Active Exercise Therapy Improves the Recovery of Knee Joint Function and Reduction of Muscle Atrophy After Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Dislocation

Overview

Journal Front Surg

Specialty General Surgery

Date 2022 Nov 17

PMID 36386504

Authors

Dong Xing

Wenyi Li

Zhaoxu Yang

Zhijie Dong

Huijun Kang

Fei Wang

Affiliations

Soon will be listed here.

Abstract

Objectives: Medial patellofemoral ligament (MPFL) reconstruction is an important surgical therapy for recurrent patellar dislocation. However, few studies have focused on exercise therapy after MPFL reconstruction. Therefore, the first purpose was to compare the active and traditional postoperative exercise therapies on the recovery of knee joint function and reduction of muscle atrophy after MPFL reconstruction, and the second purpose was to compare the active and traditional postoperative exercise therapies on the patellar stability after MPFL reconstruction.

Methods: The cases of 31 patients with recurrent patellar dislocation treated with patella double semi-tunnel anatomical MPFL reconstruction from February 2016 and February 2019 were retrospectively reviewed. The clinical outcomes, including the patellar tilt angle (PTA), lateral patellofemoral angle (LPFA), thigh circumference reduction, Kujala score, and Lysholm score, were compared between two groups (i.e., active exercise and traditional exercise groups) preoperatively, 3 months postoperatively, 6 months postoperatively, 12 months postoperatively, and 24 months postoperatively.

Results: The Kujala score was significantly higher in the active exercise group than traditional exercise group 3 months postoperatively (80.06 vs. 74.80, < 0.01), 6 months postoperatively (89.19 vs. 82.07, < 0.01), 12 months postoperatively (91.43 vs. 86.60, < 0.01), and 24 months postoperatively (92.50 vs. 90.27, = 0.02). Similarly, there was a higher Lysholm score in the active exercise group compared with traditional exercise group 3 months postoperatively (81.25 vs. 76.53, < 0.01), 6 months postoperatively (89.81 vs. 84.80, < 0.01), 12 months postoperatively (93.25 vs. 88.40, < 0.01), and 24 months postoperatively (93.69 vs. 90.67, < 0.01). Significantly lower thigh circumference reduction was reported in the active exercise group compared with that in the traditional exercise group 3 months postoperatively (1.90 ± 0.57 vs. 2.45 ± 0.45, < 0.01) and 6 months postoperatively (1.50 ± 0.31 vs. 1.83 ± 0.32, < 0.01). No statistical difference was observed between the two groups in terms of PTA ( > 0.05) or LPFA postoperatively ( > 0.05).

Conclusions: Our results suggested that active exercise therapy might benefit the early recovery of knee joint function and reduction of muscle atrophy in patients with recurrent patellar dislocation after MPFL reconstruction.

References

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

Niu J, Lin W, Qi Q, Lu J, Dai Y, Wang F . Anatomical Medial Patellofemoral Ligament Reconstruction for Recurrent Patella Dislocation: Two-Strand Grafts versus Four-Strand Grafts. J Knee Surg. 2019; 34(2):147-154. DOI: 10.1055/s-0039-1694039. View

ESCAMILLA R, Fleisig G, Zheng N, Barrentine S, Wilk K, Andrews J . Biomechanics of the knee during closed kinetic chain and open kinetic chain exercises. Med Sci Sports Exerc. 1998; 30(4):556-69. DOI: 10.1097/00005768-199804000-00014. View

Fu K, Duan G, Liu C, Niu J, Wang F . Changes in femoral trochlear morphology following surgical correction of recurrent patellar dislocation associated with trochlear dysplasia in children. Bone Joint J. 2018; 100-B(6):811-821. DOI: 10.1302/0301-620X.100B6.BJJ-2017-1295.R1. View

Bitar A, Demange M, DElia C, Camanho G . Traumatic patellar dislocation: nonoperative treatment compared with MPFL reconstruction using patellar tendon. Am J Sports Med. 2011; 40(1):114-22. DOI: 10.1177/0363546511423742. View

Kang H, Zheng R, Dong C, Fu K, Wang F . No influence of patellar fixation technique on clinical outcomes of double-bundle medial patellofemoral ligament reconstruction: a systematic review. Arch Orthop Trauma Surg. 2018; 139(1):79-90. DOI: 10.1007/s00402-018-3008-8. View

Schepsis A, Rogers A . Medial patellofemoral ligament reconstruction: indications and technique. Sports Med Arthrosc Rev. 2012; 20(3):162-70. DOI: 10.1097/JSA.0b013e318264188b. View

Zhang F, Wang J, Wang F . Comparison of the clinical effects of open and closed chain exercises after medial patellofemoral ligament reconstruction. J Phys Ther Sci. 2014; 26(10):1557-60. PMC: 4210397. DOI: 10.1589/jpts.26.1557. View

Clancy Jr W, Nelson D, Reider B, Narechania R . Anterior cruciate ligament reconstruction using one-third of the patellar ligament, augmented by extra-articular tendon transfers. J Bone Joint Surg Am. 1982; 64(3):352-9. View

10.

Camp C, Krych A, Dahm D, Levy B, Stuart M . Medial patellofemoral ligament repair for recurrent patellar dislocation. Am J Sports Med. 2010; 38(11):2248-54. DOI: 10.1177/0363546510376230. View

11.

Outerbridge R . The etiology of chondromalacia patellae. 1961. Clin Orthop Relat Res. 2001; (389):5-8. DOI: 10.1097/00003086-200108000-00002. View

12.

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

13.

Amis A . Current concepts on anatomy and biomechanics of patellar stability. Sports Med Arthrosc Rev. 2007; 15(2):48-56. DOI: 10.1097/JSA.0b013e318053eb74. View

14.

Kujala U, Jaakkola L, Koskinen S, Taimela S, Hurme M, Nelimarkka O . Scoring of patellofemoral disorders. Arthroscopy. 1993; 9(2):159-63. DOI: 10.1016/s0749-8063(05)80366-4. View

15.

Ronga M, Oliva F, Longo U, Testa V, Capasso G, Maffulli N . Isolated medial patellofemoral ligament reconstruction for recurrent patellar dislocation. Am J Sports Med. 2009; 37(9):1735-42. DOI: 10.1177/0363546509333482. View

16.

Fisher B, Nyland J, Brand E, Curtin B . Medial patellofemoral ligament reconstruction for recurrent patellar dislocation: a systematic review including rehabilitation and return-to-sports efficacy. Arthroscopy. 2010; 26(10):1384-94. DOI: 10.1016/j.arthro.2010.04.005. View

17.

Schiphouwer L, Rood A, Tigchelaar S, Koeter S . Complications of medial patellofemoral ligament reconstruction using two transverse patellar tunnels. Knee Surg Sports Traumatol Arthrosc. 2016; 25(1):245-250. DOI: 10.1007/s00167-016-4245-4. View

18.

Zhou J, Wang C, Ji G, Ma L, Wang J, Zhang F . A minimally invasive medial patellofemoral ligament arthroscopic reconstruction. Eur J Orthop Surg Traumatol. 2013; 24(2):225-30. DOI: 10.1007/s00590-012-1162-1. View

19.

Brand Jr J, Weiler A, Caborn D, Brown Jr C, Johnson D . Graft fixation in cruciate ligament reconstruction. Am J Sports Med. 2000; 28(5):761-74. DOI: 10.1177/03635465000280052501. View

20.

Lightsey H, Wright M, Trofa D, Popkin C, Ahmad C, Redler L . Rehabilitation variability following medial patellofemoral ligament reconstruction. Phys Sportsmed. 2018; 46(4):441-448. DOI: 10.1080/00913847.2018.1487240. View