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Good results seen with single-bundle transpatellar tunnel and double-anchor anatomic techniques for ligament reconstruction
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Although good results were achieved by both the single-bundle transpatellar tunnel technique and the double-anchor anatomic reconstruction technique for medial patellofemoral ligament reconstruction, according to recently published results, the double-anchor anatomic technique may be more effective as it provided a more congruous patellofemoral joint and better knee function.
Researchers randomly categorized 91 patients with recurrent patellar dislocation to either receive the traditional single-bundle transpatellar tunnel technique or the double-anchor anatomic reconstruction technique. CT with congruence angle, lateral patellar angle, patellar tilt angle and lateral patellar translation were used to evaluate the patellar position and rotation preoperatively and at the follow-up. The mean follow-up was 41.1 months. Kujala, Lysholm, Tegner and the IKDC scores were used to assess subjective symptoms and functional outcomes. Investigators conducted clinical examinations and also recorded any redislocations or episodes of instability.
Results showed no recurrent patellar dislocations occurred at the final follow-up, apart from four patients with instability symptoms among patients who underwent medial patellofemoral ligament reconstruction with the single-bundle transpatellar tunnel technique. However, there was no significant difference between the two treatment groups. Investigators noted CT measurements decreased significantly to the normal range. The groups were not significantly different regarding this measure; however, a lesser patellar tilt angle was seen in patients who underwent medial patellofemoral ligament reconstruction with double-anchor anatomic reconstruction technique.
There were significant improvements seen in the clinical examinations. There were also no statistically significant differences seen between the two treatment groups with regard to the number of patients with abnormal lateral patellar translation grade and firm end point.
The outcome scores improved significantly between the groups, with no significant differences seen between the groups. However, higher Kujala and IKDC scores were seen in patients who underwent the double-anchor anatomic reconstruction technique. – by Monica Jaramillo
Disclosures: The researchers report no relevant financial disclosures.
Perspective
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John P. Fulkerson, MD
The article by Li and colleagues demonstrates, again, that MPFL reconstruction effectively controls lateral instability of the patella in recurrent patella dislocation patients with deficient medial retinacular restraints. The authors mention greater than 150° trochlea angle and grade 4 to 5 Wiberg patella dysplasia as exclusion criteria, suggesting that patients in this series had lesser degrees of dysplasia and no malalignment. They also limited the study to patients with a TT-TG distance of less than 15. Previous studies have shown efficacy of MPFL reconstruction in such patients regardless of technique used, so the study by Li and colleagues is consistent with what we see in the literature to date.
The low complication rate with both procedures indicates that grafts were properly tensioned and that the surgery was well done with both techniques. A properly tensioned MPFL reconstruction will work well as long as the patella is aligned with the trochlea in all planes prior to reconstruction, regardless of the technique and as long as normal anatomy is reconstructed accurately.The Patellofemoral Foundation
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