Minimally invasive medial patellofemoral ligament reconstruction for patellar instability using an artificial ligament: A two year follow-up

Khemka, Aditya; Lord, Sarah J.; Doyle, Zelda; Bosley, Belinda; Muderis, Munjed Al

doi:10.1016/j.knee.2015.07.002

Cited by 15 publications

(14 citation statements)

References 32 publications

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“…In many knee ligament reconstruction surgeries, biomechanical properties of implanted grafts are known to change with the effects of stress relaxation and graft remodeling. Autogenous tendon grafting has always been the gold standard for reconstruction, but in recent years, with the progress of materials science, artificial ligaments have been reported as an alternative option 9, 20 . Using suture augmentation as an internal brace against lateral patellar translation, the MPFL may have a better chance of healing and repair of concomitant cartilage lesions is protected from additional instability episodes after surgery.…”

Section: Discussionmentioning

confidence: 99%

“…In the last few decades, increasing research on materials has been carried out, and it is hoped that synthetic materials can replace autogenous tendons. One study describes a minimally invasive technique to reconstruct the MPFL using an artificial ligament and provides descriptive information about clinical benefits and safety in a broad population of patients with all grades of patellar instability 9 . Reports on FiberTape in MPFL reconstruction demonstrated that it is safe and effective and provides higher initial strength than the hamstring tendon 10, 11 .…”

Section: Introductionmentioning

confidence: 99%

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Medial Patellofemoral Ligament Reconstruction Using Suture Tape for Patellofemoral Joint Instability

Zhang

Jia

et al. 2021

Orthopaedic Surgery

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Objective To describe a surgical technique using suture tape for reconstruction of the medial patellofemoral ligament (MPFL). This technique restores the stability of the reconstructed ligament and has excellent postoperative outcomes. Method This is a retrospective analysis. From January 2016 to June 2018, 17 patients underwent MPFL reconstruction using high‐strength suture (FiberTape; Arthrex) augmentation, with at least 12 months of follow up. There were 11 female and 6 male patients. The mean age at the time of MPFL reconstruction was 22.1 years (range 13–34 years). Clinical outcomes included pain level, knee range of motion, passive patellar hypermobility, and maltracking at follow‐up. The lateral patellofemoral angles, congruence angles, and patellar tilt angles were measured in a skyline view by CT at 30° of knee flexion at 12 months. Functional outcomes were assessed using the Lysholm knee scoring scale, the SF‐12 score, the Tegner score, and the Crosby and Insall grading system at yearly follow‐up. Result No patients were lost at the last follow up. One patient had recurrence of patellar dislocation and none of the others had serious complications. The success rate of MPFL repair for preventing recurrent dislocations was 94.1% (16 of 17 knees). Fifteen knees had full range of motion of more than 130°. At follow‐up, 2 knees were judged to have mild hypermobility and none had severe hypermobility or maltracking. Using the Crosby and Insall grading system, 12 knees (70.6%) were graded as excellent, 4 knees (23.5%) as good, 1 knee (5.9%) as fair to poor, and none as worse at the last follow‐up assessment. In all patients, the Lysholm knee score (55.12 ± 13.52 vs 79.88 ± 7.50, P < 0.01), the SF‐12 score (47 ± 9.53 vs 65.24 ± 12.82, P < 0.01), and the Tegner score (2.76 ± 1.39 vs 6.53 ± 1.70, P < 0.01) had improved at their 12‐month follow up. Compared with preoperative radiological findings, there was a significant improvement in lateral patellofemoral angle (−10.24 ± 7.10 vs 6 ± 5.43, P < 0.01), patellar tilt angle (26.53 ± 7.23 vs 9.88 ± 4.24, P < 0.01), and congruence angle (29.59 ± 11.95 vs −8.65 ± 4.86, P < 0.01). Conclusion The use of FiberTape in MPFL reconstruction can improve the stability of the knee following surgery and has good midterm clinical results and low complication rates.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Medial Patellofemoral Ligament Reconstruction Using Suture Tape for Patellofemoral Joint Instability

Zhang

Jia

et al. 2021

Orthopaedic Surgery

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“…Suganuma et al [ 48 ] were the only authors who excluded patients with pathoanatomical risk factors, while there was high variability among the other included studies. Khemka et al [ 44 ] also included patients with pathological ligamentous laxity. This heterogeneity certainly introduces an important source of bias; however, considering the lack of data in the literature, no additional subgroup analyses were possible.…”

Section: Discussionmentioning

confidence: 99%

Synthetic graft for medial patellofemoral ligament reconstruction: a systematic review

et al. 2022

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Background This systematic review investigates the role of synthetic graft for primary medial patellofemoral ligament (MPFL) reconstruction in patients with recurrent patellofemoral instability, focusing on clinical scores and the rate of complications. Methods This systematic review was conducted according to the PRISMA statement. The main online databases were accessed in January 2022 without time constraints. All clinical studies investigating the use of synthetic grafts for MPFL reconstruction were accessed. Revision settings were not considered. Only articles reporting data on patients with recurrent patellofemoral instability were eligible. Studies regarding congenital or acute patellofemoral dislocation were excluded. Only studies performing a follow-up longer than 24 months were considered. Results Data on 199 patients [mean age 22.3 (range 19.0–28.0) years] were collected. The mean follow-up was 60.5 (39.0–142.8) months. All the scores of interest improved at last follow-up: Kujala (+ 24.8; P = 0.0002), Lysholm (+ 42.0; P = 0.02), Tegner (+ 1.2; P = 0.03), IKDC (+ 20.9; P = 0.02). Post-operatively, a positive apprehension test was detected in 6.1% (7/115) of patients, and a sensation of instability was reported by 1.5% (3/199) of patients. The rate of re-dislocations was 2.5% (5 of 199 patients), and revision procedures were performed in less than 1% (1 of 199) of patients. Conclusion Synthetic graft may be reliable and feasible for primary MPFL reconstruction in patients with recurrent patellofemoral instability.

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“…28 In 2016, Khemka et al published a retrospective review of 29 patients who underwent MPFL reconstruction using artificial ligaments and noted that 17 of the 29 patients had underlying ligamentous laxity. 29 The Beighton score is a validated measure to assess for hypermobility in pediatric patients. 30,31 Despite this suspected correlation, we did not routinely conduct Beighton scoring on our patients before this study was completed, and this focus could inform future studies.…”

Section: Discussionmentioning

confidence: 99%

Autograft vs Allograft Comparison in Pediatric Medial Patellofemoral Ligament Reconstruction

Hendawi

Godshaw

Flowers

et al. 2019

TOJ

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Background: Patella instability and medial patellofemoral ligament (MPFL) injury are frequently encountered in pediatric patients. MPFL reconstruction is often chosen to treat this condition with good results; however, no consensus has been reached about which graft or technique to use. The purpose of this study was to evaluate the differences in graft survivorship, clinical outcomes (assessed with Kujala scores), and cost between autograft and allograft usage in MPFL reconstruction in pediatric patients. Methods: In this retrospective review of patients who underwent MPFL reconstruction between 2012-2015, autograft gracilis tendon was used for Group 1, and allograft gracilis tendon was used for Group 2. Outcomes were graft survivorship, postoperative Kujala scores, operative time, costs, graft size, and tibial tubercle-trochlear groove distance. Results: Fifty-six patients were included in this study, 21 in Group 1 and 35 in Group 2. No differences in age, sex, or chronicity were seen between the groups. Patients in Group 1 had longer operative times (134.5 minutes vs 97.3 minutes, P=0.0002), higher rates of graft failure (28.6% vs 0%, P=0.0037), and lower Kujala scores (80.3 vs 92.1, P=0.0032) compared to Group 2. All graft failures occurred in patients with chronic patella dislocations and occurred an average of 13.8 months postoperatively. Overall, autograft was costlier than allograft because of the cost of reoperation. Conclusion: This study supports the use of allograft for chronic patellar instability because of improved graft survivorship and clinical outcome scores, as well as the lower cost and reoperation rate.

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Minimally invasive medial patellofemoral ligament reconstruction for patellar instability using an artificial ligament: A two year follow-up

Cited by 15 publications

References 32 publications

Medial Patellofemoral Ligament Reconstruction Using Suture Tape for Patellofemoral Joint Instability

Medial Patellofemoral Ligament Reconstruction Using Suture Tape for Patellofemoral Joint Instability

Synthetic graft for medial patellofemoral ligament reconstruction: a systematic review

Autograft vs Allograft Comparison in Pediatric Medial Patellofemoral Ligament Reconstruction

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