DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20212436

Medial patellofemoral ligament reconstruction using autologous hamstring graft for recurrent patellar dislocation: a clinical and functional outcome evaluation

Sanjib Ghosh, Ayon Das, Mahak Baid, Arijit Das

Abstract


Patellofemoral instability is a painful and often recurring disorder with many negative long-term consequences. Surgical treatment for patellar dislocation has evolved from the initial medial reefing to the present-day anatomical reconstruction of medial patellofemoral ligament (MPFL) which is thought to be the most appropriate treatment. MPFL reconstruction successfully addresses patellofemoral instability by restoring the deficient most important static primary soft tissue restraint. This prospective case series was conducted at a Tertiary care Govt. Hospital in Kolkata between January 2019 to August 2020 on 15 patients who underwent MPFL reconstruction for recurrent patellar dislocation. All patients were followed up at an interval of 2 weeks, 6 weeks, 3 months and 6 months. Kujala score was used to assess the functional outcomes of the patients. Out of 15 patients, 13 (86.7%) showed good to excellent results whereas 2 (13.3%) had Fair outcome and none of the patients demonstrated Poor surgical result. The mean Kujala score improved from 49.6 pre-operatively to 92.7 post-operatively. By the end of 6 months follow-up, 13 (86.7%) patients achieved almost full range of motion. Majority (80%) of patients did not have any complications. Only 2 patients had a post-operative recurrence (13.3%). Reconstruction of MPFL using autologous hamstring graft showed excellent results over the short term with a low re-dislocation rate and acceptable complication rates. It greatly helps in preventing further episodes of patellar subluxations or dislocations and in improving quality of life.


Keywords


Recurrent patellar dislocation, MPFL, Patellofemoral instability, Hamstring tendon

Full Text:

PDF

References


Panni AS, Vasso M, Cerciello S. Acute patellar dislocation. What to do? Knee Surg Sports Traumatol Arthrosc. 2013;21:275-8.

Mäenpää H, Huhtala H, Lehto MU. Recurrence after patellar dislocation: redislocation in 37/75 patients followed for 6-24 years. Acta Orthop Scand. 1997;68:424-6.

Nomura E, Horiuchi Y, Kihara M. Medial patellofemoral ligament restraint in lateral patellar translation and reconstruction. Knee. 2000;7:121-7.

Zaffagnini S, Colle F, Lopomo N, Sharma B, Bignozzi S, Dejour D et al. The influence of medial patellofemoral ligament on patellofemoral joint kinematics and patellar stability. Knee Surg Sports Traumatol Arthrosc. 2013;21(9):2164-71.

Smirk C, Morris H. The anatomy and reconstruction of the medial patellofemoral ligament. Knee. 2003;10(3):221-7.

Elias DA, White LM, Fithian DC. Acute lateral patellar dislocation at MR imaging: injury patterns of medial patellar soft-tissue restraints and osteochondral injuries of the inferomedial patella. Radiology. 2002;225(3):736-43.

Amis AA, Firer P, Mountney J, Senavongse W, Thomas NP. Anatomy and biomechanics of the medial patellofemoral ligament. Knee. 2003;10:215-20.

Fithian D, Paxton E, Stone ML. Epidemiology and natural history of acute patellar dislocation. Am J Sports Med. 2004;32(5):1114-21.

Mäenpää H. The dislocating patella. Predisposing factors and a clinical, radiological and functional follow-up study of patients treated primarily non-operatively. Ann Chir Gynaecol. 1998;87(3):248-9.

Kumara K, Renganthan S, Joseph CJ. Medial Patellofemoral reconstruction for patellar instability. Indian J orthop. 2014;48(5):501-5.

Carmen MR, Maffuli N. Medial patellofemoral ligament reconstruction: a new technique. BMC Musculoskeletal disorders. 2007;8:22.

Mathews JJ, Schranz P. Reconstruction of medial patellofemoral ligament using a longitudinal tunnel technique. Int Orthop. 2010;34;1321-5.

Mäenpää H, Lehto MU. Patellar dislocation. The long-term results of nonoperative management in 100 patients. Am J Sports Med. 1997;25:213-7.

Camanho GL, Viegas Ade C, Bitar AC, Demange MK, Hernandez AJ. Conservative versus surgical treatment for repair of the medial patellofemoral ligament in acute dislocations of the patella. Arthroscopy. 2009;25:620-5.

Petri M, Liodakis E, Hofmeister M. Operative vs conservative treatment of traumatic patellar dislocation: Results of a prospective randomized controlled clinical trial. Arch Orthop Trauma Surg. 2013;133:209-13.

Schöttle PB, Fucentese SF, Romero J. Clinical and radiological outcome of medial patellofemoral ligament reconstruction with a semitendinosus autograft for patella instability. Knee Surg Sports Traumatol Arthrosc. 2005;13(7):516-21.

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

Ostemeier S, Stukenborg-Colsman C, Hurschler C, Wirth CJ. In vitro investigation of the effect of medial patellofemoral ligament reconstruction and medial tibial tuberosity transfer on lateral patella stability. Arthroscopy. 2006;22:308-19.

Smith TO, Walker J, Russell N. Outcomes of medial patellofemoral ligament reconstruction for patellar instability: A systematic review. Knee Surg Sports Traumatol Arthrosc. 2007;15:1301-14.

Panagopoulos A, van Niekerk L, Triantafillopoulos IK. MPFL reconstruction for recurrent patella dislocation: A new surgical technique and review of the literature. Int J Sports Med. 2008;29:359-65.

Schöttle PB, Fucentese SF, Romero J. Clinical and radiological outcome of medial patello-femoral ligament reconstruction with a semitendinosus autograft for patella instability. Knee Surg Sports Traumatol Arthrosc. 2005;13:516-21.

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 Orthopaedica Belgica. 2006;72(1):65.

Bitar A, Demange M, D’Elia C, Camanho G. Reconstruction of the medial patellofemoral ligament was effective for traumatic patellar dislocation. Am J Sports Med. 2012;40:114-22.

Mishra CB. Reconstruction of medial patellofemoral ligament for chronic patellar instability. Indian journal of orthopaedics. 2012;46:447-54.

Enderlein D, Nielsen T, Christiansen SE, 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;22:2458-64.

Sappey-Marinier E, Sonnery-Cottet B, O’Loughlin P, Ouanezar H, Fernandes LR, Kouevidjin B et al. Clinical outcomes and predictive factors for failure with isolated MPFL reconstruction for recurrent patellar instability: A series of 211 reconstructions with a minimum follow-up of 3 years. Am J Sports Med. 2019;47:1323-30.

Goncalves MBJ, Carvalho Júnior LH, Soares LFM, Goncalves TJ, Santos RL, Pereira ML. Reconstrucão do ligamento patelofemoral medial para tratamento da luxacão recidivante da patela. Rev Bras Ortop. 2011;46(2):160-4.

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.