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Am J Sports Med. 2011 Dec;39(12):2647-55. doi: 10.1177/0363546511420079. Epub 2011 Aug 25.

Medial patellofemoral ligament reconstruction with a divergent patellar transverse 2-tunnel technique.

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  • 1Molise University, Science of Health, Orthopaedic Department, Campobasso, Italy.

Abstract

BACKGROUND:

The medial patellofemoral ligament (MPFL) is the primary passive restraint to lateral patellar dislocation and there is increasing awareness of its role in recurrent lateral patellar instability.

PURPOSE:

This study was conducted to prospectively analyze the functional results of a modified MPFL reconstruction technique in recurrent patellar dislocation.

STUDY DESIGN:

Case series; Level of evidence, 4.

METHODS:

Forty-eight patients (51 knees) with at least 3 episodes of lateral patellar dislocation who had been treated with a 6-month rehabilitation protocol were included in this study. All patients practiced sports regularly. Reconstruction was with a semitendinosus tendon using a divergent 2-tunnel technique. Outcome was evaluated with the Kujala, Larsen, modified Lysholm, and Fulkerson outcome scores. Patient satisfaction with range of motion, pain, and sporting activities was also assessed.

RESULTS:

Three patients were lost at the final follow-up, giving a follow-up rate of 94%. The mean follow-up was 33 months. There was no patella dislocation postoperatively. The mean Kujala score improved significantly (P < .01) from 56.7 ± 17.7 (2 × standard deviation) preoperatively to 86.8 ± 14.4 postoperatively. The mean Larsen score improved significantly (P < .01) from 12.4 ± 3.2 to 17.1 ± 2.7. The mean Fulkerson score improved significantly (P < .01) from 59.2 ± 21.8 to 90.1 ± 14. The mean modified Lysholm score improved significantly (P < .01) from 57.6 ± 19.6 to 88.1 ± 16.2. Sixty-four percent of patients returned to the same type of sport at the same level, 16% reduced the level or type of sport for reasons unrelated to the surgery, while 20% reduced the level of sport or changed it for reasons related to surgery. Eighty-seven percent were either satisfied or very satisfied with the pain relief achieved. The patellar tilt decreased significantly from a preoperative mean of 11.1° to 8.9° at the last follow-up (P = .02). The mean preoperative Insall-Salvati ratio of 1.1 decreased to 1.06, although the change was not significant (P = .1).

CONCLUSION:

The results of modified MPFL reconstructions are encouraging, with minimal risks of redislocation and an overall patient satisfaction rate of over 80%. These early and medium-term results are comparable with those of other MPFL reconstruction techniques reported in the literature.

PMID:
21868688
DOI:
10.1177/0363546511420079
[PubMed - indexed for MEDLINE]
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