Purpose
To report the long-term clinical outcomes after isolated medial patellofemoral ligament
reconstruction (MPFLr) to treat recurrent patellar instability.
Methods
This was a single-center study of patients undergoing an isolated MPFLr between 2000
and 2011. All patients underwent reconstruction using hamstring autograft. The inclusion
criteria were a minimum 10-year follow-up period and skeletally mature patients with
more than 1 episode of patellar dislocation who underwent MPFLr without an associated
bony procedure.
Results
A total of 54 knees were available for final analysis. The mean follow-up period was
12.3 years (range, 10-14 year). The mean age at surgery was 25 years. No patients
had patellofemoral arthritis (PFA) prior to surgery. Preoperatively, the mean Caton-Deschamps
index was 1.1 and the mean tibial tubercle–trochlear groove distance was 14.9 ± 2
mm (range, 7-17 mm). All patients had trochlear dysplasia according to the Dejour
classification. At final follow-up, the mean Kujala score was 82.9 ± 15.3; mean International
Knee Documentation Committee score, 78.3 ± 18.5; and mean Tegner score, 4.0 ± 1.7.
Patients with an unsatisfactory outcome as determined by a Kujala score lower than
80 had a higher Caton-Deschamps index preoperatively and were more likely to be female
patients; however, neither factor reached significance. Of the patients, 33 (66%)
had no radiographic evidence of PFA whereas 15 (30%) had Iwano stage 1 and 2 had Iwano
stage 2 (4%). At final follow-up, 4 patients (7.4%) had recurrent instability requiring
revision surgery.
Conclusions
Isolated MPFLr with gracilis tendon autograft in appropriately selected patients is
an effective long-term treatment for recurrent patellofemoral instability with low
rates of recurrence. One-third of patients exhibit radiographic evidence of PFA more
than 10 years after isolated MPFLr.
Level of Evidence
Level IV, case series.
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Article info
Publication history
Published online: August 17, 2022
Accepted:
July 28,
2022
Received:
March 7,
2022
Footnotes
See commentary on page 358
The authors report the following potential conflicts of interest or sources of funding: C.B. reports institutional research support from Group Lepine. S.L. is a consultant for Corin, Smith & Nephew, Stryker, Group Lepine, DePuy Synthes, and Haereus; reports institutional research support from Group Lepine, Corin, and Amplitude; receives royalties from Smith & Nephew and Stryker; and is on the editorial board of The Journal of Bone and Joint Surgery (American edition). E.S. is a consultant for Corin. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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© 2022 by the Arthroscopy Association of North America
