Effective patellofemoral joint stabilization and low complication rates using a hardware-free MPFL reconstruction technique with an intra-operative adjustment of the graft tension

Engelhardt, Lars Victor von; Fuchs, Torsten; Weskamp, Pia; Jerosch, J.

doi:10.1007/s00167-017-4723-3

Cited by 15 publications

(12 citation statements)

References 45 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…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.…”

mentioning

confidence: 99%

“…For patellar tunnel fixation, graft was passed through the patellar tunnels and the free ends of the graft were fixed in the femoral tunnel. 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.…”

mentioning

confidence: 99%

See 1 more Smart Citation

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

Niu

Lin

et al. 2019

J Knee Surg

View full text Add to dashboard Cite

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.

show abstract

mentioning

confidence: 99%

mentioning

confidence: 99%

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

Niu

Lin

et al. 2019

J Knee Surg

View full text Add to dashboard Cite

show abstract

“…Considering that 30° of knee flexion seems to be recommended most frequently in the literature[ 8 , 26 , 28 ], we begin with a temporary graft fixation at 30° of flexion. Only after testing and balancing the tension is the graft permanently fastened[ 14 ]. Because our technique uses nearly the entire length of the gracilis tendon with a loop through the patella, this construct appears less rigid (Figure 1C ).…”

Section: Discussionmentioning

confidence: 99%

“…As a logical consequence, a MPFL plastic surgery seems advisable, not only to address a torn, insufficient ligament, but also because a balancing and alignment of the medial soft tissue restraints is necessary (Figure 1 ). Therefore, our technique of a MPFL reconstruction allowing a simple intra-operative testing and adjustment of the graft tension[ 14 ], might be convenient especially in cases with a combined trochleoplasty. This might help in minimizing common complications of MPFL reconstructions, such as an overtensioning with anterior knee pain and/or motion deficits, patellar fractures, etc .…”

Section: Introductionmentioning

confidence: 99%

Deepening trochleoplasty combined with balanced medial patellofemoral ligament reconstruction for an adequate graft tensioning

Engelhardt

Weskamp

Lahner

et al. 2017

WJO

Self Cite

View full text Add to dashboard Cite

AIMTo evaluate our modified deepening trochleoplasty combined with a balanced medial patellofemoral ligament (MPFL) reconstruction for soft tissue alignement.METHODSThirty-three knees with with recurrent patellar dislocations and a trochlear dysplasia in 30 patients (m/f = 12/21, mean age 24 ± 9 years) underwent a combination of a modified deepening trochleoplasty and a balanced MPFL reconstruction for a medial soft tissue alignement. After a mean follow-up period of 29 ± 23 mo, patients’ return to sports, possible complications as well as the clinical outcomes using the Kujala, International Knee Documentation Committee (IKDC) and Lysholm scoring were evaluated. Moreover, patients’ satisfaction with the general outcome, the cosmetic outcome, the pre- and postoperative pain and a potential avoidance behaviour were assessed with additional standardized questionnaires which also included different visual analog scales.RESULTSThere were no signs of a persistent instability. The Kujala score improved from a mean of 64 ± 16 points to 94 ± 9 points, the Lysholm score improved from a mean of 63 ± 17 to 95 ± 6 points and the IKDC score from 58 ± 11 to 85 ± 12 points, P < 0.0001, respectively. The assessment of pain using a visual analog scale showed a significant pain reduction from a mean of 4.8 ± 2.0 to 1.3 ± 3.4 points (P < 0.0001). Two of 26 cases (92%) who were engaged in regular physical activity before surgery did not return to full sporting activities. One patient felt that his sport was too risky for his knee and reported an ongoing avoidance behaviour. The other patient preferred to wait for surgery of her contralateral knee. Of the eight patients who were not engaged in sporting activities before surgery, three started regular sporting activities after surgery. In 31 of the 33 cases (94%), the patients were very satisfied with the clinical outcome of the surgery. Regarding the cosmetic results, no patients felt impaired in their self-confidence and in their clothing decisions.CONCLUSIONOur technique shows a good clinical outcome in terms of the common scorings as well as in terms of pain, return to sports and patient satisfaction.

show abstract

“…l. Von engelhardt с соавторами в 2017 г. опубликовали результаты еще одной методики двухпучковой реконструкции MpFl аутотрансплантатом из сухожилий подколенных сгибателей без использования фиксаторов [53]. Методика заключается в формировании двух V-образно сходящихся каналов в надколеннике, одного слепого туннеля в бедренной кости и выведением нитей, которыми прошиты концы сухожилия, через два отдельных дивиргентных тонких канала на латеральном мыщелке бедренной кости.…”

Section: статистический анализunclassified

Transpatellar Reconstruction of Medial Patellofemoral Ligament by Semitendinous Tendon Autograft

Korolev

Магнитская²,

Рязанцев³

et al. 2018

Traumatology and Orthopedics of Russia

View full text Add to dashboard Cite

Purpose of the study— to evaluate surgical treatment outcomes of the patients with chronical patella instabilitywho underwent double bundle transpatellar reconstruction of medial patella-femoral ligament (MPFL) by a semitendinous tendon autograft. Material and methods.26 patients with minimal 12 months follow up were included into the study. In all casessemitendinous tendon autograft was inserted through a vertical tunnel in the patella, formed in a loop, and fixed in femoral tunnel by a biodegradable screw. Preoperative MRIs were used to evaluate trochlear dysplasia type by D. Dejour classification, tibial tubercle to trochlear groove distance (TT-TG) and Insall-Salvati ratio. Postoperative x-rays were used to measure femoral tunnel angle (FTA), postoperative MRIs — to measure diameter of patella tunnel (d_Pat), distance from tunnel to medial border of patella (MPM) and diameter of tunnel in medial femoral condyle (d_Fem). Functional outcomes were evaluated by Kujala Score, Lysholm and IKDC, also the authors assessed the level of sports activity prior to and after the surgery. Results.Age median of the patients at the moment of procedure was 22 years. MRI data prior to surgery reportedthat the majority of patients suffered from B type of trochlear dysplasia, median TT-TG distance was 14.6 mm, median Insall-Salvati ratio was 1.1 mm. Postoperative x-rays and MRIs demonstrated median FTA of 18°, d_Pat median — 5.4 mm, MPM median — 7.0 mm, d_Fem median — 8.2 mm, no implant migrations were observed. Subjective assessment scores demonstrated excellent outcomes: Kujala Score — 96, IKDC — 87.4, Lysholm — 91. No secondary dislocations during follow up were reported, 48% of patients returned to sports on the pre-surgery or higher level, 52% of patients returned to sports with decreased activity. Conclusion.Transpatellar reconstruction of MPFL by semitendinous tendon autograft proved to be the efficienttreatment method of chronical patella instability.

show abstract

Effective patellofemoral joint stabilization and low complication rates using a hardware-free MPFL reconstruction technique with an intra-operative adjustment of the graft tension

Abstract: IV.

Cited by 15 publications

References 45 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

Deepening trochleoplasty combined with balanced medial patellofemoral ligament reconstruction for an adequate graft tensioning

Transpatellar Reconstruction of Medial Patellofemoral Ligament by Semitendinous Tendon Autograft

Contact Info

Product

Resources

About