Reconstruction of the medial patellofemoral ligament with autologous peroneal longus tendon versus semitendinosus tendon: a case control study

Abstract

Objective：In order to treat and improve recurrent patellar dislocation (RPD), autologous partial peroneal long tendon (PLT) or autologous partial semitendinosus tendon (ST) were taken to reconstruct the medial patellofemoral ligament (MPFL) respectively. The postoperative effects of the two methods were compared.Method:Patients with RPD in the Department of orthopedics of the Sixth Affiliated Hospital of Xinjiang Medical University were selected, and underwent MPFL reconstruction from February 2018 to February 2021. There were 65 cases, including 20 male patients and 45 female patients. The grafts were autologous PLT or ST, including 32 cases in PLT group and 33 cases in ST group. The evaluation indexes include: postoperative complications: patellar fracture, patellar subluxation, knee pain, knee stiffness, lower limb skin paresthesia, patellar tilt angle, patellar concentration angle, Kujala score and kofoed score of ankle. The functional improvement and complications of patella and knee joint before and after operation were compared, and the curative effect of PLT and ST reconstruction of MPFL was analyzed.Results：The follow-up time was 12-15 months. There were 7 cases of knee pain and 5 cases of knee stiffness in PLT group and 5 cases of knee pain and 3 cases of knee stiffness in ST group. There was no significant difference in postoperative pain and stiffness between the two groups (P > 0.05). There were 18 cases of infrapatellar branch of saphenous nerve (IPBSN) injury in ST group, but no IPBSN injury was found in PLT group (P < 0.05). The IPBSN injury in ST group was positively correlated with the incision length of tendon extraction (P < 0.05). In the last follow-up, there was no significant difference in patellar tilt angle, patellar convergence angle and Kujala score between the two groups (P > 0.05). The kofoed score of ankle joint in both groups was excellent.Conclusions：Autologous PLT and ST reconstruction of MPFL can effectively treat RPD, significantly improve patellar tilt angle and patellar concentration angle, improve Kujala score, improve knee function and clinical symptoms. Both are effective ways to treat RPD, but ST group will lead to IPBSN injury and sensory impairment of anterolateral skin of lower leg.