Preliminary clinical results after Medial Patellofemoral Ligament Reconstruction

Author: Ruzsa Paul - Gabriel

Co-author: Gal Mihaela - Alexandra Jerdea Bogdan - Daniel Pop Sorin - Ioan

Scientific coordinator: Lecturer Russu Octav, MD, PhD

The patellofemoral articulation

• Role in locomotion and activities that involve knee flexion and extention

The patellofemoral articulation

• 94 % of patients suffer tear to the medial patellofemoral ligament following

patellar dislocation

•Is a band of tissue that

extends from the upper

aspect of the patella to the

femoral medial epicondyle

Medial Patellofemoral Ligament (MPFL)

Medial Patellofemoral Ligament (MPFL)

• The most important soft

tissue stabilizer of the

patella (first 30⁰ of flexion)

• Helps in preventing lateral

patellar subluxation or

dislocation

MPFL reconstruction

• Is a surgical procedure indicated to patients with severe lateral patellar instability

• Was first described in 1992 by Dr. Ellera Gomes• There have been various approaches to this

technique

MPFL reconstruction: Double bundle technique

• Replicates the nativeshape of the MPFL using a gracilis autograft which is harvested and prepared at the beginning of the surgery

1.Preparation of the patella

2.4 mm drill tip Guide Pin 4.5 mm cannulated rimmer

2.Graft fixation to the patella

bioabsorbable screw

3.Preparation of the femoral insertion

MPFL Template

4.Preparation of the Medial Patellofemoral Layer

5. Femoral Graft Passage and Fixation

Postoperative considerations

1 Day1 Day 6 weeks6 weeks 12 weeks12 weeks

Active quadriceps exercises between 0⁰ – 90⁰ of flexion

Post operative knee brace locked at 0⁰ - 90⁰

of flexion and crutch until wound healing

Full range of motion with light jogging or cycling

The patient can resume full activity

Objective

To evaluate the short-term clinical results of patients after

MPFL reconstruction

Material and methods

• There have been 10 cases of MPFL reconstruction (May 2012 – April 2014) at the Orthopaedic and Traumatology II Clinic in Târgu Mureş

• There were 6 female and 4 male patients between 16-38 years old, all of them were diagnosed with recurrent lateral patellar dislocation

• This score is meant to asses the activity and functionality of the knee joint

• Grading <65 Poor65-83 Fair84-90 Good>90 Excellent

Results

• There were no postoperative patellar complication or redislocations and the patients regained full mobility after 6 weeks

• The mean value of Tegner – Lysholm score improved to 90.8 (range 82 - 95) from a preoperative mean value of 63.5 (range 55 - 72)

Conclusion

• Regarding the different methods of treating lateral patellofemoral instability MPFL reconstruction is one of the most promising procedures performed nowadays thanks to its simplicity, lack of complication and patient evolution

Conclusion

• Our results show improved knee function and physical activity in patients treated with this procedure

• In order to clearly state the long-term benefits of this reconstruction technique a large scale case study is required

Preliminary clinical results after Medial Patellofemoral Ligament Reconstruction

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1.Shital N. Parikh, Senthil T. Nathan,Eric J. Wall and Emily A. Eismann:Complications of Medial Patellofemoral Ligament Reconstruction in Young PatientsAm J Sports Med May 2013 41 1030-1038; published online before print March 28, 2013, doi:10.1177/03635465134820852. Tegner Y, Lysholm J. :Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res. 1985 Sep;(198):43-93. Schottle PB, Hensler D, Imhoff AB:Anatomical Double-Bundle MPFL Reconstruction with an Aperture Fixation Knee Surg Sports Traumatol Arthroscopy (epub ahead of print), 2009. 4.Schottle PB, Schmeling A, Rosenstiel N, Weiler A : Radiographic Landmarks For Femoral Tunnel Placement In Medial Patellofemoral Ligament Reconstruction Am J Sports Med 35: 801-804, 2007. 5.Steensen RN, Dopirak RM, McDonald WG, III : The Anatomy and Isometry of the Medial Patellofemoral Ligament: Implications for Reconstruction Am J Sports Med 32: 1509-1513, 2004.

Bibliography