Arthroscopic medial patellofemoral ligament reconstruction may be reliable for recurrent patellar dislocation
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Published results showed arthroscopic medial patellofemoral ligament reconstruction with autograft gracilis tendon may be reliable and safe among patients with recurrent patellar dislocation.
Researchers analyzed clinical and minimum 5-year follow-up data of 66 patients with recurrent patellar dislocation who underwent arthroscopic medial patellofemoral ligament reconstruction with autograft gracilis tendon and a modified double-patellar tunnels technique. Researchers assessed joint hypermobility preoperatively with the Beighton score, and preoperatively and postoperatively collected patient-reported outcomes, including the Kujala, Lysholm and Tegner scores. Researchers measured the Insall-Salvati ratio, tibial tubercle-trochlear groove (TT-TG) distance and Q angle on radiographic images. Researchers also recorded complications and recurrent dislocation occurring after surgery. At the end of 5 years, researchers assessed patient satisfaction.
Results showed no association between postoperative patient-reported outcomes with Beighton score, Insall-Salvati ratio, TT-TG distance or severity of trochlear dysplasia. Researchers noted a negative correlation between Q angle with Kujala scores and Lysholm scores. Researchers noted an increase in mean Kujala score from approximately 69.4 preoperatively to 96.1 postoperatively. Mean Tegner score also increased from approximately 3.1 preoperatively to 5.9 postoperatively, as well as Lysholm score from approximately 73.5 preoperatively to 95.3 postoperatively, according to results. Researchers noted recurrent patellar dislocation during follow-up in two patients.
“Our operation mainly aimed to restore the anatomy of the affected knee to the status before the first dislocation and thus prevent recurrent patellar dislocation,” the authors wrote. “Restoration of anatomy and reconstruction of the [medial patellofemoral ligament] MPFL are probably most beneficial for patients with MPFL rupture caused by trauma and congenitally weak medial structures. However, we recognize that some patients may still be at high risk for patellar dislocation even after MPFL reconstruction.” – by Casey Tingle
Disclosures: The authors report no relevant financial disclosures.
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Matthew Bollier, MD, FAOA
I enjoyed reading this retrospective case series by Guanying Gao, MD, and colleagues. There are many ways to perform medial patellofemoral ligament reconstruction and the authors did a good job of explaining their technique and having good follow-up data. I perform medial patellofemoral ligament reconstruction similarly except we make a 4-cm incision over the patella to drill our patella tunnels outside the capsule. We then used the arthroscope to confirm that we didn’t enter the knee joint with our screws. I would be concerned with having the graft intra-articular with the technique described in this paper. In addition, there are clear biases with a case series study.
Sports medicine fellowship director
Iowa City, Iowa
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