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Double-bundle reconstruction of MPFL seen as effective treatment for patellar instability
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Investigators of a recently published study found long-term clinical results of double-bundle reconstruction of the medial patellofemoral ligament showed the procedure was effective for the treatment of chronic patellar instability.
Researchers identified 68 patients with chronic patellar instability who underwent double-bundle reconstruction of the medial patellofemoral ligament with the semitendinosus tendon from May 2005 to February 2010. During follow-up, investigators assessed the Tegner activity scale score, Kujala score and Lysholm knee score. An objective physical examination was also performed. Median follow-up was 8 years. After 2 years postoperatively, there were eight patients lost to follow-up.
Results showed the mean Tegner score increased preoperatively to 6 months postoperatively from 2.85 to 4.91. At 2 years postoperatively, the mean Tegner score had increased to 7.26. At the last follow-up, it increased to 7.82. All patients had achieved “pain-free at rest” at the last follow-up; however, eight patients had knee pain in activities of daily living.
The preoperative mean Kujala score was approximately 58. At 6 months, 2 years and the last follow-up, it increased to about 61, 90 and 89, respectively. The preoperative Lysholm score was approximately 44, which increased to 58 at 6 months postoperatively. The Lysholm score also increased to about 89 at 2 years postoperatively. At the last follow-up, the score was about 90. Preoperatively and at 6 months, 2 years and at the last follow-up, the range of motion was about 121°, 129°, 131° and 131°, respectively. – by Monica Jaramillo
Disclosures: The researchers report no relevant financial disclosures.
Perspective
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Miho J. Tanaka, MD
In this study, Zhang and Li reported on 68 patients, mean age 21 years, who underwent double-bundle medial patellofemoral ligament (MPFL) reconstruction for the treatment of chronic patellar instability. The study population included patients with two or more dislocations without signs of significant bony malalignment or trochlear dysplasia. The authors used a technique that secured semitendinosus autograft with two suture anchors to the superomedial and middle patella, and secured the graft ends within a single tunnel on the medial femur while setting graft length at 30° knee flexion. At 8-year follow-up (range 6 to 10 years), there were no recurrences or patella fractures. At final follow-up, the mean Tegner score was 7.82 ± 0.89, Kujala score was 88.92 ± 3.84 and Lysholm score was 89.67 ± 4.13. Range of motion was 130.78° ± 5.80°.
The authors presented one of the largest and longest-term series demonstrating outcomes after double-bundle MPFL reconstruction, reporting no recurrences or major complications in this group. Although the results are promising for this technique, further studies are needed to determine whether the addition of this second strand leads to improved long-term outcomes vs. single-strand reconstruction techniques. Studies that identify the optimal knee flexion angle to set graft length for each bundle, as well as the role of proximal bundle fixation of the quadriceps tendon, can improve our techniques in double-stranded reconstructions. Understanding the role of double- vs. single-bundle MPFL reconstruction in the setting of various anatomic risk factors may help tailor our indications in the surgical treatment of patellar instability.
Department of orthopaedic surgery
The Johns Hopkins Hospital
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