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Simple Cost-Effective Reinsertion of Avulsed Medial Patellofemoral Ligament in Acute Patellar Dislocation.

ABSTRACT: The medial patellofemoral ligament (MPFL) is the main restraining force against lateral patellar displacement in the first 20° of flexion and is disrupted after patellar subluxation or dislocation. Management of acute patellar dislocations is controversial, and many clinicians opt for conservative treatment in the acute phase. However, a traumatic rupture of the MPFL warrants surgical attention. Several considerations must be made by surgeons attempting reinsertion of the MPFL, including the choice of implant and timing of surgery, to restore the anatomy and biomechanics of the patellofemoral joint. Our aim is to achieve robust reinsertion of the MPFL restoring the anatomy and biomechanics of the patellofemoral joint using a simple, reproducible, and economical technique. We present MPFL reinsertion to the medial border of the patella in an acute patellar dislocation with a braided No. 2 ultrahigh-molecular-weight polyethylene suture (No. 2 Ultrabraid; Smith & Nephew, Memphis, TN) that is passed through 3 transverse parallel tunnels and tied over a bone bridge on the lateral border of the patella. This technique is simple with no implanted hardware, does not have the risk of donor-site morbidity of MPFL reconstruction, and can be performed in skeletally immature patients without growth plate concerns.

SUBMITTER: Abdel-Aziz A

PROVIDER: S-EPMC7953263 | biostudies-literature | 2021 Mar

REPOSITORIES: biostudies-literature

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Simple Cost-Effective Reinsertion of Avulsed Medial Patellofemoral Ligament in Acute Patellar Dislocation.

Abdel-Aziz Ahmed A Sherif Mohamed Mamdouh MM Waly Mohammed Refaat MR Abdel-Aziz Mahmoud Ahmed MA Mostafa Zaky Abdelrazek Begad Hesham BH

Arthroscopy techniques 20210219 3

The medial patellofemoral ligament (MPFL) is the main restraining force against lateral patellar displacement in the first 20° of flexion and is disrupted after patellar subluxation or dislocation. Management of acute patellar dislocations is controversial, and many clinicians opt for conservative treatment in the acute phase. However, a traumatic rupture of the MPFL warrants surgical attention. Several considerations must be made by surgeons attempting reinsertion of the MPFL, including the cho ...[more]

PMID: 33738223

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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:BackgroundThe redislocation rate of conservatively treated patella instability is high. One of the leading surgical strategies is medial patellofemoral ligament reconstruction. Over-tensioning is one of the most challenging complications in static medial patellofemoral ligament reconstruction as the graft used for reconstruction is isometric and the anatomical MPFL is a mostly dynamic structure. As an alternative to established static reconstruction techniques, dynamic graft techniques have been introduced for stabilizing the patella with the aim of providing a more physiological reconstruction of the medial patellofemoral ligament. To date, data on clinical outcomes are scarce and on biomechanical outcomes of the dynamic MPFL reconstruction are lacking. Here, we present the protocol of a randomized clinical trial for comparing clinical and biomechanical outcomes of dynamic versus static medial patellofemoral ligament reconstruction.MethodsThis study is a prospective, single blinded, randomized, multicenter, multimodal (clinical and biomechanical) clinical trial. Patients with recurrent patella dislocation requiring isolated MPFL reconstruction will be recruited and randomized to the dynamic or static reconstruction technique. Participants will be followed up for 2 years with a total of five follow-ups. Preoperative magnetic resonance imaging, upright radiographs, surgical reports and patient records will be evaluated, and clinical and functional outcomes will be measured. Patient-reported knee function and anterior knee pain as assessed with the Kujala score will serve as primary outcome. For biomechanical outcome, pre- and postoperative evaluations will be performed to assess isokinetic muscle strength, gait asymmetry, joint kinematics and kinetics, and timing of muscle activity.DiscussionThe results of the study will clarify whether the reported surgery success for patella stabilization via dynamic MPFL reconstruction is due to muscle contraction or to the passive tenodesis effect combined with clinical outcome measures. With this study, we will provide much needed information on knee biomechanics after dynamic versus static MPFL reconstruction to provide evidence to support orthopedic surgeons in evidence-based decision-making in their quest for surgical techniques most favorable for their patients. Trial registration The study protocol was registered at clinicaltrials.gov (NCT04849130). Registered 19 April 2021, https://clinicaltrials.gov/ct2/show/NCT04849130 .

Dataset Information

Simple Cost-Effective Reinsertion of Avulsed Medial Patellofemoral Ligament in Acute Patellar Dislocation.

Publications

Simple Cost-Effective Reinsertion of Avulsed Medial Patellofemoral Ligament in Acute Patellar Dislocation.

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