Double-Tunnel Technique Was Similar to Single-Tunnel Technique in Clinical, Imaging and Functional Outcomes for Medial Patellofemoral Ligament Reconstruction: A Randomized Clinical Trial

Qiao, Yi; Xu, Junjie; Ye, Zipeng; Chen, Jiebo; Zhang, Xiuyuan; Zhao, Song; Xu, Caiqi; Zhao, Jinzhong

doi:10.1016/j.arthro.2022.04.019

Cited by 8 publications

(16 citation statements)

References 59 publications

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“…PLSR was defined as the ratio of the patellar lateral shift distance to the width of the patella. 48 PLSR was reported in 3 studies, 37,46,60 with 86 cases in the SL graft group and 98 cases in the DL graft group. Data processing yielded a reduction of 10.68% ± 6.08% in the SL graft group and 12.24% ± 7.79% in the DL graft group, with a statistically significant difference detected (WMD, 2.12; 95% CI, 0.38-3.86; I 2 = 0%; P = .02) (Figure 4A).…”

Section: Resultsmentioning

confidence: 97%

“…Postoperative instability was defined as multiple episodes (>2 times) of instability symptoms regardless of the occurrence of redislocation. Four studies 30,39,46,60 reported postoperative instability, the result of which was 10 of 228 (4.4%) in the SL graft group and 0 of 240 (0%) in the DL graft group (OR, 7.31; 95% CI, 1.62-32.93; I 2 = 0%; P = .01) (Figure 3A). Among the 10 patients who experienced symptomatic instability, patellar redislocation occurred in 6, while the other 4 had multiple episodes of instability symptoms without the need for a reduction maneuver.…”

Section: Resultsmentioning

confidence: 99%

“…The patellar tilt angle was reported in 4 studies, 10,30,46,60 with 157 cases in the SL graft group and 171 cases in the DL graft group. Analysis of preoperative data showed no significant difference between the groups ( P = .68).…”

Section: Resultsmentioning

confidence: 99%

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Double-Limb Graft Versus Single-Limb Graft Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Dislocation: A Meta-analysis of Randomized Controlled Trials and Cohort Studies

Pang

Mou

et al. 2022

Am J Sports Med

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Background: The medial patellofemoral ligament (MPFL) is the most important stabilizer of lateral dislocation of the patella. Single-limb (SL) and double-limb (DL) graft MPFL reconstructions have been increasingly used to treat recurrent patellar dislocations, but the clinical efficacy of SL versus DL graft MPFL reconstructions remains controversial owing to the inconsistent conclusions of previous studies. Purpose: This study aimed to compare the clinical outcomes of SL and DL graft MPFL reconstructions for patients with recurrent patellar dislocation by conducting a meta-analysis of randomized controlled trials and cohort studies. Study Design: Meta-analysis; Level of evidence, 3. Methods: PubMed, Embase, Web of Science, and the Cochrane Library were searched for relevant studies. The retrieval time was up to July 25, 2022. Two evaluators independently screened the literature, extracted data, and assessed the methodological quality of the enrolled studies. Meta-analysis was conducted using RevMan 5.4 software. Results: A total of 4 randomized controlled trials and 3 cohort studies with 451 patients were included. The joint stability and functional scores in both groups improved significantly from baseline. When compared with SL graft reconstruction, DL graft reconstruction provided reduced recurrent instability ( P = .01), anterior patella–related pain ( P = .02), and patellar lateral shift rate ( P = .02). Regarding functional recovery, patients undergoing DL graft reconstruction presented better scores on the Kujala ( P < .001), Tegner ( P = .009), and International Knee Documentation Committee (IKDC) ( P < .001) but similar Lysholm scores as compared with SL graft reconstruction. No statistically significant difference was found between the techniques in the reduction of the patellar tilt angle, complications other than anterior patella–related pain, or postoperative pain. Conclusion: When compared with SL graft MPFL reconstruction, DL graft MPFL reconstruction yielded better outcomes in terms of postoperative recurrent instability, anterior patella–related pain, patellar lateral shift rate, Kujala score, Tegner score, and IKDC score. The amount of high-quality evidence is insufficient, so this conclusion should be interpreted with caution.

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Section: Resultsmentioning

confidence: 97%

Section: Resultsmentioning

confidence: 99%

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Double-Limb Graft Versus Single-Limb Graft Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Dislocation: A Meta-analysis of Randomized Controlled Trials and Cohort Studies

Pang

Mou

et al. 2022

Am J Sports Med

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“…The surgical procedure was similar to that described in previous studies. 36,43 In brief, a peroneus longus tendon autograft was used for MPFLR. The patellar tunnel was drilled from the medial edge of the patella to the midline of the anterior surface of the patella, at the level of the maximal width (Figure 2A).…”

Section: Methodsmentioning

confidence: 99%

“…The indication for concomitant tibial tubercle transfer was TT-TG distance >15 mm. 36,51 The technique of tibial tubercle transfer 36,51 is a modification of the Fulkerson osteotomy (Figure 2B). In brief, TT osteotomy was performed along a plane from the medial edge of the TT and the posterolateral ridge of the proximal tibia.…”

Section: Methodsmentioning

confidence: 99%

Effect of Lower Extremity Torsion on Clinical Outcomes After Medial Patellofemoral Ligament Reconstruction and Tibial Tubercle Transfer for Recurrent Patellofemoral Instability

Qiao

Zhang

et al. 2023

Am J Sports Med

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Background: Increased femoral torsion (FT) or tibial torsion (TT) has been suggested to be a potential risk factor for recurrent patellofemoral instability. However, the influence of increased FT or TT on the postoperative clinical outcomes of recurrent patellofemoral instability has rarely been investigated. Purpose: To assess the effect of increased FT or TT on postoperative results in patients with recurrent patellofemoral instability after combined medial patellofemoral ligament reconstruction (MPFLR) and tibial tubercle transfer, along with the influence of other risk factors. Study Design: Cohort study; Level of evidence, 3. Methods: Out of 91 patients, the study’s analyses included 86 patients with recurrent patellofemoral instability who were treated with MPFLR and tibial tubercle transfer and enrolled between April 2020 and January 2021. FT and TT were assessed using preoperative computed tomography images. According to the torsion value of FT or TT, patients were categorized into 3 groups for each of FT and TT: group A (<20°), group B (20°-30°), and group C (>30°). Patellar height, femoral trochlear dysplasia, and the tibial tuberosity–trochlear groove (TT-TG) distance were also assessed. Patient-reported outcome scores (Tegner, Kujala, International Knee Documentation Committee [IKDC], Lysholm, and Knee injury and Osteoarthritis Outcome Score [KOOS]) were evaluated pre- and postoperatively. Clinical failure of MPFLR was recorded. Subgroup analysis was conducted to evaluate the effect of increased FT or TT on the postoperative outcomes. Results: A total of 86 patients were enrolled with a median follow-up time of 25 months. At the final follow-up, all functional scores improved significantly. Patella alta, high-grade trochlear dysplasia, and increased TT-TG distance did not have any significant effect on the postoperative functional scores. Regarding FT, subgroup analysis indicated that all functional scores of group C were lower than those of groups A and B except the KOOS knee-related Quality of Life score. For TT, group C had lower scores than group A for all functional outcomes except Tegner and KOOS Quality of Life and lower scores than group B for Kujala, IKDC, KOOS (Symptoms and Sport and Recreation subscales), Tegner, and Lysholm scores. The comparison between group A and group B, whether for FT or TT, revealed no significant differences. Conclusion: For patients with recurrent patellofemoral instability, increased lower extremity torsion (FT or TT >30°) was associated with inferior postoperative clinical outcomes after combined MPFLR and tibial tubercle transfer.

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Three different patellar fixation techniques yield similar clinical and radiological outcomes in recurrent patellar dislocation undergoing medial patellofemoral ligament reconstruction

Huo,

Niu,

Kang

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThe purpose of this study was to evaluate and compare the clinical and radiological outcomes of three different patellar fixation techniques on medial patellofemoral ligament reconstruction (MPFLR) in the treatment of patellar dislocation (PD).MethodsBetween 2015 and 2020, 130 patients with recurrent PD who underwent surgical reconstruction were eligible for this retrospective study: 48 patients were treated with the semi‐tunnel bone bridge fixation technique (Group A), 42 patients were treated with the suture anchor fixation technique (Group B) and 40 patients were treated with the transpatellar tunnel fixation technique (Group C). Clinical outcomes included functional outcomes (Kujala, Lysholm and International Knee Documentation Committee scores), activity levels (Tegner activity score and return to sports), physical examinations, patellar re‐dislocation rate and complications. Radiological outcomes included patellar congruence angle, patellar tilt angle, lateral patellar translation and lateral patellar angle.ResultsAll clinical and radiological outcomes improved significantly in all groups, without any significant difference among these three groups. At the final follow‐up, no re‐dislocation occurred, and all groups achieved a successful return to sports. However, the semi‐tunnel bone bridge and suture anchor fixation techniques showed statistically higher Tegner activity scores (p = 0.004) and shorter time from surgery to return to sports (p = 0.007) than the transpatellar tunnel fixation technique.ConclusionThe three MPFLR patellar fixation techniques achieved favourable and comparable clinical and radiological outcomes in the treatment of PD. Compared with the transpatellar tunnel fixation technique, the semi‐tunnel bone bridge and suture anchor fixation techniques may be more effective with higher activity levels.Level of EvidenceLevel III.

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Double-Tunnel Technique Was Similar to Single-Tunnel Technique in Clinical, Imaging and Functional Outcomes for Medial Patellofemoral Ligament Reconstruction: A Randomized Clinical Trial

Cited by 8 publications

References 59 publications

Double-Limb Graft Versus Single-Limb Graft Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Dislocation: A Meta-analysis of Randomized Controlled Trials and Cohort Studies

Double-Limb Graft Versus Single-Limb Graft Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Dislocation: A Meta-analysis of Randomized Controlled Trials and Cohort Studies

Effect of Lower Extremity Torsion on Clinical Outcomes After Medial Patellofemoral Ligament Reconstruction and Tibial Tubercle Transfer for Recurrent Patellofemoral Instability

Three different patellar fixation techniques yield similar clinical and radiological outcomes in recurrent patellar dislocation undergoing medial patellofemoral ligament reconstruction

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