MPFL reconstruction with suture tape, knotless anchors may improve outcomes
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Results showed medial patellofemoral ligament reconstruction with polyester high-strength suture tape with knotless anchors yielded no repeat dislocations and a low risk of residual patellar apprehension signs without major complications.
Researchers recorded repeated dislocation and residual patellar apprehension signs among 65 knees in 43 patients who underwent MPFL reconstruction using polyester high-strength suture tape (FiberTape, Arthrex) with knotless anchors (SwiveLock, Arthrex). Researchers also measured congruence and tilting angles and analyzed changes in KOOS scores and the associations with the preoperative tibial tubercle-trochlear groove distance (TT-TG). Overall, 65 knees in 43 patients had at least 1-year follow-up and 43 knees in 27 patients had 2-year follow-up.
Results showed no patients had repeat dislocations and 2.4% of patients had a residual positive patellar apprehension sign. Researchers found a decrease in the mean tilting angle from 24.8° to 10.7°, as well as a decrease in the mean congruence angle from 24.9° to 4.3°.
All KOOS subscales improved at 2-year follow-up, including pain, symptoms, activities of daily living, sports activity, quality of life and patellofemoral outcomes, according to results. Researchers also noted KOOS subscale scores improved regardless of the preoperative TT-TG distance.
Perspective
Back to TopSeth L. Sherman, MD, and Steven D. Jones Jr., MD
Recurrent patellar instability can lead to long-term painful joint dysfunction and is considered an operative indication. The gold standard for surgical intervention is restoration of the medial patellofemoral complex, typically by performing soft tissue autograft or allograft MPFL reconstruction. Several recent authors have considered the use of all-synthetic materials to either augment or replace allograft reconstruction. Theoretical benefits include limited invasiveness, supraphysiologic strength, lack of harvest morbidity and accelerated rehabilitation. Risks include potential tissue reaction, stress shielding, overconstraint and cost. The paucity of data and historic concern about synthetic ligament reconstruction make this a controversial topic.
In their retrospective case series, Eiji Sasaki, MD, PhD, and colleagues report good to excellent short-term results in 43 patients (65 knees) who underwent MPFL reconstruction using a synthetic suture tape fixed with knotless anchors. They had no repeat dislocations and only one patient with residual apprehension at 1 year. At 2-year follow-up (43 of 65 knees), all KOOS subscales had improved. While these data suggest early safety and efficacy, this is limited by the lack of comparison or control groups. The study population is not well defined and leaves more questions than answers. Should synthetic grafts be utilized to augment or replace reconstruction in high-risk populations following primary or recurrent dislocation? Who may benefit the most from synthetic augmentation? Would biologic augmentation make more sense? Time will tell.
References:
Hopper GP, et al. Arthrosc Tech. 2019;doi:10.1016/j.eats.2018.08.021.
Lee PYF, et al. Knee Surg Sports Traumatol Arthrosc. 2018;doi:10.1007/s00167-017-4711-7.
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