Anatomical transverse patella double tunnel reconstruction of medial patellofemoral ligament with a hamstring tendon autograft for recurrent patellar dislocation.

摘要

INTRODUCTION: The purpose of this study was to describe our transverse patella double tunnel technique to reconstruct the medial patellofemoral ligament (MPFL) with a hamstring tendon autograft in patients who suffered recurrent dislocation of the patella, and to evaluate the intermediate-term outcomes of reconstruction treatment. MATERIALS AND METHODS: Fifty-nine consecutive knees (52 patients) with recurrent dislocation of the patella without marked predisposing anatomic abnormalities and radiographically documented moderate/severe osteochondral lesions were included in the study. Outcomes were assessed with physical and radiographic examination, the Kujala and the modified Cincinnati scores preoperatively and postoperatively at 3, 6, 12, 36, 60 and 84 months. RESULTS: There were 19 male and 33 female patients with up to 7.1-year follow-up (mean 5.7 years). The mean age was 24.3 years. A comparison of preoperative scores with those obtained at most recent follow-up revealed a significant improvement for all outcomes measured: range of motion (30 +/- 2 degrees vs. 125 +/- 5 degrees , P < 0.01), the mean Kujala scores (41.4 vs. 82.6, P < 0.001), the mean modified Cincinnati scores (50.6 vs. 88.7, P < 0.01), the mean congruence angle (12.2 degrees vs. -2.4 degrees , P < 0.01) and the mean tilt angle (11.4 degrees vs. 8.4 degrees , P < 0.05). No recurrent episodes of dislocation or subluxation were postoperatively reported, although there were seven knees with an occasional unstable feeling without redislocation. CONCLUSIONS: MPFL reconstruction with the double-transverse tunnels technique is safe and effective in patients of all ages, without marked predisposing anatomic abnormalities and moderate/severe osteochondral lesions, who suffered recurrent dislocation of the patella.