MPFL Reconstruction for Recurrent Patella Dislocation: A New Surgical Technique and Review of the Literature

Abstract

Recurrent dislocation, subluxation and functional instability due to patellofemoral pain might be present in 30 % to 60 % of patients managed non-operatively for posttraumatic patella instability. Disruption of the capsule, medial patella retinaculum and/or vastus medialis obliquus have been associated with recurrent patella instability but recently the medial patellofemoral ligament (MPFL) has been recognised as the most important ligamentous stabiliser preventing lateral dislocation of the patella. Many nonanatomical surgical techniques for the treatment of recurrent patellar dislocation have been described in the literature. These procedures alter the pre-morbid patella mechanics by several principles, including the release of tight lateral ligaments, tensioning of loose medial structures and distal realignment of the extensor mechanism or a combination of these. Very few address the principle site of pathology in patella dislocation, i.e., the torn MPFL. The outcomes are inconsistent and many studies have reported recurrent dislocations and patellofemoral pain and arthritis in up to 40 %. We describe a simple technique of MPFL reconstruction using a single hamstring tendon graft which is passed through the medial intermuscular septum at the adductor's magnus insertion and is fixed to the superomedial pole of the patella. A comprehensive review of the existing techniques of MPFL reconstruction using semitendinosus tendon autografts is also provided.

Patellar instability

“…There was one case of patella fracture but no cases of post-operative patellar instability 42 . Panagopoulos reported significant improvements in pain function after MPFL reconstruction in this series 42 . To our knowledge, there are no studies evaluating the long-term outcomes following MPFL reconstruction.…”

Reconstruction of Medial Patellofemoral Ligament Through Two Transverse Patellar Tunnel Technique Using Hamstring Autograft

“…[18] MPFL reconstruction gives better results in recurrent patellar dislocations than with non-anatomical reconstruction, which may alter the biomechanics of the patellofemoral joint. [ [25] In cadaver study, MPFL reconstruction showed a significant reduction in lateral displacement of patella and joint load compared with medial transfer of the tibial tuberosity. Hence, medial patellofemoral ligament reconstruction is an anatomical reconstruction.…”

Patellofemoral Joint Instability: A Review of Current Concepts

“…In a recent meta-analysis, a total of 1,065 MPFL reconstructions were identified in 31 studies, and it was found that autograft reconstructions were associated with greater postoperative improvements in Kujala scores when compared to allograft, and that double-limbed reconstructions were associated with both improved postoperative Kujala scores and lower failure rate [58]. Overall, in the absence of significant malalignment, MPFL reconstructions appear to provide long-term functional improvement with improved Kujala scores, low rate of redislocation, and decreases in apprehension and patellofemoral pain [59,60,61,62,63,64]. However, the current literature on MPFL outcomes has substantial methodological limitations with small sample sizes and limited follow-ups [65].…”