Reconstruction of the Medial Patellofemoral Ligament in Skeletally Immature Patients

Hernandez, Arnaldo José; Fávaro, Edimar; Almeida, Arací Malagodi de; Bonavides, Aloísio Fernandes; Demange, Marco Kawamura; Camanho, Gilberto Luís

doi:10.1097/btk.0b013e318184c7e4

Cited by 6 publications

(8 citation statements)

References 39 publications

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“…Thus, MPFL‐R‐G was used as an internal reference to validate the test protocol and reconstruction technique. MPFL‐R with quadriceps tendon has also been widely used, with favourable clinical results [10, 12, 21, 30]. MPFL‐R‐QT does not require additional fixation on the patella, and thus has the advantages of lower cost and avoidance of complications arising from patellar fixation.…”

Section: Discussionmentioning

confidence: 99%

Isolated MPTL reconstruction fails to restore lateral patellar stability when compared to MPFL reconstruction

Ambra

Franciozi

Phan

et al. 2020

Knee Surg Sports Traumatol Arthrosc

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PurposeTo biomechanically evaluate MPTL reconstruction and compare it with two techniques for MPFL reconstruction in regard to changes in patellofemoral contact pressures and restoration of patellar stability. MethodsThis is an experimental laboratory study in eight human cadaveric knees. None had patellofemoral cartilage lesions or trochlear dysplasia as evaluated by conventional radiographs and MRI examinations. The specimens were secured in a testing apparatus, and the quadriceps was tensioned in line with the femoral shaft. Contact pressures were measured using the TekScan sensor at 30°, 60° and 90°. The sensor was placed in the patellofemoral joint through a proximal approach between femoral shaft and quadriceps tendon to not violate the medial and lateral patellofemoral complex. TekScan data were analysed to determine mean contact pressures on the medial and lateral patellar facets. Patellar lateral displacement was evaluated with the knee positioned at 30° of flexion and 9 N of quadriceps load, then a lateral force of 22 N was applied. The same protocol was used for each condition: native, medial patellofemoral complex lesion, medial patellofemoral ligament reconstruction (MPFL‐R) using gracilis tendon, MPFL‐R using quadriceps tendon transfer, and medial patellotibial ligament reconstruction (MPTL‐R) using patellar tendon transfer. ResultsNo statistical differences were found for mean and peak contact pressures, medial or lateral, among all three techniques. However, while both techniques of MPFL‐R were able to restore the medial restraint, MPTL‐R failed to restore resistance to lateral patellar translation to the native state (mean lateralization of the patella [mm]: native: 9.4; lesion: 22; gracilis MPFL‐R: 8.1; quadriceps MPFL‐R: 11.3; MPTL‐R: 23.4 (p < 0.001). ConclusionMPTL‐R and both techniques for MPFL‐R did not increase patellofemoral contact pressures; however, MPTL‐R failed to provide a sufficient restraint against lateral patellar translation lateral translation in 30° of flexion. It, therefore, cannot be recommended as an isolated procedure for the treatment of patellar instability.

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Section: Discussionmentioning

confidence: 99%

Isolated MPTL reconstruction fails to restore lateral patellar stability when compared to MPFL reconstruction

Ambra

Franciozi

Phan

et al. 2020

Knee Surg Sports Traumatol Arthrosc

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“…2 , Fig. 3 ) 12 : An incision of 3 cm was made proximally to the patella. Using a scalpel blade, a strip of 8 mm in width from the medial portion of the quadriceps tendon containing the superficial portion of the quadriceps (in relation to the rectus femoris) was cut out, while its patellar insertion was maintained.…”

Section: Methodsmentioning

confidence: 99%

“…Several types of graft for reconstructing the MPFL with good results have been described. 12 , 13 , 14 It is important to have different types of graft with similar results in order to make it possible to individualize the treatment and to perform revision on the reconstruction.…”

Section: Introductionmentioning

confidence: 99%

Reconstruction of medial patellofemoral ligament using quadriceps tendon combined with reconstruction of medial patellotibial ligament using patellar tendon: initial experience

Hinckel

Gobbi

Bonadio

et al. 2016

Revista Brasileira de Ortopedia (English Edition)

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ObjectiveTo describe a surgical technique for anatomical reconstruction of the medial patellofemoral ligament using the quadriceps tendon, combined with reconstruction of the medial patellotibial ligament using the patellar tendon; and to present the initial results from a case series.MethodThe proposed technique was used on a series of cases of patients with diagnoses of patellofemoral instability and indications for surgical treatment, who were attended by the Knee Group of HC-IOT, University of São Paulo. The following were evaluated before and after the operation: range of motion (ROM), apprehension test, lateral translation test, patellar inclination test, inverted J sign, subluxation upon extension, pain from compression of the patella and pain from contraction of the quadriceps. After the operation, the patients were asked whether any new episode of dislocation had occurred, what their degree of satisfaction with the surgery was (on a scale from 0 to 10) and whether they would be prepared to go through this operation again.ResultsSeven knees were operated, in seven patients, with a mean follow-up of 5.46 months (±2.07). Four patients who presented apprehension before the operation did not show this after the operation. The lateral translation test became normal for all the patients, while the patellar inclination test remained positive for two patients. The patients with an inverted J sign continued to be positive for this sign. Five patients were positive for subluxation upon extension before the operation, but all patients were negative for this after the operation. None of the patients presented any new episode of dislocation of the patella. All of them stated that they were satisfied: five gave a satisfaction score of 9 and two, a score of 10. All of them said that they would undergo the operation again. Only one patient presented a postoperative complication: dehiscence of the wound.ConclusionReconstruction of the medial patellofemoral ligament using the quadriceps tendon, combined with reconstruction of the medial patellotibial ligament using the patellar tendon, was technically safe and presented good objective and subjective clinical results in this case series with a short follow-up.

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“…Atkin et al 10 , describe that after 06 months from an acute patellar luxation episode, more than half of the patients from his set presented limitation for extenuating physical activities. This high index of unsatisfactory results in the treatment of acute patellar luxation, many of which practitioners of sports activities, stimulated us to investigate the patellar biomechanical functioning through its main medial static stabilizer, the medial patellofemoral ligament (1,2) . The MPFL was initially described by Kaplan, in 1957 (15) , but he did not name it.…”

Section: Discussionmentioning

confidence: 99%

“…The study of the disorders between the patella and femur is of great relevance not only for their high prevalence but also for the expressive number of cases of difficult solution, especially in athletes, this context becomes more complex (1,2) The current literature has emphasized the importance of the injury of the medial patellofemoral ligament (MPFL) in acute patellar luxation, since it is the main static stabilizer of the medial side of the patella and is the first structure injured in this condition (1)(2)3,4) (figure 1). Many authors use different imaging methods to refer to the MFPL injury as an essential factor in the patellar instability after an acute patellar luxation episode (5)(6)(7) .…”

Section: Introductionmentioning

confidence: 99%

Importância do ligamento femoropatelar medial no deslocamento e na inclinação lateral da patela: estudo radiográfico em cadáveres

Fávaro

Severino²,

Fávaro

et al. 2011

Rev Bras Med Esporte

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Objective: Acute patellar luxation is a complex disease that mainly affects young patients. Its physiopathology is little known and the understanding of it and its therapeutic conduct are controversial. The medial patellofemoral ligament (MPFL) is the main static stabilizer for preventing lateral displacement of the patella. In order to assess the stability of the patellofemoral joint, the authors radiographically assessed the presence, or absence of lateral displacement and inclination of the patella before and after the MPFL section in the knees of cadavers. Methods: Thirty knees of cadavers were radiographed on the axial incidence of the patella by means of the technique described by Merchant before and after MPFL section. The Merchant congruence angle and Laurin lateral patellofemoral angle were measured. Results: The medial patellofemoral ligament presented mean length of 4.8cm, and width of 1.6 cm. In six anatomical pieces there was no change in the Laurin lateral patellofemoral angle (20%), in three anatomical pieces the change was one degree (10%), in 20 (67%) two degrees and in one anatomical piece it was four degrees (3%). Changes occurred between zero and two degrees in 97% of the knees of cadavers. In six anatomical pieces there was no change in the Merchant congruence angle (17%); in six anatomical pieces the change was one degree (20%), in 17 (57%) two degrees, in one anatomical piece it was three degrees (3%) and in one it was six degrees (3%). These changes occurred between zero and two degrees in 93% of the knees of cadavers. Conclusion: Analysis of the results obtained in this study allowed us to conclude that the medial patellofemoral ligament is important in the lateral inclination and displacement of the patella with knee flexed at 45º.

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Reconstruction of the Medial Patellofemoral Ligament in Skeletally Immature Patients

Cited by 6 publications

References 39 publications

Isolated MPTL reconstruction fails to restore lateral patellar stability when compared to MPFL reconstruction

Isolated MPTL reconstruction fails to restore lateral patellar stability when compared to MPFL reconstruction

Reconstruction of medial patellofemoral ligament using quadriceps tendon combined with reconstruction of medial patellotibial ligament using patellar tendon: initial experience

Importância do ligamento femoropatelar medial no deslocamento e na inclinação lateral da patela: estudo radiográfico em cadáveres

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