Original Article| Volume 24, ISSUE 8, P881-887, August 2008

Isolated Repair of the Medial Patellofemoral Ligament in Primary Dislocation of the Patella: A Prospective Randomized Study

      Purpose: The purpose of this study was to evaluate the effect of surgical reinsertion of the medial patellofemoral ligament (MPFL) to the adductor tubercle compared with conservative treatment in patients with primary dislocation of the patella. Methods: Eighty patients with primary patella dislocation were included in the study. Delayed arthroscopy (mean, 50 days after injury) was performed to assess cartilage injury and status. During arthroscopy, patients were randomized to surgical reinsertion of the MPFL or to conservative treatment. Conservative treatment was use of a brace with 0° to 20° motion for the first 2 weeks after dislocation. Patients were followed up for 2 years. The incidence of recurrent patella dislocation was recorded along with the clinical Kujala scores and Knee Injury and Osteoarthritis Outcome Scores. Results: The redislocation rates were 17% and 20% in the operative and conservative treatment groups, respectively (P = not significant). Kujala scores were 85 and 78 in the operative and conservative treatment groups, respectively (P = .07). The patella stability subscore was significantly higher in the operative group. No difference in Knee Injury and Osteoarthritis Outcome Scores was found. Conclusions: Delayed primary repair of the MPFL by use of an anchor-based reattachment to the adductor tubercle without vastus medialis obliquus repair after primary patella dislocation does not reduce the risk of redislocation nor does it produce any significantly better subjective functional outcome based on the Kujala knee score. Only the specific subjective patella stability score was improved by MPFL repair compared with conservative treatment. Level of Evidence: Level I, therapeutic randomized controlled trial.

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        • Nomura E.
        Classification of lesions of the medial patello-femoral ligament in patellar dislocation.
        Int Orthop. 1999; 23: 260-263
        • Hautamaa P.V.
        • Fithian D.C.
        • Kaufman K.R.
        • Daniel D.M.
        • Pohlmeyer A.M.
        Medial soft tissue restraints in lateral patellar instability and repair.
        Clin Orthop Relat Res. 1998; : 174-182
        • Desio S.M.
        • Burks R.T.
        • Bachus K.N.
        Soft tissue restraints to lateral patellar translation in the human knee.
        Am J Sports Med. 1998; 26: 59-65
        • Sallay P.I.
        • Poggi J.
        • Speer K.P.
        • Garrett W.E.
        Acute dislocation of the patella.
        Am J Sports Med. 1996; 24: 52-60
        • Feller J.A.
        • Feagin Jr, J.A.
        • Garrett Jr, W.E.
        The medial patellofemoral ligament revisited: An anatomical study.
        Knee Surg Sports Traumatol Arthrosc. 1993; 1: 184-186
        • Koskinen S.K.
        • Rantanen J.P.
        • Nelimarkka O.I.
        • Kujala U.M.
        Effect of Elmslie-Trillat and Roux-Goldthwait procedures on patellofemoral relationships and symptoms in patients with patellar dislocations.
        Am J Knee Surg. 1998; 11: 167-173
        • McManus F.
        • Rang M.
        • Heslin D.J.
        Acute dislocation of the patella in children.
        Clin Orthop Relat Res. 1979; : 88-91
        • Hawkins R.J.
        • Bell R.H.
        • Anisette G.
        Acute patellar dislocations.
        Am J Sports Med. 1986; 14: 117-120
        • Maenpaa H.
        • Lehto M.U.
        Patellar dislocation.
        Am J Sports Med. 1997; 25: 213-217
        • Feller J.A.
        • Amis A.A.
        • Andrish J.T.
        • Arendt E.A.
        • Erasmus P.J.
        • Powers C.M.
        Surgical biomechanics of the patellofemoral joint.
        Arthroscopy. 2007; 23: 542-553
        • Barber F.A.
        • McGarry J.E.
        Elmslie-Trillat procedure for the treatment of recurrent patellar instability.
        Arthroscopy. 2008; 24: 77-81
        • Christiansen S.E.
        • Jacobsen B.W.
        • Lund B.
        • Lind M.
        Reconstruction of the medial patellofemoral ligament with gracilis tendon autograft in transverse patellar drill holes.
        Arthroscopy. 2008; 24: 82-87
        • Ahmad C.S.
        • Stein B.E.
        • Matuz D.
        • Henry J.H.
        Immediate surgical repair of the medial patellar stabilizers for acute patellar dislocation.
        Am J Sports Med. 2000; 28: 804-810
        • Nikku R.
        • Nietosvaara Y.
        • Kallio P.E.
        • Aalto K.
        • Michelsson J.E.
        Operative versus closed treatment of primary dislocation of the patella.
        Acta Orthop Scand. 1997; 68: 419-423
        • Mountney J.
        • Senavongse W.
        • Amis A.A.
        • Thomas N.P.
        Tensile strength of the medial patellofemoral ligament before and after repair or reconstruction.
        J Bone Joint Surg Br. 2005; 87: 36-40
        • Spritzer C.E.
        • Courneya D.L.
        • Burk Jr, D.L.
        • Garrett W.E.
        • Strong J.A.
        Medial retinacular complex injury in acute patellar dislocation: MR findings and surgical implications.
        AJR Am J Roentgenol. 1997; 168: 117-122
        • Fithian D.C.
        • Paxton E.W.
        • Cohen A.B.
        Indications in the treatment of patellar instability.
        J Knee Surg. 2004; 17: 47-56
        • Conlan T.
        • Garth Jr, W.P.
        • Lemons J.E.
        Evaluation of the medial soft-tissue restraints of the extensor mechanism of the knee.
        J Bone Joint Surg Am. 1993; 75: 682-693
        • Goh J.C.
        • Lee P.Y.
        • Bose K.
        A cadaver study of the function of the oblique part of vastus medialis.
        J Bone Joint Surg Br. 1995; 77: 225-231
        • Tuxoe J.I.
        • Teir M.
        • Winge S.
        • Nielsen P.L.
        The medial patellofemoral ligament: A dissection study.
        Knee Surg Sports Traumatol Arthrosc. 2002; 10: 138-140
        • Garth Jr, W.P.
        • DiChristina D.G.
        • Holt G.
        Delayed proximal repair and distal realignment after patellar dislocation.
        Clin Orthop Relat Res. 2000; : 132-144