Medial Patellofemoral Ligament Reconstruction: A Comprehensive Review

Abstract

It has been suggested that in the majority of patellar dislocation cases, the medial patellofemoral ligament (MPFL) is disrupted with a high recurrence rate especially in female patients. Although MPFL tear is not the primary cause of instability, MPFL reconstruction is effective for stabilizing the knee and may alone prevent lateral patellar dislocation. There is limited but growing evidence that MPFL reconstruction for patellofemoral instability leads to excellent functional outcomes. Growing awareness of the biomechanical contribution of the MPFL has led to an upsurge in the publication of techniques and trials dealing with reconstructive techniques, warranting a review that includes the most recent evidence. The aim of this article was to review and summarize the recent literatures concerning MPFL reconstruction and provide a comprehensive review of previous studies ranging from basic science to current surgical techniques and results.

Medial Patellofemoral Ligament Reconstruction Using All-Soft Suture Anchors for Patellar Fixation

“…The MPFL has been determined to be the primary restraint to lateral translation of the patella from 0° to 30° of knee flexion, and its biomechanical properties are critical for both patellar stability and normal kinematics of the patellofemoral joint. 8 , 9 , 21 , 22 , 23 Most acute patellar dislocations result in disruption of the MPFL, and the high rate of recurrent dislocations can be attributed to insufficiency or loosening of the ligament. 5 , 24 , 25 Consequently, MPFL reconstruction is advocated in recurrent dislocations to restore native patellar constraints.…”

“… 7 It also acts as an indirect dynamic stabilizer of the patella, with the contraction of the vastus medialis obliquus pulling the patella medially through the MPFL. 8 …”

“…Because of the role played by the MPFL in stability of the patellofemoral joint, MPFL reconstruction may be considered in patients who are recurrent dislocators and those in whom conservative treatment fails. 8 For anatomic double-bundle MPFL reconstruction, multiple different techniques for fixation of the soft-tissue graft to the patella have been described. These include bone tunnels, interference screws, and suture anchors (SAs).…”

Modern tendencies in the treatment of patellofemoral arthrosis

“…К примеру, на длительном сроке наблюдения (11,9 лет) из 22 обследованных (24 сустава) лишь у двух констатированы неудовлетворительные результаты. По шкале Kujala наблюдалось улучшение с 63,2 до 94,2 [20].…”

“…В ряду радикальных вмешательств использование пластики пателлофеморального сочленения практикуется не один десяток лет, однако есть факты, подтверждающие выживаемость эндопротеза лишь в 63 % случаев при сроке в 7 лет после вмешательства [20]. Имеется большой ассортимент имплантатов, созданных специально для этой операции, с различной геометрией -как мыщелковых, так и самого надколенника.…”