MPFL reconstruction with suture augmentation may improve knee stability
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Published results showed medial patellofemoral ligament reconstruction with a high-strength suture augmentation may improve knee stability and yield good midterm clinical results and low complication rates.
Researchers collected pain level, knee range of motion, passive patellar hypermobility and maltracking among 17 patients who underwent MPFL reconstruction with high-strength suture (FiberTape, Arthrex) augmentation from January 2016 to June 2018 and had at least 12 months of follow-up. At 12 months postoperatively, researchers measured lateral patellofemoral angles, congruence angles and patellar tilt angles in a skyline view by CT at 30° of knee flexion. Researchers also used the Lysholm knee scoring scale, the SF-12 score, the Tegner score and the Crosby and Insall grading system at yearly follow-up to assess functional outcomes.
Results showed MPFL repair had a success rate of 94.1% for preventing recurrent dislocations, with one patient experiencing recurrence of patellar dislocation and no other patients reporting serious complications. Researchers found full range of motion of more than 130° in 15 knees, mild hypermobility in two knees and no severe hypermobility or maltracking. In the last follow-up assessment, the Crosby and Insall grading system revealed 70.6% of knees graded as excellent, 23.5% as good, 5.9% as fair to poor and none as worse, according to results. Researchers noted improvements in the Lysholm knee score, the SF-12 score and the Tegner score in all patients at 12-month follow-up. Researchers also found significant improvements in postoperative lateral patellofemoral angle, patellar tilt angle and congruence angle compared with preoperative radiological findings.
Although autogenous tendon grafting has been the gold standard for reconstruction, the authors wrote artificial ligaments have been reported as an alternative option in recent years due to the progress of materials science. They noted the MPFL may have a better chance of healing with use of suture augmentation as an internal brace against lateral patella translation, while the repair of concomitant cartilage lesions is protected from additional instability episodes after surgery.
“The MPFL augmentation repair can be performed quickly in a minimally invasive manner and without the need for tendon autograft or allograft, ultimately reducing the morbidity and cost compared with an MPFL reconstruction,” the authors wrote. “The suture tape has stronger biomechanical properties and resistance to elongation, and the angulation of the suture tape augmentation provides a secure fixation that can mimic the strength of the native MPFL.”
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