Medial Patellofemoral Ligament (MPFL) Reconstruction Surgery in Iranian Patients with Recurrent Patellar Dislocation: Report of Three Years Experiences

2015 ◽  
Vol 8 (1) ◽  
pp. 165-170 ◽  
Author(s):  
Ali Torkaman ◽  
Siamak Monshizadeh ◽  
Mohammadhasan Shabanpour
Keyword(s):  
Patellar Dislocation ◽  
Medial Patellofemoral Ligament ◽  
Mpfl Reconstruction ◽  
Recurrent Patellar Dislocation ◽  
Reconstruction Surgery ◽  
Iranian Patients

scholarly journals Clinical Outcomes After Medial Patellofemoral Ligament Reconstruction With Suture Fixation of the Gracilis Tendon via Transosseous Tunnels

2020 ◽  
Vol 8 (2) ◽  
pp. 232596711990037
Author(s):  
Hangzhou Zhang ◽  
Mao Ye ◽  
Qingwei Liang
Keyword(s):  
Patellar Dislocation ◽  
Medial Patellofemoral Ligament ◽  
Case Series ◽  
Mpfl Reconstruction ◽  
Suture Fixation ◽  
Recurrent Patellar Dislocation ◽  
Patellar Tilt ◽  
Transosseous Suture ◽  
Patellar Tilt Angle

Background: Several fixation methods have been introduced in medial patellofemoral ligament (MPFL) reconstruction. However, the optimal management of patients with recurrent patellar dislocation remains controversial. Purpose: To present a case series with a minimum 2-year follow-up of 29 patients with recurrent patellar dislocation who underwent a new transosseous suture fixation technique for MPFL reconstruction. Study Design: Case series; Level of evidence, 4. Methods: From January 2014 through February 2016, a total of 29 patients with recurrent patellar dislocation for which the MPFL was reconstructed with transosseous suture patellar fixation were studied. All patients were available for follow-up (mean, 37.52 months; range, 26-48 months). The patellar attachment was fixed by transosseous patellar sutures. The International Knee Documentation Committee (IKDC) subjective knee score, Kujala score, Tegner score, range of motion, congruence angle, patellar tilt angle, and complications were assessed both pre- and postoperatively. Results: No recurrent dislocation was observed in any of the 29 patients for a minimum of 2 years. All outcome scores improved significantly from preoperatively to postoperatively: the average IKDC subjective knee evaluation score from 53 to 87, Kujala from 54 to 90, Lysholm from 50 to 89, and Tegner from 3 to 5 ( P < .001 for all). The congruence angle significantly decreased from 22° preoperatively to –3° postoperatively, and the patellar tilt angle (Merchant) decreased from 23° preoperatively to 5° postoperatively ( P < .001 for both). In total, 25 patients (25/29; 86.21%) were completely pain-free when performing activities of daily living at the last follow-up, and 27 patients (93.1%) rated themselves as very satisfied or satisfied with the results. Conclusion: In patients with chronic recurrent patellar dislocation, transosseous patellar suture fixation for MPFL reconstruction can significantly improve patellar stability and achieve good results at short-term follow-up.

scholarly journals Medial patellofemoral ligament reconstruction using autologous hamstring graft for recurrent patellar dislocation: a clinical and functional outcome evaluation

2021 ◽  
Vol 7 (4) ◽  
pp. 854
Author(s):  
Sanjib Ghosh ◽  
Ayon Das ◽  
Mahak Baid ◽  
Arijit Das
Keyword(s):  
Patellar Dislocation ◽  
Medial Patellofemoral Ligament ◽  
Patellofemoral Instability ◽  
Outcome Evaluation ◽  
Mpfl Reconstruction ◽  
Anatomical Reconstruction ◽  
Complication Rates ◽  
Hamstring Graft ◽  
Recurrent Patellar Dislocation ◽  
Kujala Score

<p>Patellofemoral instability is a painful and often recurring disorder with many negative long-term consequences. Surgical treatment for patellar dislocation has evolved from the initial medial reefing to the present-day anatomical reconstruction of medial patellofemoral ligament (MPFL) which is thought to be the most appropriate treatment. MPFL reconstruction successfully addresses patellofemoral instability by restoring the deficient most important static primary soft tissue restraint. This prospective case series was conducted at a Tertiary care Govt. Hospital in Kolkata between January 2019 to August 2020 on 15 patients who underwent MPFL reconstruction for recurrent patellar dislocation. All patients were followed up at an interval of 2 weeks, 6 weeks, 3 months and 6 months. Kujala score was used to assess the functional outcomes of the patients. Out of 15 patients, 13 (86.7%) showed good to excellent results whereas 2 (13.3%) had Fair outcome and none of the patients demonstrated Poor surgical result. The mean Kujala score improved from 49.6 pre-operatively to 92.7 post-operatively. By the end of 6 months follow-up, 13 (86.7%) patients achieved almost full range of motion. Majority (80%) of patients did not have any complications. Only 2 patients had a post-operative recurrence (13.3%). Reconstruction of MPFL using autologous hamstring graft showed excellent results over the short term with a low re-dislocation rate and acceptable complication rates. It greatly helps in preventing further episodes of patellar subluxations or dislocations and in improving quality of life.</p>

scholarly journals Medial patellofemoral ligament reconstruction combined with biplanar supracondylar femoral derotation osteotomy in recurrent patellar dislocation with increased femoral internal torsion and genu valgum: a retrospective pilot study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Xiangtian Deng ◽  
Lingzhi Li ◽  
Peng Zhou ◽  
Fuyuan Deng ◽  
Yuan Li ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Patellar Dislocation ◽  
Medial Patellofemoral Ligament ◽  
Mechanical Axis ◽  
Genu Valgum ◽  
Mpfl Reconstruction ◽  
Ct Scans ◽  
Recurrent Patellar Dislocation ◽  
Derotation Osteotomy

Abstract Background The purpose of this study was to evaluate the clinical and radiographic outcomes after medial patellofemoral ligament (MPFL) reconstruction combined with supracondylar biplanar femoral derotation osteotomy (FDO) in recurrent patellar dislocation (RPD) with increased femoral anteversion angle (FAA) and genu valgum. Methods Between January 2017 to December 2020, a total of 13 consecutive patients (13 knees, 4 males and 9 females, mean age 18.7 (range, 15–29 years) with RPD with increased FAA (FAA > 25°) and genu valgum (mechanical axis deformity of ≥5°) who underwent supracondylar biplanar FDO using a Tomofix-locking plate combined with MPFL reconstruction in our institution were included. Preoperative full-leg standing radiographs, lateral views, and hip-knee-ankle computed tomography (CT) scans were used to evaluate the mechanical lateral distal femoral angle (mLDFA), anatomical femorotibial angle (aFTA), mechanical axis, patellar height, tibial tubercle-trochlear groove (TT-TG) distance, and torsional angle of the tibial and femoral in the axial plane. Patient reported outcomes were evaluated using the International Knee Documentation Committee (IKDC) score, Kujala score, Lysholm score, visual analog scale (VAS), and Tegner score preoperatively and postoperatively. Postoperative CT scans were used to evaluate the changes of FAA and TT-TG, and full-leg standing radiographs was used to evaluate the changes of mLDFA, aFTA, and mechanical axis. Results A total of 13 patients (13 knees) were included with an average follow-up period of 26.7 months (range 24–33). No cases developed wound infection, soft tissue irritation, and recurrent patellar dislocation during the follow-up period after surgery. Bone healing at the osteotomy site was achieved in all cases, and all patients regained full extension and flexion. Clinical outcomes (VAS, Kujala, IKDC, Lysholom, and Tegner scores) improved significantly at the final follow-up after surgery (p < 0.05). The mean mLDFA, aFTA, mechanical axis, and TT-TG distance showed statistically significant improvement following the combined surgery (p < 0.05), while the CDI did not change significantly after surgery (p>0.05). Conclusion MPFL reconstruction combined with supracondylar biplanar FDO showed satisfactory clinical outcomes and radiographic results in the short-term follow-up period.

scholarly journals Efficacy Study of Medial Patellofemoral Ligament Single-bundle Reconstruction with Anterior Half of the Peroneus Longus Tendon Autograft for Treatment of Recurrent Patellar Dislocation

2020 ◽  
Author(s):  
Junjun Zha ◽  
Tianwei Zhang ◽  
E Cai ◽  
Ju Tang
Keyword(s):  
Patellar Dislocation ◽  
Medial Patellofemoral Ligament ◽  
Mpfl Reconstruction ◽  
Lateral Release ◽  
Recurrent Patellar Dislocation ◽  
Peroneus Longus Tendon ◽  
Longus Tendon ◽  
Peroneus Longus ◽  
Anterior Half ◽  
Tendon Autograft

Abstract Background To report the clinical outcomes of a longitudinal patellar tunnel technique in reconstruction of the medial patellofemoral ligament(MPFL) with anterior half of the peroneus longus tendon autograft treatment of recurrent patellar dislocation.Methods From May 2010 to January 2019, we performed MPFL reconstruction with anterior half of the peroneus longus tendon autograft by using a longitudinal patellar tunnel technique on 48 knees in 45 patients(26 female, 19 male) with the median age was 24 (17 ~ 44) years old with recurrent patellar dislocation. We made one 4. 5 mm channel from the medial upper edge of the patella to the surface (medial half) of the patella so that to introduce autograft into the medial femoral channel. The autograft was fixed with absorbable screws with the knee bent at 30°. CT and X-rays were used to assess the correction of the tibia tuberosity- trochlear groove (TT-TG) distance, patellar tilt angle, Caton-Deschamps index, femoral anteversion angle, tibial extorsion angle, and the presence or absence of knee valgus. Subjective scores, such as Kujala score and Lysholm score, were used to evaluate knee function preoperatively and postoperatively.Results No recurrence of patellar dislocation occurred in these patients during an average of 25 ± 7.6 months (range, 6 to 54 months) of follow-up. Preoperative TT-TG distance, patellar tilt angles, and Caton-Deschamps index was (18.9 ± 5.7)mm(10.2mm ~ 32.4 mm),31.5°±13.7° (20.3°~58.4°),1.1 ± 0.2 (1.0 ~ 1.5), respectively, which were corrected by (10.8 ± 4.3) mm (4.5 mm ~ 17.1 mm), 10.7°±2.6° (5.6°~15.3°), and 1.07 ± 0.06 (1.02 ~ 1.15) postoperatively(P < 0.05). 28 knees were treated with lateral release + MPFL reconstruction; 11 knees were treated with lateral release + tibial tubercle ingression + MPFL reconstruction; 9 knees were treated with lateral release + tibial tubercle ingression and depression + MPFL reconstruction. At the last follow-up, Lysholm score was (89.7 ± 2.3), which significantly improved (P < 0.05) compared with the pre-operational score of (54.4 ± 5.9); Kujala score was (91.5 ± 4.4) points, which significantly improved (P < 0.05) compared with the pre-operational score of (60.6 ± 5.8).Conclusion One patellar tunnels in reconstruction of the medial patellofemoral ligament (MPFL) with anterior half of the peroneus longus tendon autograft is a safe, effective, and economic method for recurrent patellar dislocation.

scholarly journals Medial patellofemoral ligament reconstruction combined with biplanar supracondylar femoral derotation osteotomy in recurrent patellar dislocation with increased femoral internal torsion and genu valgum: a retrospective study

2021 ◽  
Author(s):  
Xiangtian Deng ◽  
Lingzhi Li ◽  
Peng Zhou ◽  
Yuan Li ◽  
Yanwei He ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Patellar Dislocation ◽  
Medial Patellofemoral Ligament ◽  
Genu Valgum ◽  
Mpfl Reconstruction ◽  
Ct Scans ◽  
Recurrent Patellar Dislocation ◽  
Derotation Osteotomy ◽  
The Mean

Abstract Background The purpose of this study was to evaluate the clinical and radiographic outcomes after medial patellofemoral ligament (MPFL) reconstruction combined with supracondylar biplanar femoral derotation osteotomy (FDO) in recurrent patellar dislocation (RPD) with increased femoral anteversion angle (FAA) and genu valgum. Methods Between January 2017 to December 2020, a total of 13 consecutive patients (13 knees, 4 males and 9 females, mean age 18.7 (range, 15–29) years) with RPD with increased FAA and genu valgum who underwent supracondylar biplanar FDO using a Tomofix-locking plate combined with MPFL reconstruction in our institution were included. Preoperative full-leg standing radiographs, lateral views, and hip-knee-ankle computed tomography (CT) scans were used to evaluate the mechanical lateral distal femoral angle (mLDFA), patellar height, tibial tubercle-trochlear groove (TT-TG) distance, and torsional angle of the tibial and femoral in the axial plane. Patient reported outcomes were evaluated using the International Knee Documentation Committee (IKDC) score, Kujala score, Lysholm score, visual analog scale (VAS), and Tegner score preoperatively and postoperatively. Postoperative CT scans were used to evaluate the changes of FAA and TT-TG, and full-leg standing radiographs was used to evaluate the changes of mLDFA. Results A total of 13 patients (13 knees) were included with an average follow-up period of 14.7 months (range 12–26). No cases of patients developed wound infection, soft tissue irritation, and recurrent dislocation during the follow-up period after surgery. Bone healing at the osteotomy site was achieved in all cases, and all patients regained full extension and flexion. Clinical outcomes (VAS, Kujala, ICDC, Lysholom, and Tegner scores) improved significantly at the final follow-up after surgery (p < 0.05). The mean mLDFA changed significantly from 82.72°±3.27° to 88.63°±2.35°. The mean TT-TG distance significantly decreased from 19.63 ± 3.21 mm to 13.29 ± 2.78 mm, while the CDI did not change significantly after surgery (p༞0.05). The mean FAA significantly decreased from 32.77°±3.78° to 19.08°±3.14°, while the tibial torsion did not change significantly after surgery (p༞0.05). Conclusion MPFL reconstruction combined with supracondylar biplanar FDO showed satisfactory clinical outcomes and radiographic results in the short-term follow-up period.

Return to Sport After Medial Patellofemoral Ligament Reconstruction: A Systematic Review and Meta-analysis

2021 ◽  
pp. 036354652199000
Author(s):  
Brooks N. Platt ◽  
Lucy A. Bowers ◽  
Justin A. Magnuson ◽  
Sean M. Marx ◽  
Joseph N. Liu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Patellar Dislocation ◽  
Patellar Instability ◽  
Medial Patellofemoral Ligament ◽  
Meta Analysis ◽  
Return To Sport ◽  
High Rate ◽  
Mpfl Reconstruction ◽  
Recurrent Patellar Dislocation ◽  
Preoperative Level

Background: Patellar instability is frequently encountered in the athletic population. Medial patellofemoral ligament (MPFL) reconstruction is a common strategy to treat recurrent patellar dislocation and demonstrates good clinical outcomes. Purpose/Hypothesis: The purpose was to examine return to sport after MPFL reconstruction for patellar instability. We hypothesized that patients would resume athletic activity at a high rate and that a large proportion would return to their preoperative level of performance. Study Design: Systematic review and meta-analysis. Methods: A systematic review of the literature was conducted using PubMed and Cochrane Library databases to identify articles reporting return to sport after MPFL reconstruction for recurrent patellar dislocation. Athletes were defined as those reporting a preoperative sport. A random-effects model was used to evaluate return to sport rates, subsequent level, and rate of instability recurrence. Meta-regression was used to compare return to sport rates in patients undergoing MPFL reconstruction without osteotomy compared with those treated with simultaneous tibial tubercle osteotomy or trochleoplasty. Results: In total, 23 articles met inclusion criteria after full-text review. A total of 930 patients were analyzed, including 786 athletes. Women represented 61.3% of all patients. The overall mean age was 21.1 years (range, 9.5-60.0 years), with a mean follow-up time of 3.0 years (range, 0.8-8.5 years). The return to sport rate was 92.8% (95% CI, 86.4-97.6). Patients returned to or surpassed their preoperative level of activity in 71.3% (95% CI, 63.7-78.4) of cases. An osteotomy was performed on 10.5% of athletes. Return to sport did not differ significantly in patients undergoing MPFL reconstruction without osteotomy versus those receiving additional osteotomy (95.4% vs 86.9%; P = .22). Patients returned to sport at a mean of 6.7 months (range, 3.0-6.4 months) postoperatively. Osteotomy did not affect return time. Complications occurred at an overall rate of 8.8%. The most common complication was recurrence of instability (1.9%; 95% CI, 0.4-4.0). The Kujala score was reported by 13 studies, with pre- and postoperative combined means of 60.3 and 90.0, respectively. Conclusion: MPFL reconstruction is an effective and reliable treatment in the setting of patellofemoral instability. Surgeons can counsel their patients that they can expect a high rate of return to sport after MPFL reconstruction surgery alone or with concomitant osteotomy.

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