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J Knee Surg 2024; 37(03): 167-174
DOI: 10.1055/a-2001-6565
Original Article

MPFL Reconstruction Combined with a Modified Elmslie–Trillat Procedure for Recurrent Patellofemoral Instability

Genya Mitani
1   Department of Orthopaedic Surgery, Tokai University Oiso Hospital, Naka-gun, Kanagawa, Japan
,
Kenji Serigano
2   Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Kanagawa, Japan
,
Tomonori Takagaki
2   Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Kanagawa, Japan
,
Kosuke Hamahashi
2   Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Kanagawa, Japan
,
Daichi Takizawa
2   Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Kanagawa, Japan
,
Yasuyuki Sogo
2   Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Kanagawa, Japan
,
Masato Sato
2   Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Kanagawa, Japan
,
Masahiko Watanabe
2   Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Kanagawa, Japan
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Abstract

Several combined procedures have been reported for treating recurrent patellofemoral instability (RPI) with various types and severity of morphological abnormalities, but none have identified absolute threshold values as indications for surgery. We performed medial patellofemoral ligament (MPFL) reconstruction combined with a modified Elmslie–Trillat (ET) procedure on 24 knees (10 male and 11 female patients) to treat RPI with morphological abnormalities corresponding to elevated tibial tubercle–trochlear groove (TT–TG) distance, significant patella alta, and trochlear dysplasia. The inclusion criteria were RPI with morphological abnormalities corresponding to one or more of the following: sulcus angle > 160 degrees, trochlear dysplasia of Dejour classification C or D, Caton–Deschamps index > 1.5, lateral shift ratio > 50%, congruence angle > 15 degrees, or TT–TG distance > 20 mm, including habitual dislocation of the patella. Skeletally immature patients and those with congenital dislocation of the patella were excluded. The Kujala score, International Knee Documentation Committee subjective score, Knee Injury and Osteoarthritis Outcome score (KOOS), and each item of the KOOS improved significantly after surgery. Patellar apprehension sign was present preoperatively in all cases, but all disappeared postoperatively. No instance of postoperative redislocation was observed. On radiographic examination, the mean Q angle, tilting angle, lateral shift ratio, congruence angle, Caton–Deschamps index, Insall–Salvati index, and TT–TG distance improved significantly after surgery. There were no significant differences in sulcus angle after surgery. These results suggest MPFL reconstruction combined with a modified ET procedure provides satisfactory outcomes based on radiological and clinical evaluations for RPI with morphological abnormalities corresponding to elevated TT–TG distance, significant patella alta, and trochlear dysplasia.

Keywords

recurrent patellofemoral instability (RPI) - medial patellofemoral ligament (MPFL) reconstruction - Elmslie-Trillat procedure


Publikationsverlauf

Eingereicht: 29. März 2021

Angenommen: 16. Dezember 2022

Accepted Manuscript online:
20. Dezember 2022

Artikel online veröffentlicht:
02. Februar 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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