Medial patellofemoral ligament reconstruction fixed with a cylindrical bone plug and a grafted semitendinosus tendon at the original femoral site for recurrent patellar dislocation.

摘要

BACKGROUND: The medial patellofemoral ligament (MPFL) is the most important factor for stabilizing the patella and preventing lateral patellar dislocation. Medial patellofemoral ligament reconstruction is an accepted surgical technique to restore patellofemoral stability after lateral patellar dislocation. The authors recently developed a new anatomical MPFL reconstruction method using a cylindrical bone plug and grafted semitendinosus tendon at the anatomical femoral attachment site to mimic the native MPFL. This study evaluated the new technique for stabilizing recurrent patellar dislocation. HYPOTHESIS: This new MPFL reconstruction technique will improve knee symptoms and function with excellent clinical results. STUDY DESIGN: Case series; Level of evidence, 4. METHOD: Thirty-one knees were evaluated from 29 cases of recurrent patellar dislocation that were surgically treated using the anatomical MPFL reconstruction technique. The average patient age was 22.2 years (range, 12-34 years); postsurgery follow-up was 2 to 5 years (average, 3.2 years). The patients were clinically evaluated based on the Kujala score, range of motion, and signs of apprehension. The Merchant view was used to measure congruence and tilting angles. RESULTS: Of the 31 knees, 30 showed good clinical results after surgery, while 1 patient showed remaining signs of apprehension. The Kujala score improved from an average of 64 points (range, 35-70) initially to an average of 94.5 points (range, 79-100) at the final follow-up. Range of motion improved for all patients, with an average knee extension of 0 degrees +/- 2 degrees and knee flexion of 145 degrees +/- 3 degrees at final follow-up. No patellar redislocation was reported. Radiological assessment indicated significant improvement to the congruence angle from 13 degrees +/- 4 degrees before surgery to -5 degrees +/- 5 degrees at the final follow-up, while the tilting angle went from 8 degrees +/- 7 degrees before surgery to 7 degrees +/- 4 degrees at the final follow-up. CONCLUSION: This study demonstrated excellent results using the new procedure for recurrent dislocation of the patella, with instability in only 1 of 31 knees (3.2%).