Medial Patellofemoral Ligament Reconstruction in Traumatic Patellar Dislocation without Patellar Fixation

Abstract

Acute traumatic patellar dislocation is a common injury, and spontaneous reduction may occur at the time of injury or may be reduced at the field of the accident by someone. It may be associated with osteochondral fractures and rupture of medial patellar stabilizers leading to recurrent patellar instability. The aim of this prospective study was to evaluate the outcomes of medial patellofemoral (PF) ligament (MPFL) reconstruction in recurrent traumatic patellar dislocation. Forty-five patients presented with PF instability as a result of traumatic rupture MPFL with normal patellar tracking underwent MPFL reconstruction without patellar fixation hardware through two parallel transpatellar tunnels and one screw in femoral tunnel. All patients were evaluated clinically preoperatively and at a minimum follow-up of 24 months, and International Knee Documentation Committee (IKDC) and Kujala scores were used to assess the clinical results. All patients were available for evaluation at a minimum of 24 months (up to 36 months). The mean age of these patients at the time of surgery was 22.82 years (range: 18–34 years). All patients gave history of trauma of their knees. Mean IKDC scale showed significant improvement as it rose from 47.17 preoperatively to 77.94 postoperatively, and mean Kujala score rose from 53.88 preoperatively to 86.24 postoperatively (p < 0.001). No recurrence of dislocation was recorded. Only three patients had mild atrophy of thigh and one patient had some difficulty in jumping. Reconstruction of MPFL by this method provides good clinical result in the treatment of PF instability by using autologous graft (semitendinosus and gracilis). Less hardware were used with less complications.

Transpatellar bone tunnels perforating the lateral or anterior cortex increase the risk of patellar fracture in MPFL reconstruction: a finite element analysis and survey of the International Patellofemoral Study Group

“…Several different techniques for patellar graft fixation have been reported [7, 15, 21, 29, 30]. A commonly used patellar graft fixation technique requires the creation of transverse patellar bone tunnels for implant‐free patellar MPFL graft fixation [9, 17, 26, 34]. However, patellar bone tunnel techniques for patellar MPFL graft fixation are at increased risk of postoperative patellar fracture [5, 7, 26, 34].…”

MPFL Reconstruction Combined with a Modified Elmslie–Trillat Procedure for Recurrent Patellofemoral Instability

“…Patients with traumatic MPFL injury and RPI without elevated TT-TG distance, significant patella alta, or trochlear dysplasia can be expected to achieve good clinical outcomes after treatment with either MPFL-R or ET alone. 13,25 However, it has been reported that isolated MPFL-R should be avoided for the treatment of RPI in the setting of significant patella alta and an elevated TT-TG distance. [20][21][22] If this is so, what is the appropriate procedure to perform in addition to MPFL-R?…”