, 104 cases were retrospectively analyzed (follow-up: 81.3%) with regard to redislocation, subjective functional outcome (Tegner's score and sports level compared with preoperative level), patient satisfaction, revision surgery, and technique-specific complications. After a follow-up of 45.7 ± 3.2 months, 101 of 104 cases (97.1%) showed no redislocation. Mean Tegner's score was 5.1 ± 1.8 (range, 2–9). A total of 61.5% patients reported about a higher sports level compared with their preoperative level. The patient satisfaction was high with 94.2%. In two cases (1.9%), technique-specific problems occurred as the bone bridge of the V-shaped tunnel was insufficient due to a malpositioning of the aiming device. No further technique-specific problems occurred and no revision surgery was necessary during the observational period. The presented surgical technique is safe and it reliably restores the patellofemoral stability, with a low rate of redislocations, an excellent subjective functional outcome, and a high-patient-reported satisfaction. No major technique-specific complications occurred.

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Patellofemoral Instability Surgery Complications: How to Avoid Them

Laidlaw¹,

Diduch²,

Werner³

2018

Patellofemoral Pain and Instability

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Complications of medial patellofemoral ligament reconstruction using two transverse patellar tunnels

Abstract: IV.

Cited by 66 publications

References 32 publications

Anatomical Medial Patellofemoral Ligament Reconstruction for Recurrent Patella Dislocation: Two-Strand Grafts versus Four-Strand Grafts

Anatomical Medial Patellofemoral Ligament Reconstruction for Recurrent Patella Dislocation: Two-Strand Grafts versus Four-Strand Grafts

Midterm Results after Implant-Free Patellar Fixation Technique for Medial Patellofemoral Ligament Reconstruction

Patellofemoral Instability Surgery Complications: How to Avoid Them

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