Ligament Reconstruction versus Distal Realignment for Patellar Dislocation

Sillanpää, Petri; Mattila, Ville M.; Visuri, Tuomo; Mäenpää, Heikki; Pihlajamäki, Harri

doi:10.1007/s11999-008-0207-6

Cited by 107 publications

(105 citation statements)

References 39 publications

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“…This result compares favorably with the literature, which reports similar scores 2–2.5 years post-surgery of 73.40 [19], 80.90 [20], 86.00 [15], 87.00 [14], 89.20 [21], 91.40 [22], 92.00 [23], 94.03 [24], 94.69 [16] and 99.69 [18]. …”

Section: Discussionsupporting

confidence: 86%

“…Among other advantages of CT are the absence of structural overlap or image distortion, the ability to obtain axial images of the patellofemoral joint at angles less than 20 degrees of knee flexion for enhancing assessment of subluxation, and noting and measuring tibial tubercle lateralization, to better identify patients with patellofemoral malalignment [13]. Of particular note in the literature is that the presence of osteochondral fractures was missed in approximately 30–40% of the X-rays performed at initial assessment [2, 14, 15]. …”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A new minimally invasive surgical technique for medial retinaculum repair following traumatic patellar dislocation

Shtarker

Assaf

Deltoff

2018

Eur J Orthop Surg Traumatol

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A new surgical method is introduced offering a less invasive approach to reattach the medial retinaculum following acute patellar dislocation. This retrospective analysis comprised 12 cases of medial retinacular repair in 10 patients. The surgical technique achieved reinforced reattachment of the torn region of the medial retinaculum for improved patellar support and stabilization. During follow-up, no recurrent patellar dislocations occurred, except where one patient reported a subjective feeling of patellar dislocation. The average Kujala score for our sample group after 2 years was 89.2. A plethora of methods are described in the literature to repair a tear to the medial patellofemoral ligament, which attaches at the superomedial patella. However, it is our contention that traumatic patellar dislocation invariably results in osteochondral avulsion at the inferomedial patella, refuting medial patellofemoral ligament involvement, and, rather, implicating the inferior aspect of the deep layer of medial retinaculum. Our surgical technique enables stable fixation of the region, decreasing the rate of recurrent dislocations. No grafts are used, permitting tendinous and ligamentous anatomy to remain intact. We further postulate that performing a CT examination preoperatively may reduce time between diagnosis and surgery, in addition to locating fracture sites more precisely.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

A new minimally invasive surgical technique for medial retinaculum repair following traumatic patellar dislocation

Shtarker

Assaf

Deltoff

2018

Eur J Orthop Surg Traumatol

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“…There is some evidence that MPFL reconstruction may prevent progression of OA when compared to traditional distal realignment procedures [12,27]. Maybe MPFL injuries should be repaired or reconstructed similar to anterior cruciate ligament tears to avoid the often adverse consequences of subjective joint instability complaints and OA progression.…”

Section: Discussionmentioning

confidence: 99%

A mini-invasive adductor magnus tendon transfer technique for medial patellofemoral ligament reconstruction: a technical note

Sillanpää

Mäenpää

Mattila

et al. 2009

Knee Surg Sports Traumatol Arthrosc

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Patellar dislocations are associated with injuries to the medial patellofemoral ligament (MPFL). Several techniques for MPFL reconstruction have been recently published with some disadvantages involved, including large skin incisions and donor site morbidity. Arthroscopic stabilizing techniques carry the potential of inadequate restoration of MPFL function. We present a minimally invasive technique for MPFL reconstruction using adductor magnus tendon autograft. This technique is easily performed, safe, and provides a stabilizing effect equal to current MPFL reconstructions. Skin incision of only 3-4 cm is located at the level of the proximal half of the patella. After identifying the distal insertion of the adductor magnus tendon, a tendon harvester is introduced to harvest the medial two-thirds of the tendon, while the distal insertion is left intact. The adductor magnus tendon is cut at 12-14 cm from its distal insertion and transferred into the patellar medial margin. Two suture anchors are inserted through the same incision at the superomedial aspect of the patella in the anatomic MPFL origin. The graft is tightened at 30 degrees knee flexion. Aftercare includes 4 weeks of brace treatment with restricted range of motion.

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“…A combined proximal and distal realignment of the soft tissue was reported by Hughston and Walsh in 1979 [22] with return to athletic activity in 90% of treated patients. An evaluation of the medial patellofemoral system is evidently crucial and many treatment options have been proposed recently in the literature [8,23,24]. Our review of 20 knees in 19 adolescent patients affected by patellar instability with dislocation or subluxation, treated with medial transfer of the lateral patellar tendon according to Goldthwait together with an arthroscopic evaluation with lateral release, shows good and excellent results in more than 80% of cases.…”

Section: Discussionmentioning

confidence: 87%

Patellar instability: combined treatment with Goldthwait technique and arthroscopic lateral release

et al. 2011

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Patellar instability is a frequent cause of knee pain in childhood and adolescence. Treatment is usually conservative especially after a single episode of dislocation, although in cases of recurrence the surgical option needs to be evaluated. The techniques proposed involve only soft tissues in order to preserve the skeletal maturation. This study evaluates the long-term results on 20 knees in 19 adolescents affected by patellar instability treated with the distal realignment procedure involving medial transfer of the lateral hemi-patellar tendon according to Goldthwait technique, preceded by arthroscopy to perform lateral release. The results were analysed with the Cox grading system and showed 11 excellent cases, 6 good cases, 2 fair cases and 1 poor case. Similar findings were obtained with the Bray score.

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Ligament Reconstruction versus Distal Realignment for Patellar Dislocation

Cited by 107 publications

References 39 publications

A new minimally invasive surgical technique for medial retinaculum repair following traumatic patellar dislocation

A new minimally invasive surgical technique for medial retinaculum repair following traumatic patellar dislocation

A mini-invasive adductor magnus tendon transfer technique for medial patellofemoral ligament reconstruction: a technical note

Patellar instability: combined treatment with Goldthwait technique and arthroscopic lateral release

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