Abstract
Introduction Recurrent patellar instability can lead to poor functional results and progressive articular damage in the long term, and is frequently addressed by medial patellofemoral ligament reconstruction (MPFLR), with multiple techniques that most commonly differ regarding the method of patellar fixation.
Objective To evaluate the results of MPFLR using a novel technique of patellar fixation using transosseous sutures. The main objective is to determine the redislocation rates and functional results. The secondary goals include an assessment of complications and other related variables, and a comparison between isolated MPFLR and MPFLR associated to tibial tubercle osteotomy.
Methods A cross-sectional study of 34 patients who underwent MPFLR from 2013 to 2019 with a minimum of 12 months of follow-up. The reconstruction was performed by the same first surgeon with double-bundle gracilis autograft in all cases. Fixation of the graft to the medial aspect of the patella was performed with two independent transosseous fixation points with high resistance sutures, and anatomic femoral fixation with an interference screw using anatomical and radiological landmarks. There were 27 patients with isolated MPFR, and 7 with associated tibial tubercle osteotomy.
Results The mean age was of 22.8 years (standard deviation [SD]: 9.1). Men comprised 50% of the sample. The mean follow-up from surgery to the application of the questionnaire was of 30.4 months (range: 12 to 72 months). The mean Kujala score at follow-up was of 89.4 (SD: 12.8; median: 93.5; range: 51 to 100). There were no cases of redislocation. No other complications were identified during the follow-up. In total, 81% of patients returned to sports, with 47% returning to their previous level of participation. No significant differences were found when comparing isolated MPFLR with MPFLR associated osteotomy groups.
Conclusion The MPFLR procedure using transosseous sutures for patellar fixation showed that patellar stability was restored in the short to midterm. This technique is safe and has excellent functional outcomes, and it prevents potential complications of patellar tunnels or the morbidity associated to the use of implants.
Keywords
medial patellofemoral ligament - reconstruction - patellar instability
