Objective To investigate the effectiveness of reconstructing medial patellofemoral l igament with hamstring tendon autografts for the treatment of recurrent patellar dislocation under arthroscopy. Methods Between January 2005 and January 2010, 22 cases of recurrent patellar dislocation were treated by lateral retinacular release and reconstructionof the medial patellofemoral ligament with hamstring tendon autografts under arthroscopy. There were 5 males and 17 females, aged 15-19 years (mean, 17.3 years). The average number of dislocation was 4 (range, 3-8). The main cl inical symptoms were pain and swell ing of knee joint, weakness in the leg, and limited range of motion (ROM). The patellar tilt test, pressing pain of patellofemoral ligament insertion, and apprehension sign showed positive results. According to International Knee Documentation Committee (IKDC) scoring criteria, the subjective IKDC score was 36.7 ± 4.7, and the Lysholm score was 69.3 ± 3.8. X-ray films showed that the patella inclined outwards. Results All incisions healed by first intention. Twenty-two cases were followed up 18-49 months (mean, 34 months). Pain and swelling of knee joint and weakness were improved obviously. No recurrence was found during follow-up. The ROM of knee in flexion and extension was improved when compared with preoperative ROM. The subjective IKDC score was 92.4 ± 5.3 and the Lysholm knee score was 91.7 ± 5.2, showing significant differences when compared with preoperative scores (P lt; 0.05). Conclusion Reconstruction of the medial patellofemoral ligament with hamstring tendon autografts under arthroscopy is an effective method to treat recurrent patellar dislocation.
Objective To investigate the procedure and effectiveness of medial patellofemoral l igament (MPFL) reconstruction for the treatment of recurrent patellar dislocation. Methods Between June 2005 and September 2007, 29 patients with recurrent patellar dislocation underwent MPFL reconstruction with allograft semitendinosus or allograft anterior tibial is tendon. There were 6 males and 23 females with an average age of 20.3 years (range, 13-45 years). The patients sufferedfrom 2-10 times patellar dislocation preoperatively. The average time between last dislocation and surgery was 43.9 months (range, 1-144 months). CT scan was performed to measure the tibial tuberosity-trochlear groove distance (TT-TG). The femoral tunnel was made at the origin of MPFL insertion, just inferior to the medial epicondyle. The double L-shape patellar tunnels were made on the medial rim of patella with 4.5 mm in diameter. The loop side of the graft was fixed with a bioabsorbable interference screw in the femoral tunnel both ends of the graft. For the TT-TG was more than 20 mm, a modified Elmsl ie-Trillat osteotomy was performed to correct the distal al ignment of patella. The arthroscopic examination was also performed for loosebody and lateral retinacular release. Results Twenty-seven patients were followed up 45.5 months on average (range, 40-67 months). No recurrent dislocation or subdislocation occurred. All the patients showed negative apprehension test at 0° and 30° flexions of knee. The range of motion of knee restored normal 1 year after operation. The Kujala score was improved from 72.03 ± 17.38 preoperatively to 94.10 ± 7.59 postoperatively, and Lysholm score was improved from 72.65 ± 14.70 to 95.44 ± 6.25, both showing significant differences (P lt; 0.05). The Tegner score was decreased from 5.25 ± 1.83 preoperatively to 4.33 ± 1.00 postoperatively, showing no significant difference (t=1.302, P=0.213). In patients whose TT-TG was more than 20 mm, TTTG was decreased from (23.38 ± 3.70) mm to (16.88 ± 5.92) mm at last follow-up, showing significant difference (t=2.822,P=0.026). Conclusion The technique of MPFL reconstruction is an effective surgical procedure for the treatment of recurrent patellar dislocation, which can improve the patella stabil ity and knee function.
Objective To investigate the cl inical therapeutic results of allograft tendon for anatomical reconstruction of medial patellofemoral l igament (MPFL) in patellar dislocations. Methods From September 2005 to June 2008, 20 patientswith patellar dislocation underwent MPFL reconstructions. There were 4 males and 16 females, aged 13 to 31 years (19 years on average). Patellar dislocations occurred in 7 left and 13 right knees, including 6 cases of acute dislocation and 14 cases of recurrent dislocation. The disease course was 1 day to 2 years. The frequency of dislocation was 1-6 (4 on average). Affected knee joint showed pain, swell ing and patellar instabil ity; the range of action for patella obviously increased. The X-ray films showed patellar dislocation or medial margin avulsion fracture. The preoperative Q angle was (15 ± 3)°, the congruence angle was (10 ± 11)°. Reconstruction was performed via allograft tendon. Allograft tendon was anchored to the superomedial pole of the patella by two bone anchors, and the other end was fixed at the natural MPFL insertion site near the medial femoral condyle with an interference screw in a bone tunnel. All patients were evaluated postoperatively; Kujala patellofemoral scores, objective knee function, compl ications, and reoperations were assessed. Results Primary heal ing was achieved in 18 cases and secondary heal ing in 2 cases. No infection or necrosis and absorption of grafts was observed. All patients were followed up for an average of 25.6 months (range, 6-34 months) postoperatively. At last follow-up, other patients had no pain, swell ing and patellar instabil ity except 1 case; neither patella redislocation nor fracture occurred. The X-ray films showed good position of anchors and tunnel 6 months after operation, and the congruence angle was (3 ± 8)°, showed statistically significant difference when compared with preoperation (P lt; 0.05). The postoperative Q angle was (15 ± 2)°, the Kujala knee function score improvedsignificantly from 60.8 ± 7.2 to 83.4 ± 8.0 at last follow-up, showing statistically significant difference (P lt; 0.05). According to Insall et al. for function, the results were excellent in 12 cases, good in 6 cases, and fair in 2 cases, the excellent and good rate was 90%. Conclusion MPFL reconstruction improves cl inical symptoms. Anatomical MPFL reconstruction is effective for patellar dislocation, and it offer good recovery of the pre-morbid patella mechanics. There would be l ittle bone loss when tendon is fixed by anchors, and there would be less patellar fracture than bone tunnel technique. The bone anchors also provide firm fixation. Allograft can avoid the graft harvest site morbidity, but it increases the cost of the surgery.
Objective To explore the cl inical effectiveness of arthroscopic reconstruction of medial patellofemoral l igament (MPFL) with trabs of medial soft tissues in the treatment of patellar instabil ity of adolescence. Methods From January 2005 to December 2006, 23 cases of patellar instabil ity were treated, including 10 males and 13 females with an average age of 16 years old (13 to 20 years old). The locations were left knee in 11 cases, right knee in 12 cases. The disease course was 1-28 weeks (mean 15 weeks). All patients had patellar instabil ity sense and knee arthralgia during strenuous exercise. Preoperative, the International Knee Documentation Committee (IKDC) score and Lysholm score were 48.30 ± 5.77 and 50.80 ± 7.61. The congruence angle, lateral patellar angle, and Q angle were (9.00 ± 2.46), (2.94 ± 2.55) and (19.10 ± 4.16)°. All of the patients experienced the operation of reconstruction of MPFL with trabs of medial soft tissues (medial patellar retinaculum, joint capsule and vastus medial is obl ique muscle fiber) through arthroscope. Results All the wounds healed by first intention, and no postoperative early compl ication occurred. All cases were followed up 19 months on average (12 to 24 months). Apprehensive test and patella tilt test were negative. The range of motion returned to normal. There was no recurrence of dislocation after operation. At 12 months after operation, the congruence angle, lateral patellar angle, and Q angle were (—7.03 ± 0.60), (11.00 ± 3.47) and (11.30 ± 1.90)°; the IKDC score and Lysholm score were 93.20 ± 3.51 and 94.10 ± 4.26. There were statistically significant differences between preoperation and postoperation (P lt; 0.05). Conclusion Arthroscopic reconstruction of MPFL with trabs of medial soft tissues can improved obviously the affected limb function in treatment of patellar instabil ity of adolescence.
ObjectiveTo study the effect of the femoral tunnel position on the knee function recovery after medial patellofemoral ligament (MPFL) reconstruction. MethodsA retrospective analysis was made on the clinical date of 43 cases (43 knees) of recurrent patellar dislocation undergoing MPFL reconstruction and patellofemoral lateral retinaculum lysis between August 2013 and March 2014. There were 12 males and 31 females, aged 19.4 years on average (range, 9-35 years). All patients had trauma history and recurrent dislocations. The results of apprehesion test and J syndrom were positive. The patellar tilt test showed patellofemoral lateral retinaculum was tension. The effectiveness was evaluated using Lysholm knee functional score after operation. The distance from the center of the femoral tunnel to the femoral isometric point was measured on CT three dimensional reconstruction image. Whether the femoral tunnel position was isometric was evaluated. The correlation was analyzed between the distance from the center of the femoral tunnel to the femoral isometric point and Lysholm score. ResultsPrimary healing of incision was obtained in all patients. The patients were followed up 13-18 months (mean, 15 months). No patellar dislocation or subluxation occurred. The result of apprehensive test was negative. At last follow-up, the average Lysholm score was 93.8 (range, 83-100). The average distance from the center of the femoral tunnel to the femoral isometric point was 5.61 mm (range, 2-16 mm). The femoral tunnel position was isometric in 30 cases (69.8%) and non-isometric in 13 cases (30.2%). The distance from the center of the femoral tunnel to the femoral isometric point was negatively correlated with postoperative Lysholm score (r=-0.851, P=0.000). The postoperative Lysholm score was 95.7±2.3 in patients with isometric tunnel and was 89.4±3.5 in patients with non-isometric tunnel, showing significant difference (t=6.951, P=0.000). ConclusionFor patellofemoral joint instability, preparing the femoral isometric tunnel can establish a good foundation for the recovery of the knee function in MPFL reconstruction.
ObjectiveTo review the research progress of location methods and the best femoral insertion position of medial patellofemoral ligament (MPFL) reconstruction of femoral tunnel, and provide reference for surgical treatment.MethodsThe literature about femoral insertion position of the MPFL reconstruction in recent years was extensively reviewed, and the anatomical and biomechanical characteristics of MPFL, as well as the advantages and disadvantages of femoral tunnel positioning methods were summarized.ResultsThe accurate establishment of the femoral anatomical tunnel is crucial to the success of MPFL reconstruction. At present, there are mainly two kinds of methods for femoral insertion: radiographic landmark positioning method and anatomical landmark positioning method. Radiographic landmark positioning method has such advantages as small incision and simple operation, but it can not be accurately positioned for patients with severe femoral trochlear dysplasia. It is suggested to combine with the anatomical landmark positioning method. These methods have their own advantages and disadvantages, and there is no unified positioning standard. In recent years, the use of three-dimensional design software can accurately assist in the MPFL reconstruction, which has become a new trend.ConclusionFemoral tunnel positioning of the MPFL reconstruction is very important. The current positioning methods have their own advantages and disadvantages. Personalized positioning is a new trend and has not been widely used in clinic, its effectiveness needs further research and clinical practice and verification.