Midterm results of combined patellofemoral and patellotibial ligaments reconstruction in recurrent patellar dislocation

Sobhy, Mohamed H.; Mahran, M; Kamel, Eman Mohamed

doi:10.1007/s00590-012-0999-7

Cited by 36 publications

(70 citation statements)

References 24 publications

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“…Hence, only one of the previous reports describes tensioning of the MPFL and MPTL at different flexion angles. 23 Furthermore, fixing the MPTL on the proximal epiphysis of the tibia rather than on the proximal tibial metaphysis reduces the risk of distal migration of the insertion of the graft with growth, which could change its tensioning and function. The principle of the insertion in the epiphysis is analogous to that used in the reconstruction of the MPFL.…”

Section: Discussionmentioning

confidence: 99%

“…[13][14][15][16][17] The only difference in our proposed procedure involves the grafts used. The use of the quadricipital and patellar grafts for the reconstruction of the MPFL is already well-known and widespread, and the use of the patellar tendon for isolated reconstruction of the MPTL has also been described.…”

Section: Discussionmentioning

confidence: 99%

“…The use of the quadricipital and patellar grafts for the reconstruction of the MPFL is already well-known and widespread, and the use of the patellar tendon for isolated reconstruction of the MPTL has also been described. 8,9,16,[18][19][20] The risks involved are similar to those described for any MPFL reconstruction: overtightening of the graft leading to pain, restricted range of motion, medial subluxation, and patella baja. Surgeons should be careful when suturing the grafts to avoid these complications.…”

Section: Discussionmentioning

confidence: 99%

“…Some reports in the literature have described case series of combined MPFL and MPTL reconstructions, mostly in children, with good results. [13][14][15][16][17] These reconstructions use the semitendinosus or gracilis tendons with preservation of their tibial insertions, which does not coincide with the anatomic insertion of the MPTL. Reconstruction of the MPTL with the patellar tendon associated with procedures other than MPFL reconstruction (lateral retinacular lengthening, vastus medialis obliquus advancement, medial retinaculum closure, and tibial tuberosity osteotomy) has also been described with good outcomes.…”

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confidence: 99%

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Combined Reconstruction of the Medial Patellofemoral Ligament With Quadricipital Tendon and the Medial Patellotibial Ligament With Patellar Tendon

Hinckel

Gobbi

Demange

et al. 2016

Arthroscopy Techniques

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Although the medial patellotibial ligament (MPTL) has been neglected regarding its function in patellar stability, recently, its importance in terminal extension and during flexion has been recognized. Indications for reconstruction of the medial patellofemoral ligament combined with the MPTL are extension subluxation, flexion instability, children with anatomic risk factors for patellar instability, and knee hyperextension associated with generalized laxity. We describe a combined reconstruction of the medial patellofemoral ligament with quadricipital tendon and reconstruction of the MPTL with patellar tendon autografts.L ateral patellar dislocation is responsible for 2% to 3% of all knee injuries and is the second leading cause of hemarthrosis. 1,2 The medial ligaments responsible for maintaining the stability of the patellofemoral joint are the medial patellofemoral ligament (MPFL), medial patellotibial ligament (MPTL), and medial patellomeniscal ligament (MPML).There are several studies on the MPFL and its anatomic and biomechanical characteristics 2-6 ; however, little is known about the MPTL and MPML. 2,3,5,6 The first biomechanical studies showed that the MPFL contributes 50% to 60% to medial restriction during initial flexion (between 0 and 30 of flexion). [4][5][6] The contribution of the secondary restrictors varies among those studies, ranging from 0% to 24% for the MPTL and from 8% to 38% for the MPML. 3,5,6 However, in a more recent study, Philippot et al. 2 evaluated the medial ligaments in higher degrees of flexion (from 0 to 90 of flexion), showing that the contributions of the MPTL and MPML to lateral translation restriction increase from 26% in extension to 46% at 90 of flexion. In addition, the influences of the MPTL and MPML at 90 of flexion were 72% in patellar tilt and 92% in patellar rotation. 2 In the study by Philippot et al., the combined importance of the MPTL and MPML was evaluated rather than the isolated actions of each of these ligaments. In a clinical study, Garth et al. 7 observed the presence of clinical and arthroscopic subluxation in patients with isolated MPML lesions with the knee in extension. Thus the MPTL and MPML are important in maintaining normal kinematics of the patellofemoral joint in all ranges of motion, especially at extension and higher degrees of flexion.Usually, surgical treatment involves a combination of reconstruction of the injured MPFL and adjuvant procedures for better alignment and congruence of the patellofemoral joint. Several types of grafts have been described for the reconstruction of the MPFL, and they have shown good results. [8][9][10] In a systematic review of the complications associated with exclusive reconstruction of the MPFL, the observed complication rate was 26.1% of cases. Clinical failure presenting with persistence of

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Combined Reconstruction of the Medial Patellofemoral Ligament With Quadricipital Tendon and the Medial Patellotibial Ligament With Patellar Tendon

Hinckel

Gobbi

Demange

et al. 2016

Arthroscopy Techniques

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“…The reconstruction of the MPTL is gaining popularity both in patients with open physes and in adults (16,17). During the arc of motion from total extension to flexion of 90°, the MPTL and MPML contribute 28%-48% against the lateralization of the patella, 23%-71% against tilt, and 32%-92% against rotation.…”

mentioning

confidence: 99%