Clinical Outcomes After Medial Patellofemoral Ligament Reconstruction: an Analysis of Changes in the Patellofemoral Joint Alignment

Overview

Journal Int Orthop

Specialty Orthopedics

Date 2020 Aug 10

PMID 32770307

Citations 7

Authors

Yuta Fujii

Shuji Nakagawa

Yuji Arai

Hiroaki Inoue

Hiroyuki Kan

Manabu Hino

Kenta Kaihara

Yasuo Mikami

Affiliations

Soon will be listed here.

Abstract

Purpose: Medial patellofemoral ligament (MPFL) reconstruction using the hamstring tendon is widely performed to treat recurrent patellar dislocation. MPFL reconstruction includes a post-operative process of necrosis and reperfusion of the hamstring tendon graft. We hypothesise that the patella gradually shifts laterally because of this process, ultimately affecting the patellofemoral joint alignment. This study aimed to analyse the chronological changes in the patellofemoral joint alignment and the outcomes of MPFL reconstruction.

Methods: In this retrospective case-series study, the Knee Society, Lysholm, and Kujala scores were evaluated in 24 consecutive patients (27 knees). To evaluate patellar tracking defects, radiographic indices including the tilting angle, the lateral shift ratio, and the congruence angle were measured before, immediately after, and three, 12, and 36 months after MPFL reconstruction.

Results: Post-operative Kujala, Knee Society, and Lysholm scores for the study population significantly improved relative to the pre-operative scores. The tilting and congruence angles at three months after the operation significantly increased relative to those recorded immediately after the operation. The tilting and congruence angles were not significantly different at three, 12, and 36 months after the operation.

Conclusions: The post-operative outcomes of MPFL reconstruction for recurrent patellar dislocation were favourable. Insufficient union between the bone tunnel and tendon graft, along with an elongation of the necrotic tendon graft, may change the alignment of the patellofemoral joint within three months after the operation. Therefore, we believe it is necessary to refrain from knee rotation that places lateral stress on the patella until three months after the operation.

Citing Articles

Variable Guidelines for Pediatric Medial Patellofemoral Ligament Reconstruction Rehabilitation Exists Across PRiSM Member Organizations.

Greenberg E, Hannon J, Chaclas N, Albaugh J, Molony J, Williams B HSS J. 2024; 20(3):365-370.

PMID: 39108457 PMC: 11299319. DOI: 10.1177/15563316241233254.

Stiffness and Instability After MPFL Reconstruction Using a Fluoroscopic Versus Open Technique to Localize the Femoral Attachment Site: A Systematic Review and Meta-analysis.

Heindel K, Smoak J, Kocan J, Cossell C, Haider M, Levy B Orthop J Sports Med. 2023; 11(6):23259671221148482.

PMID: 37342554 PMC: 10278418. DOI: 10.1177/23259671221148482.

Change of the cross-sectional area of vastus medialis oblique in patients with recurrent patellar dislocation treated by tibial tubercle transfer combined with medial patellofemoral ligament reconstruction on axial CT.

Zhao C, Dong C, Wang X, Kong L, Chang B, Wang F J Orthop Surg Res. 2022; 17(1):469.

PMID: 36307822 PMC: 9617303. DOI: 10.1186/s13018-022-03367-z.

Isolated medial patellofemoral ligament reconstruction results in similar postoperative outcomes as medial patellofemoral ligament reconstruction and tibial-tubercle osteotomy: a systematic review and meta-analysis.

Vivekanantha P, Kahlon H, Cohen D, de Sa D Knee Surg Sports Traumatol Arthrosc. 2022; 31(6):2433-2445.

PMID: 36214831 DOI: 10.1007/s00167-022-07186-x.

Protocols of rehabilitation and return to sport, and clinical outcomes after medial patellofemoral ligament reconstruction with and without tibial tuberosity osteotomy: a systematic review.

Koshino Y, Taniguchi S, Kobayashi T, Samukawa M, Inoue M Int Orthop. 2022; 46(11):2517-2528.

PMID: 35701590 DOI: 10.1007/s00264-022-05480-4.

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