Reconstrução do ligamento patelofemoral medial pela técnica anatômica do duplo‐feixe com âncoras metálicas

Sadigursky, David; Laranjeira, Matheus Simões de Melo; Nunes, Marzo; Caneiro, Rogério Jamil Fernandes; Colavolpe, Paulo Oliveira

doi:10.1016/j.rbo.2015.07.010

Cited by 11 publications

(3 citation statements)

References 42 publications

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“…This result compares favorably with the literature, which reports similar scores 2–2.5 years post-surgery of 73.40 [19], 80.90 [20], 86.00 [15], 87.00 [14], 89.20 [21], 91.40 [22], 92.00 [23], 94.03 [24], 94.69 [16] and 99.69 [18]. …”

Section: Discussionsupporting

confidence: 85%

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

Shtarker

Assaf

Deltoff

2018

Eur J Orthop Surg Traumatol

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A new surgical method is introduced offering a less invasive approach to reattach the medial retinaculum following acute patellar dislocation. This retrospective analysis comprised 12 cases of medial retinacular repair in 10 patients. The surgical technique achieved reinforced reattachment of the torn region of the medial retinaculum for improved patellar support and stabilization. During follow-up, no recurrent patellar dislocations occurred, except where one patient reported a subjective feeling of patellar dislocation. The average Kujala score for our sample group after 2 years was 89.2. A plethora of methods are described in the literature to repair a tear to the medial patellofemoral ligament, which attaches at the superomedial patella. However, it is our contention that traumatic patellar dislocation invariably results in osteochondral avulsion at the inferomedial patella, refuting medial patellofemoral ligament involvement, and, rather, implicating the inferior aspect of the deep layer of medial retinaculum. Our surgical technique enables stable fixation of the region, decreasing the rate of recurrent dislocations. No grafts are used, permitting tendinous and ligamentous anatomy to remain intact. We further postulate that performing a CT examination preoperatively may reduce time between diagnosis and surgery, in addition to locating fracture sites more precisely.

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Section: Discussionsupporting

confidence: 85%

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

Shtarker

Assaf

Deltoff

2018

Eur J Orthop Surg Traumatol

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“…Para tensionamento final do enxerto, optou-se pela fixação femoral com o joelho entre 45 e 60º de flexão, por ser mais fácil o controle da centralização da patela na tróclea femoral. Esta posição também foi recomendada por Sadigursky et al (139) , na sua análise biomecânica realizada com o mesmo tipo de enxerto do TP, e por outros estudos clínicos e biomecânicos com diferentes tipos de enxertos (42,84,94,104,(140)(141)(142) . E, apesar de seguir os princípios da referida técnica, o autor preferiu não realizar a sutura do enxerto junto ao músculo VMO, conforme a descrição original, visto a inconstante presença de conexão entre este músculo e o LPFM conforme relatado por Steensen et al (65) em 2004 e corroborado posteriormente por Placella et al (68) .…”

Section: Discussionunclassified

“…Enquanto Arendt (85) e, posteriormente, Hopper et al (109) recomendaram a reconstrução isolada do LPFM quando a tróclea femoral fosse normal ou tipo A sem esporão troclear, os estudos de Schötlle et al (83) , Fernandez et al (104) , Steiner et al (105) , Howells et al (90) , Valkering et al (114) , Sadigurski et al (142) , Allen et al (115) , Blanke et al (160) e Thaunat e Erasmus (73) não constataram influência do grau de displasia da tróclea femoral nos resultados. Já Caplan et al (25) , Schüttler et al (52) , Hopper et al (109) , Wagner et al (106) , Kita et al (110) , Hiemstra et al (111,112) , Nakagawa et al (121) e Schüttler et al (52) encontraram piores resultados em pacientes com displasia da tróclea femoral, principalmente nos tipos mais graves.…”

Section: Discussionunclassified

Reconstrução do ligamento patelofemoral medial com o terço medial do tendão patelar no tratamento da instabilidade recidivante da patela: resultados a médio e longo prazo

Kupczik¹

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Isolated medial patellofemoral ligament reconstruction significantly improved quality of life in patients with recurrent patella dislocation

Bouras

Edmond

Brown

et al. 2019

Knee Surg Sports Traumatol Arthrosc

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Purpose The purpose of this study was to measure the improvement in quality of life (QoL) following isolated anatomical double-bundle medial patellofemoral ligament reconstruction. Methods This is a single-centre, prospective study of 56 consecutive patients (57 knees) who underwent isolated MPFL reconstruction between 2014 and 2017. Functional outcome and QoL were assessed with the Kujala score and the EQ-5D-3L questionnaire, respectively. Objective outcomes were obtained through clinical examination at the latest follow-up assessing redislocation rate, patella apprehension test, patellar tilt, pain and range of motion. ResultsThe median Kujala score increased from 60 (range 31-96) to 92 (range 34-100) at latest follow-up (p < 0.001). The median EQ-5D index also increased, from 0.69 (range 0.10-1) at baseline to 1 (range 0.16-1) at latest follow-up (p < 0.001), as well as the median EQ-5D VAS from 75 (range 20-95) to 92 (range 40-100) (p < 0.001). Four dimensions of the EQ-5D were signiicantly improved except for the anxiety/depression scores. Female patients reported lower scores at baseline and at latest follow-up, for all three outcomes (Kujala, EQ-5D index, EQ-5D VAS), however there was no evidence that gender negatively impacted on the beneit of surgery. The re-dislocation rate was 0%. Apprehension and patellar tilt test were negative in all patients and no lexion deicit was identiied at latest follow-up. Two patients had tenderness along the reconstruction requiring femoral screw removal in one of them. Conclusions Isolated anatomical double-bundle aperture MPFL reconstruction, ofered signiicantly improved short-term QoL along with excellent functional outcome. Female patients scored lower, but this did not afect the overall outcome. Including QoL tools in the assessment of ligament reconstruction operations, such as the MPFL, can provide more accurate understanding of the overall patient beneit. Level of evidence II.

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Reconstrução do ligamento patelofemoral medial pela técnica anatômica do duplo‐feixe com âncoras metálicas

Cited by 11 publications

References 42 publications

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

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

Reconstrução do ligamento patelofemoral medial com o terço medial do tendão patelar no tratamento da instabilidade recidivante da patela: resultados a médio e longo prazo

Isolated medial patellofemoral ligament reconstruction significantly improved quality of life in patients with recurrent patella dislocation

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