Complications of Medial Patellofemoral Ligament Reconstruction Using Two Transverse Patellar Tunnels

Overview

Journal Knee Surg Sports Traumatol Arthrosc

Publisher Wiley

Specialties Emergency Medicine
General Surgery
Orthopedics

Date 2016 Jul 14

PMID 27405577

Citations 40

Authors

Loes Schiphouwer

Akkie Rood

Siebren Tigchelaar

Sander Koeter

Affiliations

Soon will be listed here.

Abstract

Purpose: The aim of this study was to report the complication rate after a medial patellofemoral ligament (MPFL) reconstruction using transverse patellar tunnels in a retrospective case series performed in a single institution.

Methods: Case series of 179 patients (192 knees) that had an MPFL reconstruction, with or without additional bony realignment procedures, between January 2009 and March 2015. Data were obtained from available patient charts.

Results: Thirty-nine complications (20.3 %) were registered. Twenty-seven of these (14.7 %) were minor. Seven patients (3.6 %) sustained a patellar fracture without adequate trauma. Male gender was a risk factor for patellar fracture (p < 0.001). Sixteen (8.1 %) reported recurrence of instability, of whom 10 (5.1 %) were defined as objective instability (reported dislocation and positive apprehension test).

Conclusion: This is largest patient series to date in which the complications after a two tunnel MPFL reconstruction are described. The use of transverse patellar tunnels increases the risk of sustaining a patellar fracture.

Level Of Evidence: IV.

Citing Articles

Minipatellar Tunnels for Transosseous Fixation of Medial Patellofemoral Ligament Graft Using High-strength Suture.

Peng Y, Wang H, Yang W, Yu W, Meng C, Huang W Arthrosc Tech. 2024; 13(11):103100.

PMID: 39711888 PMC: 11662867. DOI: 10.1016/j.eats.2024.103100.

Clinical and Radiological Outcomes After Isolated Double-Bundle Medial Patellofemoral Ligament Reconstruction: A 5-Year Analysis.

Hong S, Kim S, Lee H, Song W, Kim J, Seo Y Orthop J Sports Med. 2024; 12(10):23259671241283411.

PMID: 39473765 PMC: 11519993. DOI: 10.1177/23259671241283411.

Outcomes of an All-Soft Tissue Fixation Technique for Reconstruction of the Medial Patellofemoral Complex Using Double-Bundle Quadriceps Tendon Autograft for Recurrent Patellar Dislocation in Skeletally Immature Patients.

Zein A, Allam A, Hassan A, Soliman A, Mohamed M Orthop J Sports Med. 2024; 12(6):23259671241259051.

PMID: 38895137 PMC: 11185005. DOI: 10.1177/23259671241259051.

Reconstruction of the medial patellofemoral ligament through a double bundle of a single patellar tract and quadriceps tendons combined with medial displacement of lateral hemi-tibial tuberosity for treating low-grade recurrent patella dislocation.

Wang S, Cao G, Shi X, Wang X, Yu J, Tan H Int Orthop. 2024; 48(4):913-922.

PMID: 38342822 DOI: 10.1007/s00264-024-06105-8.

Analysis of lower extremity alignment (LEA) in children with recurrent patellar dislocation by EOS system.

Miao M, Cai H, Zhang L, Cai H Front Pediatr. 2023; 11:1291739.

PMID: 37954430 PMC: 10634357. DOI: 10.3389/fped.2023.1291739.

References

Mackay N, Smith N, Parsons N, Spalding T, Thompson P, Sprowson A . Medial Patellofemoral Ligament Reconstruction for Patellar Dislocation: A Systematic Review. Orthop J Sports Med. 2015; 2(8):2325967114544021. PMC: 4555571. DOI: 10.1177/2325967114544021. View

Koeter S, Diks M, Anderson P, Wymenga A . A modified tibial tubercle osteotomy for patellar maltracking: results at two years. J Bone Joint Surg Br. 2007; 89(2):180-5. DOI: 10.1302/0301-620X.89B2.18358. View

Amis A, Firer P, Mountney J, Senavongse W, Thomas N . Anatomy and biomechanics of the medial patellofemoral ligament. Knee. 2003; 10(3):215-20. DOI: 10.1016/s0968-0160(03)00006-1. View

Enderlein D, Nielsen T, Christiansen S, Fauno P, Lind M . Clinical outcome after reconstruction of the medial patellofemoral ligament in patients with recurrent patella instability. Knee Surg Sports Traumatol Arthrosc. 2014; 22(10):2458-64. DOI: 10.1007/s00167-014-3164-5. View

Dhinsa B, Bhamra J, James C, Dunnet W, Zahn H . Patella fracture after medial patellofemoral ligament reconstruction using suture anchors. Knee. 2013; 20(6):605-8. DOI: 10.1016/j.knee.2013.05.013. View

Nomura E, Horiuchi Y, Inoue M . Correlation of MR imaging findings and open exploration of medial patellofemoral ligament injuries in acute patellar dislocations. Knee. 2002; 9(2):139-43. DOI: 10.1016/s0968-0160(02)00002-9. View

Lewallen L, Mcintosh A, Dahm D . First-Time Patellofemoral Dislocation: Risk Factors for Recurrent Instability. J Knee Surg. 2015; 28(4):303-9. DOI: 10.1055/s-0034-1398373. View

Christiansen S, Jacobsen B, Lund B, Lind M . Reconstruction of the medial patellofemoral ligament with gracilis tendon autograft in transverse patellar drill holes. Arthroscopy. 2008; 24(1):82-7. DOI: 10.1016/j.arthro.2007.08.005. View

Ellera Gomes J . Medial patellofemoral ligament reconstruction for recurrent dislocation of the patella: a preliminary report. Arthroscopy. 1992; 8(3):335-40. DOI: 10.1016/0749-8063(92)90064-i. View

10.

Tigchelaar S, van Essen P, Benard M, Koeter S, Wymenga A . A self-centring osteotomy of the tibial tubercle for patellar maltracking or instability: results with ten-years' follow-up. Bone Joint J. 2015; 97-B(3):329-36. DOI: 10.1302/0301-620X.97B3.34515. View

11.

Stupay K, Swart E, Shubin Stein B . Widespread Implementation of Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Instability Maintains Functional Outcomes at Midterm to Long-Term Follow-up While Decreasing Complication Rates: A Systematic Review. Arthroscopy. 2015; 31(7):1372-80. DOI: 10.1016/j.arthro.2014.12.029. View

12.

Calvo Rodriguez R, Figueroa Poblete D, Anastasiadis Le Roy Z, Etchegaray Bascur F, Vaisman Burucker A, Calvo Mena R . Reconstruction of the medial patellofemoral ligament: Evaluation of the clinical results of autografts versus allografts. Rev Esp Cir Ortop Traumatol. 2014; 59(5):348-53. DOI: 10.1016/j.recot.2014.10.006. View

13.

Mulliez A, Lambrecht D, Verbruggen D, Van Der Straeten C, Verdonk P, Victor J . Clinical outcome in MPFL reconstruction with and without tuberositas transposition. Knee Surg Sports Traumatol Arthrosc. 2015; 25(9):2708-2714. DOI: 10.1007/s00167-015-3654-0. View

14.

Nomura , Horiuchi , Kihara . Medial patellofemoral ligament restraint in lateral patellar translation and reconstruction. Knee. 2000; 7(2):121-127. DOI: 10.1016/s0968-0160(00)00038-7. View

15.

Astur D, Gouveia G, Borges J, Astur N, Arliani G, Kaleka C . Medial Patellofemoral Ligament Reconstruction: A Longitudinal Study Comparison of 2 Techniques with 2 and 5-Years Follow-Up. Open Orthop J. 2015; 9:198-203. PMC: 4493629. DOI: 10.2174/1874325001509010198. View

16.

Rood A, Hannink G, Lenting A, Groenen K, Koeter S, Verdonschot N . Patellofemoral Pressure Changes After Static and Dynamic Medial Patellofemoral Ligament Reconstructions. Am J Sports Med. 2015; 43(10):2538-44. DOI: 10.1177/0363546515594447. View

17.

Singhal R, Rogers S, Charalambous C . Double-bundle medial patellofemoral ligament reconstruction with hamstring tendon autograft and mediolateral patellar tunnel fixation: a meta-analysis of outcomes and complications. Bone Joint J. 2013; 95-B(7):900-5. DOI: 10.1302/0301-620X.95B7.31417. View

18.

Fithian D, Paxton E, Stone M, Silva P, Davis D, Elias D . Epidemiology and natural history of acute patellar dislocation. Am J Sports Med. 2004; 32(5):1114-21. DOI: 10.1177/0363546503260788. View

19.

Mikashima Y, Kimura M, Kobayashi Y, Miyawaki M, Tomatsu T . Clinical results of isolated reconstruction of the medial patellofemoral ligament for recurrent dislocation and subluxation of the patella. Acta Orthop Belg. 2006; 72(1):65-71. View

20.

Panni A, Alam M, Cerciello S, Vasso M, Maffulli N . Medial patellofemoral ligament reconstruction with a divergent patellar transverse 2-tunnel technique. Am J Sports Med. 2011; 39(12):2647-55. DOI: 10.1177/0363546511420079. View