J Knee Surg 2020; 33(10): 998-1003
DOI: 10.1055/s-0039-1688841
Original Article

Medial Patellofemoral Ligament Reconstruction in Traumatic Patellar Dislocation without Patellar Fixation

Samir Abdulrazik Ibrahim
1   Division of Sports Medicine, Department of Orthopaedic Surgery, Al-Razi Orthopaedic Hospital, Kuwait City, Kuwait
,
Emad Mureed Shohdy
1   Division of Sports Medicine, Department of Orthopaedic Surgery, Al-Razi Orthopaedic Hospital, Kuwait City, Kuwait
,
Sami Abdulghaffar Ramadan
1   Division of Sports Medicine, Department of Orthopaedic Surgery, Al-Razi Orthopaedic Hospital, Kuwait City, Kuwait
,
Abdulrahman Khalid Almisfer
1   Division of Sports Medicine, Department of Orthopaedic Surgery, Al-Razi Orthopaedic Hospital, Kuwait City, Kuwait
,
Wael Shoabe Abdulsattar
1   Division of Sports Medicine, Department of Orthopaedic Surgery, Al-Razi Orthopaedic Hospital, Kuwait City, Kuwait
,
Sherif Khairat
2   Department of Physical Medicine, Al-Razi Orthopaedic Hospital, Kuwait City, Kuwait
› Author Affiliations

Abstract

Acute traumatic patellar dislocation is a common injury, and spontaneous reduction may occur at the time of injury or may be reduced at the field of the accident by someone. It may be associated with osteochondral fractures and rupture of medial patellar stabilizers leading to recurrent patellar instability. The aim of this prospective study was to evaluate the outcomes of medial patellofemoral (PF) ligament (MPFL) reconstruction in recurrent traumatic patellar dislocation. Forty-five patients presented with PF instability as a result of traumatic rupture MPFL with normal patellar tracking underwent MPFL reconstruction without patellar fixation hardware through two parallel transpatellar tunnels and one screw in femoral tunnel. All patients were evaluated clinically preoperatively and at a minimum follow-up of 24 months, and International Knee Documentation Committee (IKDC) and Kujala scores were used to assess the clinical results. All patients were available for evaluation at a minimum of 24 months (up to 36 months). The mean age of these patients at the time of surgery was 22.82 years (range: 18–34 years). All patients gave history of trauma of their knees. Mean IKDC scale showed significant improvement as it rose from 47.17 preoperatively to 77.94 postoperatively, and mean Kujala score rose from 53.88 preoperatively to 86.24 postoperatively (p < 0.001). No recurrence of dislocation was recorded. Only three patients had mild atrophy of thigh and one patient had some difficulty in jumping. Reconstruction of MPFL by this method provides good clinical result in the treatment of PF instability by using autologous graft (semitendinosus and gracilis). Less hardware were used with less complications.



Publication History

Received: 20 November 2018

Accepted: 05 April 2019

Article published online:
23 May 2019

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers
333 Seventh Avenue, New York, NY 10001, USA.

 
  • References

  • 1 Feller JA. Recurrent patellar instability: assessment and decision making. Oper Tech Sports Med 2015; 23 (02) 68-76
  • 2 Manske RC, Prohaska D. Rehabilitation following medial patellofemoral ligament reconstruction for patellar instability. Int J Sports Phys Ther 2017; 12 (03) 494-511
  • 3 Chotel F, Bérard J, Raux S. Patellar instability in children and adolescents. Orthop Traumatol Surg Res 2014; 100 (1, Suppl): S125-S137
  • 4 Berruto M, Ferrua P, Tradati D, Uboldi F, Usellini E, Marelli BM. Suture anchors fixation in MPFL reconstruction using a bioactive synthetic ligament. Joints 2017; 5 (03) 188-190
  • 5 Berruto M, Ferrua P, Uboldi F. , et al. Medial patellofemoral ligament reconstruction with bioactive synthetic ligament is an option. A 3-year follow-up study. Knee Surg Sports Traumatol Arthrosc 2014; 22 (10) 2419-2425
  • 6 Calanna F, Pulici L, Carimati G, Quaglia A, Volpi P. Medial patello-femoral ligament (MPFL) reconstruction using suture anchors fixation: preliminary results. Muscles Ligaments Tendons J 2016; 6 (01) 64-70
  • 7 Charalambous CP, Kwaees TA. Anatomical considerations in hamstring tendon harvesting for anterior cruciate ligament reconstruction. Muscles Ligaments Tendons J 2013; 2 (04) 253-257
  • 8 Lee PYF, Golding D, Rozewicz S, Chandratreya A. Modern synthetic material is a safe and effective alternative for medial patellofemoral ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2018; 26 (09) 2716-2721
  • 9 Tompkins M, Kuenze CM, Diduch DR, Miller MD, Milewski MD, Hart JP. Clinical and functional outcomes following primary repair versus reconstruction of the medial patellofemoral ligament for recurrent patellar instability. J Sports Med (Hindawi Publ Corp) 2014; 2014: 702358
  • 10 Nomura E, Horiuchi Y, Kihara M. A mid-term follow-up of medial patellofemoral ligament reconstruction using an artificial ligament for recurrent patellar dislocation. Knee 2000; 7 (04) 211-215
  • 11 Azimi H, Anakwenze O. Medial patellofemoral ligament reconstruction using dual patella docking technique. Arthrosc Tech 2017; 6 (06) e2093-e2100
  • 12 Ma CB, Francis K, Towers J, Irrgang J, Fu FH, Harner CH. Hamstring anterior cruciate ligament reconstruction: a comparison of bioabsorbable interference screw and EndoButton-post fixation. Arthroscopy 2004; 20 (02) 122-128
  • 13 Carmont MR, Maffulli N. Medial patellofemoral ligament reconstruction: a new technique. BMC Musculoskelet Disord 2007; 8: 22
  • 14 Schock EJ, Burks RT. Medial patellofemoral ligament reconstruction using a hamstring graft. Oper Tech Sports Med 2001; 9 (03) 169-175
  • 15 Farr J, Schepsis AA. Reconstruction of the medial patellofemoral ligament for recurrent patellar instability. J Knee Surg 2006; 19 (04) 307-316
  • 16 Drez Jr D, Edwards TB, Williams CS. Results of medial patellofemoral ligament reconstruction in the treatment of patellar dislocation. Arthroscopy 2001; 17 (03) 298-306
  • 17 Li J, Li Z, Wang K, Liu C, Wang Y, Wang H. Medial patellofemoral ligament reconstruction: a comparison of single-bundle transpatellar tunnel and double-anchor anatomic techniques for the treatment of recurrent lateral patellar dislocation in adults. Arthroscopy 2019; 35 (03) 845-854.e1
  • 18 Mikashima Y, Kimura M, Kobayashi Y, Miyawaki M, Tomatsu T. Clinical results of isolated reconstruction of the medial patellofemoral ligament for recurrent dislocation and subluxation of the patella. Acta Orthop Belg 2006; 72 (01) 65-71
  • 19 Nomura E, Inoue M. Hybrid medial patellofemoral ligament reconstruction using the semitendinous tendon for recurrent patellar dislocation: minimum 3 years' follow-up. Arthroscopy 2006; 22 (07) 787-793
  • 20 Bicos J, Carofino B, Andersen M, Schepsis AA, Fulkerson JP, Mazzocca A. Patellofemoral forces after medial patellofemoral ligament reconstruction: a biomechanical analysis. J Knee Surg 2006; 19 (04) 317-326
  • 21 Elias JJ, Cosgarea AJ. Technical errors during medial patellofemoral ligament reconstruction could overload medial patellofemoral cartilage: a computational analysis. Am J Sports Med 2006; 34 (09) 1478-1485
  • 22 Lorbach O, Zumbansen N, Kieb M. , et al. Medial patellofemoral ligament reconstruction: impact of knee flexion angle during graft fixation on dynamic patellofemoral contact pressure-A biomechanical study. Arthroscopy 2018; 34 (04) 1072-1082
  • 23 Stephen JM, Kaider D, Lumpaopong P, Deehan DJ, Amis AA. The effect of femoral tunnel position and graft tension on patellar contact mechanics and kinematics after medial patellofemoral ligament reconstruction. Am J Sports Med 2014; 42 (02) 364-372
  • 24 Tanaka MJ, Bollier MJ, Andrish JT, Fulkerson JP, Cosgarea AJ. Complications of medial patellofemoral ligament reconstruction: common technical errors and factors for success: AAOS exhibit selection. J Bone Joint Surg Am 2012; 94 (12) e87