Combined Medial Patellofemoral Ligament and Medial Patellotibial Ligament Reconstruction for Recurrent Lateral Patellar Dislocation in Flexion

Abdelrahman, Taher; Moatshe, Gilbert; Arendt, Elizabeth A.; Feller, Julian A.; Getgood, Alan

doi:10.1016/j.eats.2020.10.017

Cited by 6 publications

(4 citation statements)

References 22 publications

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“…Our results are in line with other studies, such as the cadaver study by Nomura et al that showed that when a lateral displacement force (10 N) occurs, patella displacement is about 6 and 13 mm, respectively, with a normal medial patellofemoral ligament [80]. Other authors have demonstrated how lateral imbalance could reduce the force required to dislocate the patella by 10 mm at different angles, by approximately 20% [81].…”

Section: Discussionsupporting

confidence: 92%

Quadriceps Muscle and Medial Retinaculum Combinate Effects on Patellar Instability during Knee Flexion

2023

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Background: Patellar instability can cause pain and disability. A finite element model of a healthy human knee was performed to analyze the role of quadriceps and medial retinaculum imbalance in patellar instability. Methods: The model was created by matching magnetic resonance and computed tomography images of a normal adult patient’s knee. Muscle force intensities were calculated by static optimization, considering the lower limb muscles, knee movement and the ground reaction during walking. Patellar instability was experimentally generated by progressively uncoupling muscular forces, (90 N versus 110 N), while at the same time, the load derived from the quadriceps was gradually reduced by 20%. Results: This loss in force symmetry of 10 N on the retinaculum may produce a displacement of approximately 7 mm, with an increase in patellar contact forces of approximately 44%. When the quadriceps force is reduced by 10% and the unbalanced medial retinaculum acts together, the displacements are in the order of 14 mm, and the patellar contact forces increase by 84%. Conclusion: A reduced quadriceps force alone is not able to cause significant patellar instability, while an imbalance of forces at the level of the retinaculum could lead to patellar instability, especially when the two effects are combined. A better understanding of joint relationships and muscle synergies can help to improve clinical approaches to patella instability

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Section: Discussionsupporting

confidence: 92%

Quadriceps Muscle and Medial Retinaculum Combinate Effects on Patellar Instability during Knee Flexion

2023

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“…Lateral retinacular reconstruction may be performed using autograft or allograft tissue. This combined approach provides a more comprehensive stabilization of the patella and may reduce the risk of recurrent instability [28].…”

Section: Discussionmentioning

confidence: 99%

Medial Patellofemoral Ligament and Lateral Patellofemoral Ligament Reconstruction after Tibial Tuberosity Transposition in a Young Woman with Patellar Instability

Merkač,

Sirše

2024

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In patients with reccurent lateral and medial patellar instability, isolated medial patellofemoral ligament (MPFL) reconstruction may be insufficient due to poor lateral retinacular tissue quality. In this report, we describe a case of a patient that underwent simultaneous MPFL and lateral patellofemoral ligament (LPFL) reconstruction on the left knee due to chronic bidirectional patellar instability. A 29-year-old female patient presented with first-time lateral patellar dislocation five years ago due to acute strain. She underwent a tibial tuberosity transposition in another hospital. After the surgery, she suffered from recurrent medial and lateral patellar dislocation and presented to our center. MPFL and concomitant LPFL reconstruction on the left knee was simultaneously performed due to bilateral patellar dislocation. The patella was stable postoperatively, and the patient underwent physiotherapy with successful results to date. Single-time patellar dislocation should be treated conservatively. Surgical treatment after the first episode of dislocation can magnitude the risk of postoperative complications. The simultaneous reconstructing of the LPFL yields patellar fixation indistinguishable from the native LPFL. These grafts provide separate tensioning depending on body anatomy, allowing for individualized stability. Anatomical MPFL reconstruction is supported by well-established high-quality research. Reconstructing the LPFL anatomically yields patellar fixation indistinguishable from the native LPFL.

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“…The higher dislocation rates seen in patients managed nonoperatively may be largely due to the MPFL being an essential structure, as it acts as a primary checkrein to lateral translation throughout the flexion arc [1]. Therefore, its absence even despite aggressive physiotherapy may contribute to the higher redislocation rates seen in the rehabilitation group.…”

Section: Discussionmentioning

confidence: 99%

“…In patellar dislocations, the Medial Patellofemoral Ligament (MPFL) is almost always ruptured [13]. The MPFL acts as a checkrein to lateral translation throughout the flexion arc [1], therefore, restoring MPFL structure and function is integral for treatment. This can be achieved through surgical, or non‐operative measures [32].…”

Section: Introductionmentioning

confidence: 99%

MPFL repair after acute first-time patellar dislocation results in lower redislocation rates and less knee pain compared to rehabilitation: a systematic review and meta-analysis

Blackman

Zakharia

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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PurposeThis study aimed to explore the efficacy of medial patellofemoral ligament (MPFL) repair versus nonoperative rehabilitation treatment on the rate of patellar redislocation and functional outcomes in skeletally mature patients with traumatic, first‐time patellar dislocations. Materials and methodsMEDLINE, PubMed and EMBASE were searched from database inception to May 2022 for studies examining the management options for acute first‐time patellar dislocations. This study was conducted in accordance with PRISMA and R‐AMSTAR guidelines. Data on redislocation rates, functional outcomes including the Kujala score for anterior knee pain, and complication rates were extracted. A meta‐analysis was used to pool the mean postoperative Kujala score and calculate the proportion of patients sustaining redislocations using a random effects model. Quality assessment of included studies was performed for all included studies using the MINORS and Detsky scores. ResultsThis review included a total of 25 studies and 1,361 patients. The pooled mean redislocation rate in 15 studies comprising 798 patients in the rehabilitation group was 30% (95% CI 25–36%, I2 = 65%). Moreover, the pooled mean redislocation rate in 10 studies comprising 170 patients undergoing MPFL repair was 7% (95% CI 3–12%, I2 = 30%). The pooled mean postoperative Kujala score in 8 studies comprising 396 patients in the rehabilitation group was 82.5 (95% CI 78.3–86.8, I2 = 91%), compared to a score of 88 (95% CI 87–90, I2 = 76%) in 3 studies comprising 94 patients in the repair group. Range of motion deficits was reported in 3.8% of 893 patients in the rehabilitation group and 2.0% of 205 patients in the repair group. ConclusionMPFL repair resulted in a lower rate of redislocation, less knee pain, and noninferiority with respect to a range of motion deficits compared to nonoperative treatment for the management of acute first‐time patellar dislocations. Level of evidenceIV.

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Combined Medial Patellofemoral Ligament and Medial Patellotibial Ligament Reconstruction for Recurrent Lateral Patellar Dislocation in Flexion

Cited by 6 publications

References 22 publications

Quadriceps Muscle and Medial Retinaculum Combinate Effects on Patellar Instability during Knee Flexion

Quadriceps Muscle and Medial Retinaculum Combinate Effects on Patellar Instability during Knee Flexion

Medial Patellofemoral Ligament and Lateral Patellofemoral Ligament Reconstruction after Tibial Tuberosity Transposition in a Young Woman with Patellar Instability

MPFL repair after acute first-time patellar dislocation results in lower redislocation rates and less knee pain compared to rehabilitation: a systematic review and meta-analysis

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