Medial Patellofemoral Ligament Reconstruction With a Divergent Patellar Transverse 2-Tunnel Technique

Abstract

The results of modified MPFL reconstructions are encouraging, with minimal risks of redislocation and an overall patient satisfaction rate of over 80%. These early and medium-term results are comparable with those of other MPFL reconstruction techniques reported in the literature.

Medial patello-femoral ligament (MPFL) reconstruction using suture anchors fixation: preliminary results

“…Nevertheless suture anchor fixation may be sufficient when compared with the native MPFL. Panni et al 20 , in the 45 patients undergoing reconstruction of the MPFL, had an increase of the main evaluation scales (Kujala from 56.7 pre-operatively to 86.8, Lysholm from 57.6 pre-operatively to 88.1) and reported the presence of one of the most dangerous complications in reconstruction the MPFL, the fracture of the patella. Christiansen et al 21 , in 44 subjects investigated with MPFL reconstruction, showed an increase of Kujala score from 46 pre-operatively to 84, presenting four episodes of dislocation after surgery.…”

Clinical outcome after medial patellofemoral ligament reconstruction and autologous chondrocyte implantation following recurrent patella dislocation

“…Clinical results are good and the re-dislocation rate is low [3,5,8,15,18,23,24,32]. Kohn et al [15] examined 42 patients 2 years after MPFL reconstruction.…”

The double-pulley technique for anatomical double-bundled medial patellofemoral ligament reconstruction

“…_ 2 ) T D $ F I G ] Among all the different double-bundled MPFL reconstruction procedures described in the literature so far, majority of them vary in the methods of patellar fixation, which can be categorised into looping though bone-tunnels [24][25][26], partial bone drilling with aperture interference screw fixation with interference [27][28][29][30], and patellar rim fixation with suture anchors [31][32][33][34]. Among them, we believe patellar rim fixation with suture anchors theoretically offers the most advantages than the bone-tunnel and interference screw fixation techniques.…”

“…The 3.5-mm metal anchor used in this technique was found to have a pull-out strength of 295 N in a porcine model [37], in comparison, the pull-out strength of interference screw fixation in the setting of MPFL reconstruction have yielded slightly inferior results, with through-tunnel fixation failing at 195 N and aperture fixation failing at between 126 and 241 N [35,38]. Second, patellar fractures, the most serious complication after double-bundled MPFL reconstruction, have been reported only in procedures with patellar-bone tunnel fixation [24,28,29,39], for bone tunnels may act as stress risers whereas suture anchor fixation, sparing of bone drilling, such complication may be minimised. In a systematic review of complications after MPFL reconstruction, Shah et al [40] reported a trend of more overall complications observed utilising the bone-tunnel techniques (29.8%) compared with the sutureanchor techniques (21.6%).…”