Treatment of patellar dislocation with arthroscopic medial patellofemoral ligament reconstruction using gracilis tendon autograft and modified double-patellar tunnel technique: minimum 5-year patient-reported outcomes

Abstract

Background: The purpose of this study was to retrospectively analyze the clinical outcomes of patients with recurrent patellar dislocation who underwent arthroscopic medial patellofemoral ligament (MPFL) reconstruction using gracilis tendon autograft and a modified double-patellar tunnel method. We hypothesized that our modified method would provide good clinical outcomes. Methods: Patients who underwent arthroscopic MPFL reconstruction with autograft gracilis tendon and modified double-patellar tunnels technique for recurrent patellar dislocation and were followed up for a minimum of 5 years were identified, and the clinical and follow-up data were retrospectively analyzed. Preoperatively, joint hypermobility was assessed with the Beighton score. The Insall-Salvati ratio, TT-TG distance, and Q angle were measured on radiographic images. Patient-reported outcomes including the Kujala, Lysholm, and Tegner scores were collected preoperatively and postoperatively. Patient satisfaction was assessed at the end of 5 years. Complications and recurrent dislocation occurring after surgery were recorded. Results: A total of 79 patients (94 knees) were enrolled; of these, 13 (16.5%) were lost to follow-up. The data of 66 patients (80 knees) were available for final analysis. Mean age at surgery was 21.3 ± 7.8 years. Mean follow-up time was 66.1 ± 5.5 months (range, 60-78 months). Postoperative patient-reported outcome was not associated with Beighton score, Insall-Salvati ratio, or TT-TG distance. Q angle was negatively correlated to Kujala scores and Lysholm scores. Severity of trochlear dysplasia was not associated with postoperative patient-reported outcome. The mean Kujala score increased from 69.4 ± 7.9 to 96.1 ± 1.9, the mean Tegner score increased from 3.1 ± 1.3 to 5.9 ± 1.3, and the mean Lysholm score increased from 73.5 ± 14.6 to 95.3 ± 3.4. Two patients experienced recurrent patellar dislocation during follow-up. Conclusions: MPFL reconstruction using autologous gracilis tendon under arthroscopy appears to be a reliable and safe method for treating recurrent patellar dislocation. Level of evidence: Level IV.

Medial patellofemoral ligament reconstruction

“…[ 33 ] There are also people who identify the adductor tubercle and the medial femoral epicondyle during the operation, and regard the midpoint between them as the MPFL femoral insertion point, and the postoperative results are satisfactory. [ 34 ]…”

“…In comparison, fixation strength of patellar tunnel technique is closest to that of uninjured MPFL. [ 34 ]…”

Arthroscopic Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Dislocation: Short-term Clinical Results

“…Currently, arthroscopy application in the treatment of recurrent patellar dislocation is mainly for joint exploration, synovial cleansing, and lateral support band loosening. Gao et al 25 The contracture of the lateral retinaculum is one of the factors for the outward movement of the patella. By loosening the lateral retinaculum, the pressure on the lateral patella can be relieved and the dislocation of the patella corrected 29 .…”

“…Arthroscopy is used to loosen the lateral retinaculum and treat the intraarticular cartilage damage, reducing the surgical incisions and achieving early recovery 24 . Gao et al 25 made a window through the joint capsule under arthroscopy to expose the inner edge of the patella and reconstruct the MPFL patella insection. The insection of the femoral tunnel needs to be located by C-arm fluoroscopy, which has the disadvantages of the prolonged operation time, inaccurate positioning, and exposure of patients and medical staff to ionizing radiation.…”

Comparable outcome for autografts and allografts in primary medial patellofemoral ligament reconstruction for patellofemoral instability: systematic review and meta-analysis

“…Independent from the specific cause of the instability, following patellar dislocations the medial patellofemoral ligament (MPFL) is most often damaged [ 10 , 31 ]. This ligament is an important dynamic restraint to patellar lateralization during the first degrees of knee flexion, and therefore its reconstruction is often indicated when it is damaged [ 16 , 38 ]. Reconstruction of the MPFL, in combination with additional stabilization procedures when indicated, yields predictable improvements in patellar stability and patient satisfaction [ 3 , 39 ].…”