Medial patellofemoral ligament reconstruction with autologous gracilis tendon: Clinical and radiological outcomes at a mean 6 years of follow up

Basso, Marco; Arnaldi, Enrico; Tamini, Jacopo; Bruno, Andrea

doi:10.1016/j.knee.2021.10.009

Cited by 9 publications

(9 citation statements)

References 37 publications

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“…Patellofemoral instability is relatively common [ 39 ] and can be difficult to manage [ 22 ], and although treatment algorithms exist [ 10 , 23 , 24 ], the basic surgical treatment remains MPFL reconstruction due to its extremely low morbidity and excellent outcomes [ 3 , 30 ]. In the present systematic review, most of the studies reported performing an MPFL in addition to the DeDFO.…”

Section: Discussionmentioning

confidence: 99%

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Promising results following derotational femoral osteotomy in patellofemoral instability with increased femoral anteversion: A systematic review on current indications, outcomes and complication rate

Klasan,

Compagnoni,

Grassi

et al. 2024

J. exp. orthop.

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PurposePatellofemoral joint instability (PFJI) can surgically be treated with a multitude of approaches, depending on the underlying pathology. In the presence of increased femoral anteversion, some authors have reported good results with a derotational distal femoral osteotomy (DeDFO). The purpose of the study was to investigate the indications, outcomes and complication rate of DeDFO for PFJI.MethodsA systematic review was performed according to the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta‐analyses) by searching Medline, Embase, Web of Science and Cochrane Library databases through 1 December 2023. Included were levels 1–4 clinical studies of skeletally mature patients undergoing a DeDFO for PFJI irrespective of concomitant procedures. Study characteristics, indications, radiological and clinical outcomes, surgical technique and concomitant procedures, re‐dislocation and complication rate were all analysed, as was methodological quality.ResultsA total of 12 studies including 310 patients (325 knees) were included. Three studies were cohort studies, all others were case series. The mean patient age across the studies was 22 years, and the mean follow‐up was 29.4 months. Femoral anteversion cut‐off was between 20° and 30°. Every study included at least one concurrent soft tissue, bony or combined procedure. Across all studies, one case of re‐dislocation was reported (0.3%) and four implant or osteotomy‐related complications (1.2%) were reported. All studies reported a statistically significant increase in clinical scores.ConclusionThis systematic review of DeDFO for patellofemoral instability in the presence of increased femoral anteversion demonstrates promising clinical results and an extremely low dislocation and complication rate. The heterogeneity of the cut‐off in anteversion and concomitant procedures, especially tibial tubercle osteotomy with seemingly identical results, indicates the need for high‐quality evidence for treating patellofemoral instability. Based upon this systematic review, we strongly recommend that DeDFO be added to the ‘menu à la carte’ of PFJI.Level of EvidenceLevel III Systematic Review.

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Section: Discussionmentioning

confidence: 99%

“…Medial patellofemoral ligament reconstruction (MPFL‐R) has been the go‐to surgical treatment option [ 3 , 30 ]. Outcomes of MPFL‐R as an isolated procedure are dependent on tunnel position [ 14 , 34 ] and adequately identifying and addressing other underlying pathomorphological changes [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Promising results following derotational femoral osteotomy in patellofemoral instability with increased femoral anteversion: A systematic review on current indications, outcomes and complication rate

Klasan,

Compagnoni,

Grassi

et al. 2024

J. exp. orthop.

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“… 7 SAs were initially introduced as an alternative to IS fixation due to the incidence of fracture associated with tunnel drilling and screw placement. A study, performed by Basso et al., 3 demonstrated that the use of an autologous gracilis graft with SAs achieved strong midterm clinical results at an average of 72.3 months. Another systematic review determined that the use of SA for transpatellar fixation was associated with greater improvement in Kujala scores compared with double transpatellar tunnel fixation methods, though there was no difference in patellar redislocation rate.…”

Section: Discussionmentioning

confidence: 99%

“…2 Reconstruction of the MPFL typically involves the use of either an allograft or autograft and a construct to aid in the fixation of the graft to the native origin and insertion of the pathologic MPFL. 3 A commonly used construct for MPFL fixation is the interference screw (IS), although the IS has come under scrutiny due to the large socket required for fixation and trochlear and notch geometries that limit safe placement. 4 Suture anchors (SAs) have demonstrated efficacy in other tendinous and ligamentous repairs within the musculoskeletal system and may represent a viable alternative to IS for fixation in MPFL reconstruction.…”

mentioning

confidence: 99%

Interference Screws Are Biomechanically Superior to Suture Anchors for Medial Patellofemoral Ligament Reconstruction: A Systematic Review and Meta-Analysis

Sequeira

Imbergamo

Gould

2022

Arthroscopy, Sports Medicine, and Rehabilitation

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“…The insufficiency or injury of the MPFL is an important risk factor leading to LPD, and the MPFL was ruptured in up to 90% of cases with LPD that required surgical treatment [25]. Therefore, MPFL reconstruction (MPFLR) has become the primary procedure for the treatment of LPD, with favorable functional outcomes and low complication rates, even in patients with bony deformities [1, 4, 27].…”

Section: Introductionmentioning

confidence: 99%

Medial patellofemoral ligament reconstruction combined with derotational distal femoral osteotomy yields better outcomes than isolated procedures in patellar dislocation with increased femoral anteversion

Hao

Niu

Kong

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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PurposeThe purpose of this study was to evaluate and compare clinical and radiological outcomes between isolated medial patellofemoral ligament reconstruction (MPFLR) and MPFLR combined with derotational distal femoral osteotomy (DDFO) for patellar dislocation with increased femoral anteversion (FA). MethodsBetween 2014 and 2019, 36 patients who underwent isolated MPFLR and 31 patients who underwent MPFLR combined with DDFO were retrospectively included. Clinical outcomes included physical examinations, functional outcomes (Kujala, Lysholm, International Knee Documentation Committee (IKDC), and Banff Patella Instability Instrument (BPII) scores), activity level (Tegner activity score and return to sports), complications, and patellar re‐dislocation rate. Radiological outcomes included patella tilt angle, patellar congruence angle, and patella–trochlear groove distance. ResultsAll clinical outcomes improved significantly in both groups, but the DDFO group had significantly better postoperative scores than the MPFLR group (Kujala: 85.1 ± 7.7 vs. 80.5 ± 8.4, P = 0.023; Lysholm: 86.8 ± 8.2 vs. 81.9 ± 9.1, P = 0.026; IKDC: 86.2 ± 10.0 vs. 81.7 ± 8.1, P = 0.045; and BPII: 68.0 ± 12.5 vs. 62.3 ± 10.0, P = 0.039). Both groups achieved successful return to sports (90.3% vs. 91.7%). No re‐dislocation or major complications occurred. Radiological outcomes improved significantly in both groups, but the DDFO group had better outcomes (P < 0.05). The tibial tubercle–trochlear groove distance was only improved after DDFO from 17.0 ± 2.3 mm to 15.1 ± 2.0 mm (P = 0.001). ConclusionBoth isolated MPFLR and MPFLR combined with DDFO yielded satisfactory clinical and radiological outcomes in the treatment of patellar dislocation with increased FA. However, combined DDFO had better outcomes and should be considered a priority. Level of evidenceLevel III.

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Medial patellofemoral ligament reconstruction with autologous gracilis tendon: Clinical and radiological outcomes at a mean 6 years of follow up

Cited by 9 publications

References 37 publications

Promising results following derotational femoral osteotomy in patellofemoral instability with increased femoral anteversion: A systematic review on current indications, outcomes and complication rate

Promising results following derotational femoral osteotomy in patellofemoral instability with increased femoral anteversion: A systematic review on current indications, outcomes and complication rate

Interference Screws Are Biomechanically Superior to Suture Anchors for Medial Patellofemoral Ligament Reconstruction: A Systematic Review and Meta-Analysis

Medial patellofemoral ligament reconstruction combined with derotational distal femoral osteotomy yields better outcomes than isolated procedures in patellar dislocation with increased femoral anteversion

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