Factors Affecting the Outcomes of Double-Bundle Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Dislocations Evaluated by Multivariate Analysis

Kita, Keisuke; Tanaka, Yoshinari; Toritsuka, Yukiyoshi; Amano, Hiroshi; Uchida, Ryohei; Takao, Rikio; Horibe, Shuji

doi:10.1177/0363546515606102

Cited by 131 publications

(113 citation statements)

References 47 publications

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“…The main finding in this study was a statistically significant correlation between measures of trochlear dysplasia and QOL physical symptoms scores, an average of 2 years following patellofemoral stabilization surgery. This statistically significant finding aligns with previous research that demonstrated poorer clinical outcomes for MPFL imbrication 22,23 and MPFL reconstruction 18,19,21,31 in patients with high-grade trochlear dysplasia. This study used a disease-specific patient-reported outcome measure as an assessment tool, and therefore provided further evidence that trochlear dysplasia is a predictor of surgical outcome in patients with patellofemoral instability.…”

Section: Discussionsupporting

confidence: 91%

“…Biomechanical and clinical studies have identified trochlear dysplasia as a significant risk factor for lateral patellar translation and recurrent instability. [12][13][14][15][16][17] Trochlear dysplasia has also been implicated as a significant risk for the failure of stabilization procedures such as reconstruction [18][19][20][21] and imbrication of medial patellofemoral ligament (MPFL). 22,23 A systematic review of the indications for MPFL reconstruction noted that trochlear dysplasia was the second most common reason cited in studies for not performing an isolated MPFL reconstruction.…”

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confidence: 99%

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Quality-of-Life Outcomes of Patients following Patellofemoral Stabilization Surgery: The Influence of Trochlear Dysplasia

2017

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Trochlear dysplasia is a well-described risk factor for recurrent patellofemoral instability. Despite its clear association with the incidence of patellofemoral instability, it is unclear whether the presence of high-grade trochlear dysplasia influences clinical outcome after patellofemoral stabilization. The purpose of this study was to assess whether trochlear dysplasia influenced patient-reported, disease-specific outcomes in surgically treated patellar instability patients, when risk factors were addressed in accordance with the à la carte surgical approach to the treatment of patellofemoral instability. The study design is of a case series. A total of 318 patellar stabilization procedures were performed during the study period. Of these procedures, 260 had adequate lateral radiographs and complete Banff Patellar Instability Instrument (BPII) scores available for assessment. A Pearson correlation was calculated between four characteristics of trochlear dysplasia, the BPII total and the BPII symptoms, and physical complaints scores, a mean of 24 months following patellofemoral stabilization. Independent-tests were performed between stratified trochlear dysplasia groups (no/low grade and high grade) and all BPII measures. There was a statistically significant correlation between measures of trochlear dysplasia and quality-of-life physical symptoms scores, an average of 2 years following patellofemoral stabilization surgery. The BPII symptoms and physical complaints domain score, as well as the individual weakness and stiffness questions, correlated with the classification of trochlear dysplasia as well as the presence of a trochlear bump ( < 0.05). Independent -tests demonstrated statistically significant differences between the no/low-grade and high-grade dysplasia groups for the BPII stiffness ( = 0.002), BPII weakness ( = 0.05) and BPII symptom, and physical complaints values ( = 0.04). Two additional measures-the 24-month postoperative total BPII score ( = 0.11) and BPII pain score ( = 0.07)-demonstrated trends toward statistical significance. This research has established a statistically significant correlation between trochlear dysplasia and disease-specific quality-of-life outcomes following patellofemoral stabilization surgery. There was a significant correlation between patient-reported physical symptoms after surgery and high-grade trochlear dysplasia.

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Section: Discussionsupporting

confidence: 91%

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confidence: 99%

Quality-of-Life Outcomes of Patients following Patellofemoral Stabilization Surgery: The Influence of Trochlear Dysplasia

2017

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“…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).…”

Section: Patientsmentioning

confidence: 99%

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

Zhang

2018

J Knee Surg

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Medial patellofemoral ligament (MPFL) reconstruction is a satisfactory technique for patellar instability, and the anatomical double bundle variant is recommended for better clinical results. However, long-term outcomes are still uncharacterized. This study aimed to assess the effectiveness of double bundle reconstruction of the MPFL for patellar instability by means of established scores. A total of 68 patients with chronic patellar instability who underwent surgery from May 2005 to February 2010 were included prospectively. Anatomical double reconstruction of the MPFL with the semitendinosus tendon was conducted. Tegner Activity Scale (TAS), Kujala score, Lysholm knee score, and objective physical examination were assessed during follow-up. Median follow-up time for the patients was 8 (range, 6-10) years. Eight patients were lost to follow-up after 2 years. Preoperative mean TAS was 2.85 ± 0.78, increased to 4.91 ± 0.84 at 6 months and 7.26 ± 0.78 at 2 years postoperatively, and was 7.82 ± 0.89 at last follow-up. At last follow-up, pain free at rest was achieved in all patients; and 8 patients had knee pain in activities of daily living. Mean Kujala score was 57.53 ± 8.59 preoperatively, and increased to 61.22 ± 6.46, 89.51 ± 3.90, and 88.92 ± 3.84 at 6 months, 2 years postoperatively, and at last follow-up, respectively. Lysholm scores were also increased from preoperative values of 43.53 ± 10.20 to 58.22 ± 6.80, 89.37 ± 4.38, and 89.67 ± 4.13 at 6 months, 2 years postoperatively, and at last follow-up, respectively. Range of motion was 121.44 ± 12.69, 129.71 ± 6.39, 130.93 ± 5.67, and 130.78 ± 5.80 at preoperative point, 6 months, 2 years postoperatively, and at last follow-up, respectively. Long-term clinical results of double bundle reconstruction of the MPFL for patellar instability were encouraging.

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“…However, there are other important drivers of clinical outcome that need to be recognized. Kita et al 6 reported that severe trochlear dysplasia is the most important predictor of residual patellofemoral instability after isolated MPFL reconstruction. In addition, an increased TT-TG distance affected the outcomes in patients with type D trochlea.…”

Section: See Related Article On Page 2410mentioning

confidence: 99%

“…In addition, an increased TT-TG distance affected the outcomes in patients with type D trochlea. 6 Liu et al 7 showed that isolated MPFL reconstruction is safe and effective in the presence of trochlear dysplasia in patients without significantly elevated TT-TG distances or significant patella alta. Hopper et al also reported that when patients with high-grade trochlear dysplasia were excluded, anatomically placed femoral MPFL tunnels had significantly better clinical scores than did tunnels not placed anatomically (Kujala score, P ¼ .028; Lysholm score, P ¼ .012).…”

Section: See Related Article On Page 2410mentioning

confidence: 99%

Editorial Commentary: When It Comes to Patient Outcome, Femoral Tunnel Vision May Miss the ‘Point’ in Knee Medial Patellofemoral Ligament Reconstruction

Sherman¹

2018

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Surgeons care deeply about optimizing femoral tunnel position in medial patellofemoral ligament reconstruction. We use a combination of anatomy, isometry, and fluoroscopy to determine the appropriate position of our graft. Although malposition does increase the risk of surgical complication, it is unclear whether femoral tunnel position actually matters for clinical outcome. Surgeons should avoid "tunnel vision" in medial patellofemoral ligament reconstruction by recognizing the combination of anatomic, biomechanical, patient-specific, and technique-dependent variables that may drive patient satisfaction and subjective outcome.

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Factors Affecting the Outcomes of Double-Bundle Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Dislocations Evaluated by Multivariate Analysis

Cited by 131 publications

References 47 publications

Quality-of-Life Outcomes of Patients following Patellofemoral Stabilization Surgery: The Influence of Trochlear Dysplasia

Quality-of-Life Outcomes of Patients following Patellofemoral Stabilization Surgery: The Influence of Trochlear Dysplasia

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

Editorial Commentary: When It Comes to Patient Outcome, Femoral Tunnel Vision May Miss the ‘Point’ in Knee Medial Patellofemoral Ligament Reconstruction

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