MPFL reconstruction with autograft yields good outcomes for traumatic patellar dislocation
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Medial patellofemoral ligament reconstruction using semitendinosus and gracilis autograft yielded good outcomes with less hardware and minimal complications for treatment of traumatic patellar dislocations, according to published results.
Researchers from the Al Razi Orthopaedic Hospital in Kuwait City, Kuwait, analyzed 45 patients who underwent medial patellofemoral ligament (MPFL) reconstruction using a semitendinosus and gracilis (STG) autograft without patellar xation hardware through two parallel transpatellar tunnels and one screw in femoral tunnel. According to the study, clinical results were evaluated using the IKDC and Kujala scores at a minimum follow-up of 24 months.
Among the 45 patients, no recurrent dislocation was reported. Additionally, researchers noted a “significant improvement” in both mean IKDC scores (47.17 preoperatively to 77.94 postoperatively) and mean Kujala scores (53.88 preoperatively to 86.24 postoperatively). Mild atrophy of the thigh was reported in three patients, and one patient struggled jumping, the researchers wrote in the study.
“Reconstruction of the MPFL by this method provides a good clinical result in the treatment of patellofemoral instability by using autologous graft (STG),” they concluded. “Less hardware was used with less cost and less complications.”
Perspective
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Jason L. Koh, MD, MBA, FAAOS, FAOA
Medial patellofemoral ligament reconstruction has been demonstrated to have excellent results in treating recurrent patella instability. Ibrahim and colleagues describe in “Medial patellofemoral ligament reconstruction in traumatic patella dislocation without patellar fixation” 45 patients treated with a novel technique using autologous semitendinosus and gracillis tendons looped over a lateral patella bone bridge after passing through 5-mm transverse tunnels, then docked in the femur and secured with an interference screw. At a minimum of 24 months, mean outcome scores significantly improved (IKDC 47.17 to 77.94; Kujala 53.88 to 86.24); no recurrent dislocations were noted in this group of patients with [tibial tubercle-trochlear groove] TT-TG distance of less than 20 mm. No patella fractures were noted, despite the potential risk. This technique appears to be safe and effective, but if used, keeping tunnels relatively small and avoiding disruption of the anterior cortex will decrease risk of patella fracture.
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