Summary

Quasi-anatomical reconstruction of the medial patellofemoral ligament

Abstract

Objectives:
The incidence of medial knee pain after Medial Patello-Femoral Ligament (MPFL) reconstruction is around 30%. The stiffness of the classical surgical montage may be one of the causes of the overload of the medial portion of the patella and subsequent medial pain syndrome. We followed prospectively a series of patient with patellofemoral instability treated using a implant free quasi-anatomical MPFL isolated reconstruction. The technique involves the use of a gracilis tendon autograft anatomically attached to the patella and the adductor magnus tendon as a pulley for femoral fixation without the need for any device to fix the graft. We hypothesized that this technique provides excellent result in terms of stability with a low incidence of patellofemoral pain at a minimum 2 years of follow-up.

Methods

A pilot multicenter longitudinal prospective study was carried out. 34 patients underwent isolated MPFL reconstruction between January 1, 2008 and March 31, 2016. The following parameters were evaluated: Kujala score, IKDC subjective score, Tegner score, Lysholm score, rates of failure (redislocation), Smillie test, range of Motion, VAS, and subjective satisfaction.

Results

34 patients were reviewed with a mean follow-up of 2.96 years; minimum follow-up was 2 years. 4 patients were excluded: 1 patient because of a cortical collapse between the tunnels of the patella during the drilling and anchors were used to attach the graft to the patella, 2 patients were lost to follow-up, and 1 patient had a traumatic patellar fracture. All the patients had a trochlear dysplasia. Mean post-operative Kujala score was 87.5 (mean pre-operative Kujala score was 61.6). Mean post-operative Lysholm score was 90, IKDC was 83, and Tegner score was 4.9 (mean pre-operative scores were 52, 50 and 4.6). Only one patient had a traumatic redislocation, Smillie test was positive in only one patient, mean range of Motion was 0/0/130, mean VAS was 1.9 (mean pre-operative VAS was 5.9), and satisfaction was of 3.45 over 4. When pain was present it was described as nonspecific and diffuse, no patient localized the pain at medial patellofemoral compartment.

Conclusion

Isolated quasi-anatomical MPFL reconstruction using a gracilis tendon autograft for recurrent patellar dislocation provides excellent outcomes at 2 years of follow-up in patients with trochlear dysplasia.