Why compromise the patella? Five-year follow-up results of medial patellofemoral ligament reconstruction with soft tissue patellar fixation

Boelch, Sebastian Philipp; Gurok, Anna; Gilbert, Fabian; Weißenberger, Manuel; Rudert, Maximilian; Barthel, Thomas; Reppenhagen, Stephan

doi:10.1007/s00264-020-04922-1

Cited by 7 publications

(5 citation statements)

References 22 publications

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“…In the current study, post-operative Tegner activity level was signiicantly lower than pre-injury levels. It is important to recognize that this comparison is between pre-injury and post-operative activity level and is in line with the literature, which reports a decrease in Tegner score between 0.1 and 1 point over this time period [1,3,4,13,16]. In contrast, several published studies have demonstrated an improvement in Tegner scores between 0.2 and 3.5 points following MPFL reconstruction when the comparison is made to activity level after initial injury, but prior to reconstruction [9,21,27].…”

Section: Discussionsupporting

confidence: 79%

Medial patellofemoral ligament reconstruction for recurrent patellar dislocation allows a good rate to return to sport

Meynard

Malatray

Sappey‐Marinier

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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PurposeRecurrent patellar dislocation is a frequent knee disorders in young, active patients. Medial patellofemoral ligament reconstruction (MPFLR) can restore knee stability and function, but the rate of return to sports is less clear. The aim of this study was to evaluate rate of return to sport following treatment of recurrent patellar dislocation with isolated MPFLR. MethodsBetween 2011 and 2018, 113 patients with recurrent patellar dislocation were treated with isolated MPFLR at an academic center. Pre‐injury sports participation and Tegner score, pre‐operative subjective IKDC score, time to return to sports, and post‐operative Tegner and subjective IKDC scores were collected, with a minimum of follow‐up of 2 years. ResultsOne hundred and three patients (91%) were evaluated at a mean of 4.5 ± 2.5‐year post‐operative. 92 patients (89%) participated in sports prior to onset of patellar instability. At final follow‐up, 84 of these 92 patients (91%) were able to return to sports. The mean time from surgery to return to sports was 10.4 ± 8.6 months (range: 2–48 months). 62 patients (67%) returned to the same (50 patients) or higher (12 patients) level. 22 patients (26%) returned at a lower level. 19 of these patients attributed this decreased participation to ongoing knee problems. The median Tegner score was noted to decrease from 5 pre‐injury to 4 post‐operatively (p = 0.02). ConclusionIsolated MPFL reconstruction allowed return to pre‐injury sports in 91% of patients, with 67% of patients returning to the same or higher level than pre‐injury. Mean time to return to sports was 10 months and post‐operative Tegner score was noted to be modestly decreased from pre‐injury level. Level of evidenceIV.

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Section: Discussionsupporting

confidence: 79%

Medial patellofemoral ligament reconstruction for recurrent patellar dislocation allows a good rate to return to sport

Meynard

Malatray

Sappey‐Marinier

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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“…The overall good outcome after MPFL reconstruction with restored function and improving WORMS scores over time is in line with previous studies that assessed clinical outcomes after isolated MPFL reconstruction [40][41][42]. Clinical KOOS and Kujala scores are similar to previously published outcomes [43][44][45].…”

Section: Discussionsupporting

confidence: 89%

“…Potentially, the stress reduction is inferior in those patients with persistent joint abnormalities. It was previously reported that trochlear dysplasia is the most common anatomic risk factor for patellar redislocation after primary isolated MPFL reconstruction followed by increased maltracking, while tunnel positioning had no significant influence [20,40]. In the present study, besides trochlear dysplasia parameters and TTTG distance, postoperatively persistent high lateral patellar tilt was identifyed as a risk factor for progressive knee joint degeneration after surgery.…”

Section: Discussionsupporting

confidence: 48%

“…T1rho and T2 values may be more sensitive to detect early cartilage matrix changes than T2* values [67,68]. Based on these studies, although isolated MPFL reconstruction may be appropriate in most patients, the indication for additional trochlear surgery such as deepening trochleoplasty and tibial tubercle transfer in borderline cases may need to be considered [21,40,69].…”

Section: Discussionmentioning

confidence: 99%

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Patellar instability MRI measurements are associated with knee joint degeneration after reconstruction of the medial patellofemoral ligament

et al. 2021

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Objective To qualitatively and quantitatively evaluate the 2-year magnetic resonance imaging (MRI) outcome after MPFL reconstruction at the knee and to assess MRI-based risk factors that predispose for inferior clinical and imaging outcomes. Materials and methods A total of 31 patients with MPFL reconstruction were included (22 ± 6 years, 10 female). MRI was performed preoperatively in 21/31 patients. Two-year follow-up MRI included quantitative cartilage T2 and T1rho relaxation time measurements at the ipsilateral and contralateral knee. T2relative was calculated as T2patellofemoral/T2femorotibial. Morphological evaluation was conducted via WORMS scores. Patellar instability parameters and clinical scores were obtained. Statistical analyses included descriptive statistics, t-tests, multivariate regression models, and correlation analyses. Results Two years after MPFL reconstruction, all patellae were clinically stable. Mean total WORMS scores improved significantly from baseline to follow-up (mean difference ± SEM, − 4.0 ± 1.3; P = 0.005). As compared to patients with no worsening of WORMS subscores over time (n = 5), patients with worsening of any WORMS subscore (n = 16) had lower trochlear depth, lower facetal ratio, higher tibial-tuberosity to trochlear groove (TTTG) distance, and higher postoperative lateral patellar tilt (P < 0.05). T2relative was higher at the ipsilateral knee (P = 0.010). T2relative was associated with preoperatively higher patellar tilt (P = 0.021) and higher TTTG distance (P = 0.034). TTTG distance, global T2 values, and WORMS progression correlated with clinical outcomes (P < 0.05). Conclusion MPFL reconstruction is an optimal treatment strategy to restore patellar stability. Still, progressive knee joint degeneration and patellofemoral cartilage matrix degeneration may be observed, with patellar instability MRI parameters representing particular risk factors.

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“…Dislocation episodes also may lead to articular cartilage lesions, osteochondral fractures, and overall knee dysfunction [7, 20, 23]. Thus, MPFL reconstruction (MPFLR) is often indicated to prevent recurrent instability [1, 2, 6, 14, 28].…”

Section: Introductionmentioning

confidence: 99%

Patients unable to return to play following medial patellofemoral ligament reconstructions demonstrate poor psychological readiness

Hurley

Markus

Mannino

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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Purpose Medial patellofemoral ligament reconstruction (MPFLR) is often indicated in athletes with lateral patellar instability to prevent recurrence and allow for a successful return to play. In this patient population, the ability to return to play is one of the most important clinical outcomes. The purpose of the current study was to analyze the characteristics of patients who were unable return to play following MPFL reconstruction. Methods A retrospective review of patients who underwent MPFL reconstruction and subsequently did not return to play after a minimum of 12-months of follow-up was performed. Patients were evaluated for their psychological readiness to return to sport using the MPFL-Return to Sport after Injury (MPFL-RSI) score, which is a modiication of the ACL-RSI score. A MPFL-RSI score > 56 is considered a passing score for being psychologically ready to return to play. Additionally, reasons for not returning to play including Visual Analog Scale for pain (VAS), Kujala score, satisfaction, and recurrent instability (including dislocations and subluxations) were evaluated. ResultsThe study included a total of 35 patients who were unable to return to play out of a total cohort of 131 patients who underwent MPFL reconstruction as treatment for patellar instability. Overall, 60% were female with a mean age of 24.5, and a mean follow-up of 38 months. Nine patients (25.7%) passed the MPFL-RSI benchmark of 56 with a mean overall score of 44.2 ± 21.8. The most common primary reasons for not returning to play were 14 were afraid of re-injury, 9 cited other lifestyle factors, 5 did not return due to continued knee pain, 5 were not conident in their ability to perform, and 2 did not return due to a feeling of instability. The mean VAS score was 1.9 ± 2.3, the mean Kujala score was 82.5 ± 14.6, and the mean satisfaction was 76.9%. Three patients (8.7%) reported experiencing a patellar subluxation event post-operatively. No patient sustained a post-operative patellar dislocation. Conclusion Following MPFL reconstruction, patients that do not return to play exhibit poor psychological readiness with the most common reason being fear of re-injury. Level of evidence IV.

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Why compromise the patella? Five-year follow-up results of medial patellofemoral ligament reconstruction with soft tissue patellar fixation

Cited by 7 publications

References 22 publications

Medial patellofemoral ligament reconstruction for recurrent patellar dislocation allows a good rate to return to sport

Medial patellofemoral ligament reconstruction for recurrent patellar dislocation allows a good rate to return to sport

Patellar instability MRI measurements are associated with knee joint degeneration after reconstruction of the medial patellofemoral ligament

Patients unable to return to play following medial patellofemoral ligament reconstructions demonstrate poor psychological readiness

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