Isolated medial patellofemoral ligament reconstruction is valid to stabilize patellofemoral joint but uncertain to reduce patellar height in setting of lateral patellar dislocation and patella alta

Dong, Zhao; Xu, Chenyue; Yan, Lirong; Liu, Junle; Wang, Fei

doi:10.1007/s00402-022-04429-x

Cited by 12 publications

(4 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Compared with PROs following MPFLR in non-EDS patients, our patients reported inferior outcomes across all PROs (Appendix Table A2). 5,19,21,30 Within our cohort, there was a wide range of PROs, with some patients having significant disability while others were very functional. This reflects the differences in clinical severity in patients with EDS.…”

Section: Discussionmentioning

confidence: 87%

Midterm Outcomes of Isolated Medial Patellofemoral Ligament Reconstruction for Patellar Instability in Ehlers-Danlos Syndrome

Parikh,

Nemunaitis,

Wall

et al. 2024

Orthopaedic Journal of Sports Medicine

View full text Add to dashboard Cite

Background: Patellar instability is frequently encountered in patients with Ehlers-Danlos syndrome (EDS). The clinical outcomes of isolated medial patellofemoral ligament reconstruction (MPFLR) for patellar instability in patients with EDS are unknown. Purpose: To evaluate midterm clinical outcomes of isolated MPFLR for patellar instability in patients with EDS and factors affecting these outcomes. Study Design: Case series; Level of evidence, 4. Methods: In a retrospective study, 31 patients (n = 47 knees) with EDS and patellar instability who underwent isolated MPFLR for recurrent patellar instability between 2008 and 2017 and had a minimum 2-year follow-up were identified. Preoperative radiographic images were measured for anatomic risk factors. Clinical outcomes—including postoperative complications—were evaluated. Factors associated with MPFLR failure were identified. Postoperative patient-reported outcomes (PROs)—including the pediatric version of the International Knee Documentation Committee, the Kujala score, the Hospital for Special Surgery Pediatric Functional Activity Brief Scale, the Banff Patellofemoral Instability Instrument 2.0, and the Knee injury and Osteoarthritis Outcome Score—were collected, and factors affecting PRO scores were analyzed. Results: The mean age of the cohort was 14.9 ± 2 years. At a mean follow-up of 7.2 years, 18 of 47 (38.3%) knees required reoperations, of which 9 of 47 (19.1%) knees required revision stabilization for recurrent patellar instability. Also, 7 of 31 knees (22.6%) with autografts failed compared with 2 of 16 (12.5%) with allografts ( P = .69). For autografts, 6 of 17 (35.3%) failures occurred with gracilis, but 0 of 13 (0%) occurred with semitendinosus ( P = .02). Compared with patients without failures, patients with failed primary MPFLR were significantly younger ( P = .0005) and were able to touch the palm to the floor with their knees extended ( P = .03). For radiographic parameters, the patellar height and tilt were significantly higher in the failure group. The postoperative PROs were suboptimal at a mean follow-up of 5.2 years. All but 1 patient were satisfied with the final outcome. Conclusion: At the midterm follow-up, 38.3% of patients with EDS required further surgery after isolated MPFLR for patellar instability; half of these revisions (19.1%) were to address recurrent instability. Recurrent instability after isolated MPFLR was more likely in younger patients and those who could touch the palm to the floor with their knees extended. Postoperative PROs were inferior; nonetheless, patient satisfaction was high.

show abstract

Section: Discussionmentioning

confidence: 87%

Midterm Outcomes of Isolated Medial Patellofemoral Ligament Reconstruction for Patellar Instability in Ehlers-Danlos Syndrome

Parikh,

Nemunaitis,

Wall

et al. 2024

Orthopaedic Journal of Sports Medicine

View full text Add to dashboard Cite

show abstract

“…The PTA was measured between the widest patellar axis and the PCL [23]. The PCA was measured between the line bisecting sulcus angle and the line connecting the deepest point of the sulcus and the lowest point of the patella [8]. The PTG distance was measured between the perpendicular line of the PCL through the deepest point of the trochlear groove, and the medial edge of the patella [38].…”

Section: Radiological Evaluationmentioning

confidence: 99%

Medial patellofemoral ligament reconstruction combined with derotational distal femoral osteotomy yields better outcomes than isolated procedures in patellar dislocation with increased femoral anteversion

Hao

Niu

Kong

et al. 2022

Knee Surg Sports Traumatol Arthrosc

Self Cite

View full text Add to dashboard Cite

PurposeThe purpose of this study was to evaluate and compare clinical and radiological outcomes between isolated medial patellofemoral ligament reconstruction (MPFLR) and MPFLR combined with derotational distal femoral osteotomy (DDFO) for patellar dislocation with increased femoral anteversion (FA). MethodsBetween 2014 and 2019, 36 patients who underwent isolated MPFLR and 31 patients who underwent MPFLR combined with DDFO were retrospectively included. Clinical outcomes included physical examinations, functional outcomes (Kujala, Lysholm, International Knee Documentation Committee (IKDC), and Banff Patella Instability Instrument (BPII) scores), activity level (Tegner activity score and return to sports), complications, and patellar re‐dislocation rate. Radiological outcomes included patella tilt angle, patellar congruence angle, and patella–trochlear groove distance. ResultsAll clinical outcomes improved significantly in both groups, but the DDFO group had significantly better postoperative scores than the MPFLR group (Kujala: 85.1 ± 7.7 vs. 80.5 ± 8.4, P = 0.023; Lysholm: 86.8 ± 8.2 vs. 81.9 ± 9.1, P = 0.026; IKDC: 86.2 ± 10.0 vs. 81.7 ± 8.1, P = 0.045; and BPII: 68.0 ± 12.5 vs. 62.3 ± 10.0, P = 0.039). Both groups achieved successful return to sports (90.3% vs. 91.7%). No re‐dislocation or major complications occurred. Radiological outcomes improved significantly in both groups, but the DDFO group had better outcomes (P < 0.05). The tibial tubercle–trochlear groove distance was only improved after DDFO from 17.0 ± 2.3 mm to 15.1 ± 2.0 mm (P = 0.001). ConclusionBoth isolated MPFLR and MPFLR combined with DDFO yielded satisfactory clinical and radiological outcomes in the treatment of patellar dislocation with increased FA. However, combined DDFO had better outcomes and should be considered a priority. Level of evidenceLevel III.

show abstract

“…Several methods can be used to determine and quantify patella height. The most commonly used measurements include; the Insall-Salvatti index (IS), the Blackburne-Peel index (BP) and Caton-Deschamps index (CD) [5][6][7]. These measurements are made using lateral Knee X-Rays [8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

An evaluation of a novel method for the MRI-based assessment of Caton-Deschamps index in the Knee

Palmowski,

Jung,

Hellwig

et al. 2024

Arch Orthop Trauma Surg

View full text Add to dashboard Cite

Introduction The radiographical assessment of patella height has historically been performed using X-Ray. The aim of this study was to evaluate a new method for the assessment of patella height using MRI and to assess the correlation with the X-Ray based assessment. Materials and methods 159 patients who had both lateral radiographs and MRI images were included. Parameters measured included traditional radiographical CDI, MRI-based CDI, and TT-TG distance. On the basis of the TT-TG, the patients were divided into 2 groups. Two different methods were used to assess CDI using MRI: using a single slice image, and an alternative technique using two different cross-sectional images. The correlation of the two measurement methods was assessed using Pearson’s correlation coefficient. The intraclass correlation coefficient (ICC) was determined from the measurements of the two investigators. Results The average TT-TG distance was 11.6 mm (± 4.6). In patients with a TT-TG < 15 mm, both measurement methods showed comparable correlation with measurements on X-Ray. In patients with a TT-TG of > 15 the the new cross-sectional imaging method showed higher correlation with traditional X-Ray assessment compared to CDI assessment using the traditional single slice method (r = 0.594, p < 0.001 vs. r = 0.302, p = 0.055). Conclusions The assessment of CDI on MRI using a cross-sectional imaging method has a better correlation with traditional X-Ray assessment of CDI than single-slice assessment. This is particularly true in patients with elevated TT-TG and as such should be preferentially used in the assessment of Patellar height in this cohort.

show abstract

Isolated medial patellofemoral ligament reconstruction is valid to stabilize patellofemoral joint but uncertain to reduce patellar height in setting of lateral patellar dislocation and patella alta

Cited by 12 publications

References 36 publications

Midterm Outcomes of Isolated Medial Patellofemoral Ligament Reconstruction for Patellar Instability in Ehlers-Danlos Syndrome

Midterm Outcomes of Isolated Medial Patellofemoral Ligament Reconstruction for Patellar Instability in Ehlers-Danlos Syndrome

Medial patellofemoral ligament reconstruction combined with derotational distal femoral osteotomy yields better outcomes than isolated procedures in patellar dislocation with increased femoral anteversion

An evaluation of a novel method for the MRI-based assessment of Caton-Deschamps index in the Knee

Contact Info

Product

Resources

About