Purpose
The purpose of this study was to evaluate the clinical outcomes of arthroscopically
assisted double-bundle medial patellofemoral complex reconstruction (MPFC-R).
Methods
A retrospective review was carried out among adult patients who experienced at least
2 patellar dislocations and underwent primary arthroscopically assisted MPFC-R between
January 2014 and November 2019. Dejour classification, tibial tubercle–trochlear groove
(TT-TG) distance, and patellar height (with Insall-Salvati index) were measured. Pre-and
postoperative patellar tilt were compared. Information on outcome scores, ability
to return to sports, postoperative recurrent dislocations and complications was recorded.
Results
A total of 42 MPFC reconstructions in 39 patients were included. Mean age at surgery
was 22.2 ± 7.6 years; 69.2% of patients were female. Mean follow-up was 47.3 ± 20.2
months. Seventy-four percent of cases had Dejour B (19.0%), C (33.3%), and D (21.4%)
trochlear dysplasia; mean TT-TG distance was 19.6 ± 3.5 mm, and mean Insall-Salvati
index was 1.21 ± 0.17. Mean patellar tilt decreased from 27.6 ± 11.6 degree to 9.4
± 6.5 degree (P<.001). All patients had statistically significant (P<.001) improvement in mean IKDC (44.9 ± 18.2 to 87.5 ± 6.9), Lysholm (61.4 ± 16.6
to 94.1 ± 6.4), Kujala (56.0 ± 16.8 to 92.9 ± 5.3) and Tegner score (2.7 ± 1.3 to
4.6 ± 1.4). Majority of patients (96.9%) returned to sports, with 90.3% returning
to the same or higher level of activity. No postoperative dislocations or subluxations
were reported.
Conclusion
Arthroscopically assisted double-bundle MPFC reconstruction is a promising procedure
to treat recurrent patellar instability at 2-to-7-year mid-term follow-up, despite
the presence of trochlear dysplasia, elevated TT-TG distance and patellar alta. The
improvement of IKDC score exceeded the MCID in 95.2% patients, and 66.7% surpassed
the PASS based on postoperative IKDC score with no redislocations beingreported at
latest follow-up.
Level of Evidence
Level IV, case series, retrospective.
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References
- Risk Factors and Time to Recurrent Ipsilateral and Contralateral Patellar Dislocations.Am J Sports Med. 2017; 45: 2105-2110
- The influence of risk factors on clinical outcomes following anatomical medial patellofemoral ligament (MPFL) reconstruction using the gracilis tendon.Knee Surg Sports Traumatol Arthrosc. 2013; 21: 318-324
- Derotational osteotomy at the distal femur is effective to treat patients with patellar instability.Knee Surg Sports Traumatol Arthrosc. 2019; 27: 652-658
- An Algorithmic Approach to the Management of Recurrent Lateral Patellar Dislocation.J Bone Joint Surg Am. 2016; 98: 417-427
- Recurrent Patellar Dislocations Without Untreated Predisposing Factors: Medial Patellofemoral Ligament Reconstruction Versus Other Medial Soft-Tissue Surgical Techniques-A Meta-analysis.Arthroscopy. 2020; 36: 1725-1734
- Editorial Commentary: What Is the Optimal Management of First and Recurrent Patellar Instability? Patellofemoral Instability Management Continues to Evolve.Arthroscopy. 2018; 34: 3094-3097
- Soft tissue restraints to lateral patellar translation in the human knee.Am J Sports Med. 1998; 26: 59-65
- Evaluation of the medial soft-tissue restraints of the extensor mechanism of the knee.J Bone Joint Surg Am. 1993; 75: 682-693
- Medial soft tissue restraints in lateral patellar instability and repair.Clin Orthop Relat Res. 1998; : 174-182
- Shape and size of the medial patellofemoral ligament for the best surgical reconstruction: a human cadaveric study.Knee Surg Sports Traumatol Arthrosc. 2014; 22: 2327-2333
- The Anatomic Midpoint of the Attachment of the Medial Patellofemoral Complex.J Bone Joint Surg Am. 2016; 98: 1199-1205
- Medial quadriceps tendon-femoral ligament: surgical anatomy and reconstruction technique to prevent patella instability.Arthrosc Tech. 2013; 2: e125-e128
- Medial patellofemoral ligament reconstruction for recurrent dislocation of the patella: a preliminary report.Arthroscopy. 1992; 8: 335-340
- Clinical and radiological outcome of medial patellofemoral ligament reconstruction with a semitendinosus autograft for patella instability.Knee Surg Sports Traumatol Arthrosc. 2005; 13: 516-521
- Technical note: anatomical reconstruction of the medial patellofemoral ligament using a free gracilis autograft.Arch Orthop Trauma Surg. 2008; 128: 479-484
- Anatomical double-bundle MPFL reconstruction with an aperture fixation.Knee Surg Sports Traumatol Arthrosc. 2010; 18: 147-151
- Recognition of evolving medial patellofemoral anatomy provides insight for reconstruction.Knee Surg Sports Traumatol Arthrosc. 2019; 27: 2537-2550
- Combined Reconstruction of the Medial Patellofemoral Ligament and Medial Quadriceps Tendon-Femoral Ligament.Arthrosc Tech. 2021; 10: e193-e198
- Combined Soft Tissue Reconstruction of the Medial Patellofemoral Ligament and Medial Quadriceps Tendon-Femoral Ligament.Arthrosc Tech. 2019; 8: e481-e488
- Medial Patellofemoral Ligament Reconstruction: A Comparison of Single-Bundle Transpatellar Tunnel and Double-Anchor Anatomic Techniques for the Treatment of Recurrent Lateral Patellar Dislocation in Adults.Arthroscopy. 2019; 35
- Patellar Instability Management: A Survey of the International Patellofemoral Study Group.Am J Sports Med. 2018; 46: 3299-3306
- Current Concepts Regarding Patellofemoral Trochlear Dysplasia.Am J Sports Med. 2021; 49: 1642-1650
- Clinical Comparison of Medial Patellofemoral Ligament Reconstruction With or Without Tibial Tuberosity Transfer for Recurrent Patellar Instability.Am J Sports Med. 2021; 49: 3335-3343
- Clinical Outcomes After Isolated Medial Patellofemoral Ligament Reconstruction for Patellar Instability Among Patients With Trochlear Dysplasia.Am J Sports Med. 2018; 46: 883-889
- Classifications in Brief: The Dejour Classification of Trochlear Dysplasia.Clin Orthop Relat Res. 2019; 477: 2380-2386
- Referencing the trochlear groove based on three-dimensional computed tomography imaging improves the reliability of the measurement of the tibial tuberosity-trochlear groove distance in patients with higher grades of trochlea dysplasia.Knee. 2019; 26: 1429-1436
- Observer agreement on the Dejour trochlear dysplasia classification: a comparison of true lateral radiographs and axial magnetic resonance images.Am J Sports Med. 2012; 40: 837-843
- Using Anatomic Landmarks to Locate Schöttle's Point Was Accurate Without Fluoroscopy During Medial Patellofemoral Ligament Reconstruction.Arthroscopy. 2021; 37: 1902-1908
- Assessing Femoral Trochlear Morphologic Features on Cross-Sectional Imaging Before Trochleoplasty: Dejour Classification Versus Quantitative Measurement.AJR Am J Roentgenol. 2020; 215: 458-464
- Evaluation of trochlear dysplasia using MRI: correlation between the classification system of Dejour and objective parameters of trochlear dysplasia.Knee Surg Sports Traumatol Arthrosc. 2014; 22: 120-127
- MOON's Strategy for Obtaining Over Eighty Percent Follow-up at 10 Years Following ACL Reconstruction.J Bone Joint Surg Am. 2022; 104: e7
- Preoperative Short Form Health Survey Score Is Predictive of Return to Play and Minimal Clinically Important Difference at a Minimum 2-Year Follow-up After Anterior Cruciate Ligament Reconstruction.Am J Sports Med. 2017; 45: 2784-2790
- Defining the Clinically Meaningful Outcomes for Arthroscopic Treatment of Femoroacetabular Impingement Syndrome at Minimum 5-Year Follow-up.Am J Sports Med. 2020; 48: 901-907
- Isolated Medial Patellofemoral Ligament Reconstruction for Patellar Instability Regardless of Tibial Tubercle-Trochlear Groove Distance and Patellar Height: Outcomes at 1 and 2 Years.Am J Sports Med. 2019; 47: 1331-1337
- Knee buckling: prevalence, risk factors, and associated limitations in function.Ann Intern Med. 2007; 147: 534-540
- Clinical Outcomes and Predictive Factors for Failure With Isolated MPFL Reconstruction for Recurrent Patellar Instability: A Series of 211 Reconstructions With a Minimum Follow-up of 3 Years.Am J Sports Med. 2019; 47: 1323-1330
- Return to Sport After Medial Patellofemoral Ligament Reconstruction: A Systematic Review and Meta-analysis.Am J Sports Med. 2022; 50: 282-291
- The Anatomy of the Medial Patellofemoral Complex.Sports Med Arthrosc Rev. 2017; 25
- Variability in the Patellar Attachment of the Medial Patellofemoral Ligament.Arthroscopy. 2016; 32: 1667-1670
- Quantitative and Qualitative Analysis of the Medial Patellar Ligaments: An Anatomic and Radiographic Study.Am J Sports Med. 2018; 46: 153-162
- Differential Contributions of the Quadriceps and Patellar Attachments of the Proximal Medial Patellar Restraints to Resisting Lateral Patellar Translation.Arthroscopy. 2020; 36: 1670-1676
- The quadriceps insertion of the medial patellofemoral complex demonstrates the greatest anisometry through flexion.Knee Surg Sports Traumatol Arthrosc. 2021; 29: 757-763
- Comparison of Patellofemoral Kinematics and Stability After Medial Patellofemoral Ligament and Medial Quadriceps Tendon-Femoral Ligament Reconstruction.Am J Sports Med. 2020; 48: 2252-2259
- Arthroscopic extraarticular reconstruction of the medial patellofemoral ligament with gracilis tendon autograft - surgical technique.Knee Surg Sports Traumatol Arthrosc. 2012; 20: 1245-1251
- Treatment of patellar dislocation with arthroscopic medial patellofemoral ligament reconstruction using gracilis tendon autograft and modified double-patellar tunnel technique: minimum 5-year patient-reported outcomes.J Orthop Surg Res. 2020; 15: 25
- Influence of Risky Pathoanatomy and Demographic Factors on Clinical Outcomes After Isolated Medial Patellofemoral Ligament Reconstruction: A Regression Analysis.Am J Sports Med. 2019; 47: 2904-2909
Article Info
Publication History
Accepted:
June 26,
2022
Received in revised form:
June 25,
2022
Received:
January 11,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Wei-Li Shi and Feng-Yi Hu contributed equally to this work.
Contribution of each author is justified according to ICMJE criteria for authorship. Detailed contributions are as follows: W.-L. S. (conceptualization, data collection and draft writing), F.-Y. H. (data collection, statistics analysis and draft writing), M.-T. X. (schematic drawing), Q.-Y. M. (surgical data provision and draft revision), N.-Y. C. (surgical data provision and draft revision), S. Y. (statistics analysis and draft revision), J.-N. W. (surgical data provision and draft revision), Y.-F. A. (supervision and draft revision), P. L. (conceptualization, surgical data provision and draft revision).
This work was approved by the ethics committee of Peking University Third Hospital (Project Number: M2021404).
This work was supported by grants from the National Natural Science Foundation of China (Grant Nos. 81902208); Beijing Natural Science Foundation (grant No. 7172234) and Beijing Nova Program (Grant No. Z201100006820011) from Beijing Municipal Science & Technology Commission. The authors thank Chu Hongling and Zeng Lin for their assistance in statistics in this study.
Identification
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© 2022 by the Arthroscopy Association of North America
