PDF herunterladen
CC BY-NC-ND 4.0 · Revista Chilena de Ortopedia y Traumatología 2021; 62(02): e104-e112
DOI: 10.1055/s-0041-1735603
Artículo Original | Original Article

Reconstruction of the Medial Patellofemoral Ligament with Patellar Transosseous Sutures: Cross-Sectional Study with 34 patients

Artikel in mehreren Sprachen: español | English
Andrés Pakuts 
1   Clínica Red Salud Elqui, La Serena, Chile
2   Centro Médico Ossis, La Serena, Chile
,
Luis Fernando Martin 
3   Residente Traumatología y Ortopedia, Facultad de Medicina Clínica Alemana de Santiago-Universidad del Desarrollo, Santiago, Chile
,
Christophe Riquoir 
4   Interno, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
,
Alex Schadenberg 
4   Interno, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
› Institutsangaben
› Weitere Informationen
Auch verfügbar auf
   Lizenzen und Reprints

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


Publikationsverlauf

Eingereicht: 17. Mai 2020

Angenommen: 22. März 2021

Artikel online veröffentlicht:
30. September 2021

© 2021. Sociedad Chilena de Ortopedia y Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • Referencias

  • 1 Desai VS, Tagliero AJ, Parkes CW. et al. Systematic Review of Medial Patellofemoral Ligament Reconstruction Techniques: Comparison of Patellar Bone Socket and Cortical Surface Fixation Techniques. Arthroscopy 2019; 35 (05) 1618-1628
    CrossrefPubMedSuche in Google Scholar
  • 2 Krebs C, Tranovich M, Andrews K, Ebraheim N. The medial patellofemoral ligament: Review of the literature. J Orthop 2018; 15 (02) 596-599
    CrossrefPubMedSuche in Google Scholar
  • 3 Gonçaives MB, Júnior LH, Soares LF, Gonçaives TJ, Dos Santos RL, Pereira ML. Medial patellofemoral ligament reconstruction to treat recurrent patellar dislocation. Rev Bras Ortop 2015; 46 (02) 160-164
    PubMedSuche in Google Scholar
  • 4 Atkin DM, Fithian DC, Marangi KS, Stone ML, Dobson BE, Mendelsohn C. Characteristics of patients with primary acute lateral patellar dislocation and their recovery within the first 6 months of injury. Am J Sports Med 2000; 28 (04) 472-479
    CrossrefPubMedSuche in Google Scholar
  • 5 Mäenpää H, Lehto MU. Patellofemoral osteoarthritis after patellar dislocation. Clin Orthop Relat Res 1997; (339) 156-162
    PubMedSuche in Google Scholar
  • 6 Sillanpää P, Mattila VM, Iivonen T, Visuri T, Pihlajamäki H. Incidence and risk factors of acute traumatic primary patellar dislocation. Med Sci Sports Exerc 2008; 40 (04) 606-611
    CrossrefPubMedSuche in Google Scholar
  • 7 Sillanpää PJ, Mattila VM, Visuri T, Mäenpää H, Pihlajamäki H. Patellofemoral osteoarthritis in patients with operative treatment for patellar dislocation: a magnetic resonance-based analysis. Knee Surg Sports Traumatol Arthrosc 2011; 19 (02) 230-235
    CrossrefPubMedSuche in Google Scholar
  • 8 Blønd L. Patellar Instability - An Update. Acta Orthop Belg 2017; 83 (03) 367-386
    PubMedSuche in Google Scholar
  • 9 Fithian DC, Paxton EW, Stone ML. et al. Epidemiology and natural history of acute patellar dislocation. Am J Sports Med 2004; 32 (05) 1114-1121
    CrossrefPubMedSuche in Google Scholar
  • 10 Subramanian P, Patel R. Patellofemoral instability: an overview. Orthop Trauma 2019; 33 (02) 119-126
    CrossrefPubMedSuche in Google Scholar
  • 11 Dejour H, Walch G, Nove-Josserand L, Guier C. Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 1994; 2 (01) 19-26
    CrossrefPubMedSuche in Google Scholar
  • 12 Stefancin JJ, Parker RD. First-time traumatic patellar dislocation: a systematic review. Clin Orthop Relat Res 2007; 455 (455) 93-101
    CrossrefPubMedSuche in Google Scholar
  • 13 Amin NH, Lynch TS, Patel RM, Patel N, Saluan P. Medial Patellofemoral Ligament Reconstruction. JBJS Rev 2015; 3 (07) 3-4
    PubMedSuche in Google Scholar
  • 14 Howells NR, Barnett AJ, Ahearn N, Ansari A, Eldridge JD. Medial patellofemoral ligament reconstruction: a prospective outcome assessment of a large single centre series. J Bone Joint Surg Br 2012; 94 (09) 1202-1208
    CrossrefPubMedSuche in Google Scholar
  • 15 Mistry JB, Bonner KF, Gwam CU, Thomas M, Etcheson JI, Delanois RE. Management of Injuries to the Medial Patellofemoral Ligament: A Review. J Knee Surg 2018; 31 (05) 439-447
    Thieme ConnectPubMedSuche in Google Scholar
  • 16 Russ SD, Tompkins M, Nuckley D, Macalena J. Biomechanical comparison of patellar fixation techniques in medial patellofemoral ligament reconstruction. Am J Sports Med 2015; 43 (01) 195-199
    CrossrefPubMedSuche in Google Scholar
  • 17 Migliorini F, Driessen A, Quack V, Schenker H, Tingart M, Eschweiler J. Patellar fixation graft via suture anchors versus tunnel techniques during isolated MPFL reconstruction for recurrent patellofemoral instability: a systematic review of the literature. Arch Orthop Trauma Surg 2020; 140 (09) 1201-1210
    CrossrefPubMedSuche in Google Scholar
  • 18 Lenschow S, Schliemann B, Gestring J, Herbort M, Schulze M, Kösters C. Medial patellofemoral ligament reconstruction: fixation strength of 5 different techniques for graft fixation at the patella. Arthroscopy 2013; 29 (04) 766-773
    CrossrefPubMedSuche in Google Scholar
  • 19 Lippacher S, Dreyhaupt J, Williams SR, Reichel H, Nelitz M. Reconstruction of the medial patellofemoral ligament: clinical outcomes and return to sports. Am J Sports Med 2014; 42 (07) 1661-1668
    CrossrefPubMedSuche in Google Scholar
  • 20 Lippacher S, Reichel H, Nelitz M. [Patellar fracture after patellar stabilization]. Orthopade 2010; 39 (05) 516-518
    CrossrefPubMedSuche in Google Scholar
  • 21 Parikh SN, Nathan ST, Wall EJ, Eismann EA. Complications of medial patellofemoral ligament reconstruction in young patients. Am J Sports Med 2013; 41 (05) 1030-1038
    CrossrefPubMedSuche in Google Scholar
  • 22 Parikh SN, Wall EJ. Patellar fracture after medial patellofemoral ligament surgery: a report of five cases. J Bone Joint Surg Am 2011; 93 (17) e97-( 1–8)
    CrossrefPubMedSuche in Google Scholar
  • 23 Sanchis-Alfonso V, Montesinos-Berry E, Ramirez-Fuentes C, Leal-Blanquet J, Gelber PE, Monllau JC. Failed medial patellofemoral ligament reconstruction: Causes and surgical strategies. World J Orthop 2017; 8 (02) 115-129
    CrossrefPubMedSuche in Google Scholar
  • 24 Schiphouwer L, Rood A, Tigchelaar S, Koëter S. Complications of medial patellofemoral ligament reconstruction using two transverse patellar tunnels. Knee Surg Sports Traumatol Arthrosc 2017; 25 (01) 245-250
    CrossrefPubMedSuche in Google Scholar
  • 25 Shah JN, Howard JS, Flanigan DC, Brophy RH, Carey JL, Lattermann C. A systematic review of complications and failures associated with medial patellofemoral ligament reconstruction for recurrent patellar dislocation. Am J Sports Med 2012; 40 (08) 1916-1923
    CrossrefPubMedSuche in Google Scholar
  • 26 Brown GD, Ahmad CS. The docking technique for medial patellofe-moral ligament reconstruction. Oper Tech Orthop 2007; 17 (04) 216-222
    CrossrefPubMedSuche in Google Scholar
  • 27 Gil-Gámez J, Pecos-Martín D, Kujala UM. et al. Validation and cultural adaptation of “Kujala Score” in Spanish. Knee Surg Sports Traumatol Arthrosc 2016; 24 (09) 2845-2853
    CrossrefPubMedSuche in Google Scholar
  • 28 Kujala UM, Jaakkola LH, Koskinen SK, Taimela S, Hurme M, Nelimarkka O. Scoring of patellofemoral disorders. Arthroscopy 1993; 9 (02) 159-163
    CrossrefPubMedSuche in Google Scholar
  • 29 Dejour D, Le Coultre B. Osteotomies in patello-femoral instabilities. Sports Med Arthrosc Rev 2007; 15 (01) 39-46
    CrossrefPubMedSuche in Google Scholar
  • 30 Schöttle PB, Schmeling A, Rosenstiel N, Weiler A. Radiographic landmarks for femoral tunnel placement in medial patellofemoral ligament reconstruction. Am J Sports Med 2007; 35 (05) 801-804
    CrossrefPubMedSuche in Google Scholar
  • 31 Schneider DK, Grawe B, Magnussen RA. et al. Outcomes After Isolated Medial Patellofemoral Ligament Reconstruction for the Treatment of Recurrent Lateral Patellar Dislocations: A Systematic Review and Meta-analysis. Am J Sports Med 2016; 44 (11) 2993-3005
    CrossrefPubMedSuche in Google Scholar
  • 32 Matassi F, Innocenti M, Andrea C, Zanna L, Malone J, Civinini R. Timing for Safe Return to Sport after Medial Patellofemoral Ligament Reconstruction: The Role of a Functional Test Battery. J Knee Surg. 2019 Sep 4
    PubMed
  • 33 Ambrožič B, Novak S. The influence of medial patellofemoral ligament reconstruction on clinical results and sports activity level. Phys Sportsmed 2016; 44 (02) 133-140
    CrossrefPubMedSuche in Google Scholar
  • 34 Krych AJ, O'Malley MP, Johnson NR. et al. Functional testing and return to sport following stabilization surgery for recurrent lateral patellar instability in competitive athletes. Knee Surg Sports Traumatol Arthrosc 2018; 26 (03) 711-718
    CrossrefPubMedSuche in Google Scholar
  • 35 Saper MG, Fantozzi P, Bompadre V, Racicot M, Schmale GA. Return-to-Sport Testing After Medial Patellofemoral Ligament Reconstruction in Adolescent Athletes. Orthop J Sports Med 2019; 7 (03) 232-235
    CrossrefPubMedSuche in Google Scholar
  • 36 Shams K, DiCesare CA, Grawe BM. et al. Biomechanical and Functional Outcomes After Medial Patellofemoral Ligament Reconstruction: A Pilot Study. Orthop J Sports Med 2019; 7 (02) 232-237
    CrossrefPubMedSuche in Google Scholar
  • 37 Kang H, Zheng R, Dai Y, Lu J, Wang F. Single- and double-bundle medial patellofemoral ligament reconstruction procedures result in similar recurrent dislocation rates and improvements in knee function: a systematic review. Knee Surg Sports Traumatol Arthrosc 2019; 27 (03) 827-836
    CrossrefPubMedSuche in Google Scholar
  • 38 Christiansen SE, Jacobsen BW, Lund B, Lind M. Reconstruction of the medial patellofemoral ligament with gracilis tendon autograft in transverse patellar drill holes. Arthroscopy 2008; 24 (01) 82-87
    CrossrefPubMedSuche in Google Scholar
  • 39 Dhinsa BS, Bhamra JS, James C, Dunnet W, Zahn H. Patella fracture after medial patellofemoral ligament reconstruction using suture anchors. Knee 2013; 20 (06) 605-608
    CrossrefPubMedSuche in Google Scholar
  • 40 Carstensen SE, Menzer HM, Diduch DR. Patellar Instability: When is Trochleoplasty Necessary?. Sports Med Arthrosc Rev 2017; 25 (02) 92-99
    CrossrefPubMedSuche in Google Scholar
  • 41 Balcarek P, Rehn S, Howells NR. et al. Results of medial patellofemoral ligament reconstruction compared with trochleoplasty plus individual extensor apparatus balancing in patellar instability caused by severe trochlear dysplasia: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2017; 25 (12) 3869-3877
    CrossrefPubMedSuche in Google Scholar
  • 42 Kita K, Tanaka Y, Toritsuka Y. et al. Factors Affecting the Outcomes of Double-Bundle Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Dislocations Evaluated by Multivariate Analysis. Am J Sports Med 2015; 43 (12) 2988-2996
    CrossrefPubMedSuche in Google Scholar
  • 43 Boutefnouchet T, Downham C, Bassett J, Thompson P, Sprowson A. The Efficacy of Medial Patellofemoral Ligament Reconstruction Combined with Tibial Tuberosity Transfer in the Treatment of Patellofemoral Instability. Knee Surg Relat Res 2016; 28 (02) 99-109
    CrossrefPubMedSuche in Google Scholar
  • 44 Magnussen RA, De Simone V, Lustig S, Neyret P, Flanigan DC. Treatment of patella alta in patients with episodic patellar dislocation: a systematic review. Knee Surg Sports Traumatol Arthrosc 2014; 22 (10) 2545-2550
    CrossrefPubMedSuche in Google Scholar
  • 45 Caplan N, Lees D, Newby M. et al. Is tibial tuberosity-trochlear groove distance an appropriate measure for the identification of knees with patellar instability?. Knee Surg Sports Traumatol Arthrosc 2014; 22 (10) 2377-2381
    CrossrefPubMedSuche in Google Scholar
  • 46 Mulliez A, Lambrecht D, Verbruggen D, Van Der Straeten C, Verdonk P, Victor J. Clinical outcome in MPFL reconstruction with and without tuberositas transposition. Knee Surg Sports Traumatol Arthrosc 2017; 25 (09) 2708-2714
    CrossrefPubMedSuche in Google Scholar
  • 47 Yeung M, Leblanc MC, Ayeni OR. et al. Indications for Medial Patellofemoral Ligament Reconstruction: A Systematic Review. J Knee Surg 2016; 29 (07) 543-554
    Thieme ConnectPubMedSuche in Google Scholar