Outcomes After Isolated Medial Patellofemoral Ligament Reconstruction for the Treatment of Recurrent Lateral Patellar Dislocations

Schneider, Denis; Grawe, Brian M.; Magnussen, Robert A.; Ceasar, Adrick; Parikh, Shital N.; Wall, Eric J.; Colosimo, Angelo J.; Kaeding, Christopher C.; Myer, Gregory D.

doi:10.1177/0363546515624673

Cited by 229 publications

(278 citation statements)

References 75 publications

(137 reference statements)

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“…In recently published reviews, the expected redislocation rates are described as 5% at midterm followup. 25,26 Further, persistent positive apprehension signs and subluxation events are estimated with 3.6 to 5%, 22,26 which is in accordance to our experience with recurrent subluxation in three cases (2.9%).…”

Section: Discussionsupporting

confidence: 89%

“…Over the last years, promising results of MPFLR with low redislocation rates and good functional outcome have been reported by several studies. 22 Enderlein et al published a study including 224 patients. 23 With redislocations, in 4.6% within a follow-up period of 12 to 60 months, they reported a slightly higher redislocation rate than observed in our group.…”

Section: Discussionmentioning

confidence: 99%

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Midterm Results after Implant-Free Patellar Fixation Technique for Medial Patellofemoral Ligament Reconstruction

Mayer¹,

Schuster

Schlumberger³

et al. 2019

J Knee Surg

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Problems and complications concerning the patellar fixation in medial patellofemoral ligament reconstruction (MPFLR) have been reported. The purpose of this retrospective study was to systematically analyze the surgical technique for MPFLR with a V-shaped patellar bonetunnel for implant-free fixation of an autologous gracilis tendon, allowing early functional rehabilitation, regarding restoration of the patellofemoral stability, patient satisfaction, return to sports, and technique-specific complications. In 2010, 128 cases of consecutive isolated MPFLR were performed. All these cases were included. After a minimum follow-up of 3 years, 104 cases were retrospectively analyzed (follow-up: 81.3%) with regard to redislocation, subjective functional outcome (Tegner's score and sports level compared with preoperative level), patient satisfaction, revision surgery, and technique-specific complications. After a follow-up of 45.7 ± 3.2 months, 101 of 104 cases (97.1%) showed no redislocation. Mean Tegner's score was 5.1 ± 1.8 (range, 2–9). A total of 61.5% patients reported about a higher sports level compared with their preoperative level. The patient satisfaction was high with 94.2%. In two cases (1.9%), technique-specific problems occurred as the bone bridge of the V-shaped tunnel was insufficient due to a malpositioning of the aiming device. No further technique-specific problems occurred and no revision surgery was necessary during the observational period. The presented surgical technique is safe and it reliably restores the patellofemoral stability, with a low rate of redislocations, an excellent subjective functional outcome, and a high-patient-reported satisfaction. No major technique-specific complications occurred.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Midterm Results after Implant-Free Patellar Fixation Technique for Medial Patellofemoral Ligament Reconstruction

Mayer¹,

Schuster

Schlumberger³

et al. 2019

J Knee Surg

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“…7,8 Superior results in outcomes, complications, and failures have been reported with MPFL reconstruction vs conservative treatment. 9,10,21,23 Our study of pediatric patients revealed superior graft survivorship in allograft MPFL reconstructions with 0% failures, which is significantly lower than the 28.6% failure seen in our autograft reconstructions.…”

Section: Discussionmentioning

confidence: 44%

“…7,8 Initially, nonoperative conservative management of patellar dislocations was the standard of care for MPFL injuries; however, MPFL reconstruction is becoming popular and has good outcomes. 9 In a randomized controlled trial comparing nonoperative treatment vs MPFL reconstruction, Bitar et al found significantly greater Kujala scores and fewer recurrences/subluxations in the reconstruction group. 10 Many surgical techniques for MPFL reconstruction have been described, [11][12][13][14][15][16][17][18][19] but no single technique has been proven to be significantly superior to the others.…”

Section: Introductionmentioning

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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“…It is now well established that TTM and isolated MPFLR are effective procedures to treat RPD [15][16][17], but these approaches are also imperfect. In terms of MPFLR, Shah et al [18] revealed that the overall incidence rate of complications was 26.1% when this operation is adopted.…”

Section: Discussionmentioning

confidence: 99%

Closing-wedge Distal Femoral Osteotomy Combined with Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Dislocation with Genu Valgum

Jing¹,

Wang²,

Liu³

et al. 2020

Preprint

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Background: Medial patellofemoral ligament reconstruction (MPFLR) is a well-established procedure for addressing recurrent patellar dislocation (RPD) in young patients. However, for RPD with genu valgum, simultaneous MPFLR and closing-wedge distal femoral osteotomy (CWDFO) may be a promising procedure yet rarely reported. This study’s purpose was to observe and analyse the clinical and imaging findings of CWDFO combined with MPFLR for RPD with genu valgum.Methods: From May 2015 to Apirl 2018, 25 patients with RPD and genu valgum were surgically treated in our department. Anteroposterior long-leg, weight-bearing, lower-extremity radiographs, lateral radiographs and computed tomography (CT) scans of the patellofemoral joint were obtained, and the femorotibial angle (FTA), mechanical lateral distal femoral angle (mLDFA), weight-bearing line rate (WBLR), patellar height, patellar lateral shift (PLS) and tibial tubercle–trochlear groove (TT-TG) distance were analysed. Validated knee scores, such as the Kujala, Lysholm, visual analogue scale (VAS) scores and Tegner socres, were evaluated preoperatively and 2 years postoperatively.Results: 25 patients, with an average age of 19.8 years (14–27), were evaluated. All patients had been able to achieve a better sports level without any problems during the 2-year follow-up period. There has been no recurrence of patellar instability. Compared with preoperation, the FTA, mLDFA, WBLR and PLS showed statistically significant improvement following the procedure (p < 0.001). Meanwhile, no significant differences in the Insall index and TT-TG distance was found. The mean Kujala score, average Lysholm score, VAS score and Tegner socres showed significant improvement postoperatively.Conclusions: CWDFO combined with MPFLR is a suitable treatment for RPD with genu valgum, as it leads to significant improvement in the clinical and imaging findings of the knee in the short term.

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Outcomes After Isolated Medial Patellofemoral Ligament Reconstruction for the Treatment of Recurrent Lateral Patellar Dislocations

Cited by 229 publications

References 75 publications

Midterm Results after Implant-Free Patellar Fixation Technique for Medial Patellofemoral Ligament Reconstruction

Midterm Results after Implant-Free Patellar Fixation Technique for Medial Patellofemoral Ligament Reconstruction

Autograft vs Allograft Comparison in Pediatric Medial Patellofemoral Ligament Reconstruction

Closing-wedge Distal Femoral Osteotomy Combined with Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Dislocation with Genu Valgum

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