Dynamic medial patellofemoral ligament reconstruction in recurrent patellar instability

Abstract

The medial patellofemoral ligament (MPFL) is the primary stabilizer of the patellofemoral joint; its reconstruction has been recommended in adults over the past decade after recurrent patellar instability. However, there has been no standardized technique for reconstruction, therefore, ideal graft and technique for reconstruction are yet undetermined. However, dynamic MPFL reconstruction studies claim to be superior to other procedures as it is more anatomical. This preliminary study aims at assessing the outcomes of MPFL reconstruction in a dynamic pattern using hamstring graft. We performed this procedure in four consecutive patients with chronic patellar instability following trauma. MPFL reconstruction was done with hamstring tendons detached distally and secured to patellar periosteum after being passed through a bony tunnel in the patella without an implant and using the medial collateral ligament as a pulley. In all 4 knees, the MPFL reconstruction was isolated and was not associated with any other realignment procedures. No recurrent episodes of dislocation or subluxation were reported at 24 months followup.

A new minimally invasive surgical technique for medial retinaculum repair following traumatic patellar dislocation

“…Our present study did not demonstrate any incidence of recurrent dislocation 2 years following surgery; this is identical with the findings utilizing several other techniques [ 16 , 18 , 19 , 22 – 25 ]. However, the literature does mention various percentages of recurring dislocation following certain surgeries [ 1 , 15 , 17 , 20 , 21 , 26 , 27 ].…”

Hardware-free MPFL reconstruction in patients with recurrent patellofemoral instability is safe and effective

“…The last follow-up scores were 86.23 ± 7.71 versus 88.37 ± 3.71 at a 46.5 ± 20.9 months follow-up, respectively. These results agree with the findings of the present systematic review and are further supported by additional studies which have not been included because, though published in peer-reviewed journals, they did not meet our strict inclusion criteria [19,[39][40][41][42][43][44][45][46][47][48][49][50][51]. On the other hand, the complication profile of hardware-free fixation shares similarities with implantbased fixation techniques, including subjective instability, positive apprehension test, and redislocation [55].…”

“…Titles and abstracts were independently screened, and 27 articles were selected for full-text evaluation. Seven studies were excluded because of insufficient followup [19,[39][40][41][42][43][44] and seven more because Kujala Anterior Knee Pain Scale was not used or data were insufficient to evaluate post-surgical improvement [45][46][47][48][49][50][51]. Finally, eight studies met the predetermined eligibility criteria, and no additional studies were included after citation screening in the systematic review (Fig.…”

“…Implant-based fixation techniques have shown similar pullout strength to hardwarefree fixation techniques but higher stiffness [18,60]. However, it has been suggested that the elastic behavior and lower stiffness of hardware-free fixation can result in a more compliant graft physiometry, lowering the risk of joint overconstrain and early-onset osteoarthritis [3,18,19,21,41,46,47]. Additionally, many hardware-free fixation techniques do not require intraoperative fluoroscopy, lowering associated costs and radiation exposure [21,42].…”

A polygon-shaped complex appearance of medial patellofemoral ligament with dynamic functional insertion based on an outside-in and inside-out dissection technique

“…Many surgical techniques have been developed and used in MPFL reconstruction in recent years [7, 9, 13]. In fact, more than 100 surgical procedures for patellar instability have been developed to date, [6, 14] making it challenging for doctors to decide the best option for surgery.…”