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Medial patellofemoral ligament reconstruction using an autograft or allograft for patellar dislocation: a systematic review.

ABSTRACT: PurposesThe purpose of this study is to review the use of an allograft or autograft in medial patellofemoral ligament (MPFL) reconstruction.Materials and methodsVarious electronic databases were searched for relevant articles published from January 2000 to September 2017 that evaluated clinical outcomes of MPFL reconstruction using an autograft or allograft. Data search, extraction, analysis, and quality assessments were performed based on Cochrane Collaboration guidelines.ResultsThe study of 21 autografts and one allograft was included in this review. Although direct comparative studies were unavailable, the Kujala score and subjective results were reported in the majority of these studies. While the use of an autograft for MPFL reconstruction yielded satisfactory clinical outcomes with few perioperative complications, no new outcome has been drawn from the use of allografts.ConclusionsAlthough many studies have shown favorable clinical results for MPFL reconstruction using an autograft, the clinical results of MPFL reconstruction using an allograft have not yet been sufficient to achieve meaningful clinical results due to low levels of evidence. Direct comparisons were not conducted because there were very few studies on allografts; thus, further research in this area should be performed in the future.Electronic supplementary materialThe online version of this article (10.1186/s43019-019-0008-0) contains supplementary material, which is available to authorized users.

SUBMITTER: Nha KW

PROVIDER: S-EPMC7219573 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Project description:BackgroundHabitual patellar dislocation in extension (HPD-E) is a distinctive subtype of recurrent patellar dislocation (RPD); HPD-E represents the most severe type of patellar maltracking in RPD. It has been reported that the presence of preoperative patellar maltracking is associated with a worse clinical outcome after medial patellofemoral ligament (MPFL) reconstruction (MPFL-R).PurposeTo describe the radiological characteristics of HPD-E and to compare clinical outcomes after MPFL-R among patients with and without preoperative HPD-E.Study designCohort study; Level of evidence, 3.MethodsFrom January 2012 to December 2015, a total of 230 consecutive patients (246 knees) with RPD were treated with MPFL-R alone or combined with tibial tubercle osteotomy. Among them, 28 patients diagnosed with HPD-E by preoperative 3-dimensional computed tomography (CT; HPD-E group) were matched in a 1:1 fashion to 28 control participants who did not show HPD-E (control group). Routine radiography and CT were performed to evaluate patellar height, trochlear dysplasia, tibial tubercle-trochlear groove distance, and torsional deformities. The mean patellar laxity index and lateral patellar translation assessed with stress radiography were measured preoperatively and postoperatively to quantify MPFL laxity. At minimum 2-year follow-up, patient-reported outcomes (Kujala, Lysholm, and Tegner scores), patellar maltracking, and redislocation rates were compared between the HPD-E and control groups.ResultsThe radiological characteristics of the HPD-E group were as follows: 89% (25/28) of patients had severe trochlear dysplasia (Dejour type B or D), and the mean femoral anteversion angle was 35.5° ± 4.7°. At the final follow-up, the HPD-E group had a significantly lower Kujala score (76.2 vs 84.5, respectively; P = .001), Lysholm score (75.4 vs 86.6, respectively; P < .001), and Tegner score (4.1 vs 5.8, respectively; P = .021) compared with the control group. The postoperative patellar laxity index (43% vs 19%, respectively; P < .001) and redislocation rate (25% vs 0%, respectively; P = .01) were significantly higher in the HPD-E group than in the control group.ConclusionPreoperative 3-dimensional CT is a reliable method of identfying patients with HPD-E. Treatment of HPD-E by MPFL-R alone or combined with tibial tubercle osteotomy resulted in a higher redislocation rate, more severe MPFL residual laxity, and lower patient-reported outcome scores compared with patients without HPD-E who underwent MPFL-R.

Project description:Medial patellofemoral ligament (MPFL) reconstruction is a common procedure to address MPFL deficiency. Various techniques have been reported, with the best method still being pursued. Previous studies have revealed the advantage of internal bracing and possible advantage of wide patellar insertion in MPFL reconstruction. Thus, we would like to introduce a technique that combines the internal bracing and wide patellar insertion in MPFL reconstruction, in which the critical points are proper location of the patellar and femoral tunnels and proper tensioning of the augmenting sutures and the whole graft complex. Our clinical experience indicates that the proper application of this technique can lead to satisfactory clinical outcome. We consider the introduction of this technique will provide more insight to MPFL reconstruction. Technique Video Video 1 Wide patellar insertion medial patellofemoral ligament reconstruction with internal bracing. This procedure is performed in the left leg. The anterior half of the peroneus longus tendon is harvested. Both ends of the tendon are braided with nonabsorbable sutures. All parts of the knee are examined and debrided. The MPJ point on the medial edge of the patella is defined. A medial patellar incision is made over the MPJ (junction of the medial and proximal one-third). Two tunnels are created from the medial edge of the patella to the midline of the anterior surface of the patella. A longitudinal incision is made over the medial femoral epicondyle and the adductor tubercle. The femoral tunnel is located and created. Two guide sutures are passed though the patellar tunnels. The graft tendon along with 2 augmenting sutures are passed through the proximal tunnel and pulled back through the distal tunnel. Lateral retinaculum release is performed as indicated. The tendon and the augmenting sutures are pulled subcutaneously out of the medial incision. A cortical suspensory fixation device with an adjustable loop is passed through the femoral tunnel from the medial to the lateral side. Each tendon end, as well as the augmenting sutures are tied to the adjustable loop. A lateral incision is made. The sutures from the adjustable loop are pulled through the soft-tissue fissure resulting from the lateral retinaculum release out of the lateral incision. The cortical fixation device is pulled through the femoral tunnel till the tendon ends are pulled into the femoral tunnel. The arthroscope is placed to the lateral gutter of the knee though the anterolateral portal. The adjustable loop is reduced until the cortical fixation button is pulled back against the lateral orifice of the femoral tunnel. At 30? flexion of the knee, lateral displacement of the patella is checked to make sure that the medial stability of the patella is restored. (MPJ, medial–proximal junction.)

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Medial patellofemoral ligament reconstruction using an autograft or allograft for patellar dislocation: a systematic review.

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