Summary

Reconstruction of the MPFL using fascia lata allograft, alone or combined with other procedures, was technically safe, showed low morbidity and good objective and subjective clinical results.

Abstract

Objective

The purpose of the present study was to evaluate the clinical and radiological outcomes of patients who underwent MPFL reconstruction with an original technique using fascia lata allograft. [1] The hypothesis was that the present technique would be able to stabilize the patella, improve the knee function and return to sport at 24 months minimum follow-up.

Methods

From 2012, 26 patients with recurrent patellar dislocation were enrolled in
this study and treated with the above reported surgical technique, both as an isolate
procedure or in combination with other patellar stabilizing surgeries (50%). 19 patients
(12 males/7 females; mean age at surgery of 21.7±5.1 years, range 15.9-30.3) reached 24-month minimum follow-up and were prospectively evaluated (mean follow-up 31.4±8.0 months). Knee function was assessed pre and postoperative using Kujala score and KOOS score. Knee pain symptoms were assessed using VAS 0-10. Tegner activity score was used for the evaluation of sports activity level. Objective and functional results were evaluated with the grind test, the range of motion and using the Objective IKDC. New episodes of patellar dislocation after the surgery were considered failures. Radiographic measurements of patellar tilt, patellar height and signs of osteoarthritis (OA) according to the Iwano score were
recorded. Student's t-test was used to compare data between pre-to-postoperative in case of normal distribution of the data, while Wilcoxon Signed Rank test was used to compare data non-normally distributed. Significance was set at P <0.05.

Results

The average Kujala score increased from 61.2±18.1 to 86.7±8.7 (p<0.001), KOOS increased from 54.5±19 to 86.8±9.6 (p<0.001), VAS Score decreased from 5.1±2.2 (p<0.05) to 2.4±1.5 (p=0.001) and Tegner activity score from 3 [2-4] to 5 [3-8] (p<0.001). Failure (recurrence) was observed in one patient (5%), and required a new surgical treatment. 50% of patients had positive grind test at follow-up but there was no case of stiffness; ROM improved from 0°-130°(±23°) to 0°- 141.3°(±6.3°). Preoperative IKDC: 2 A (11%), 12 B (63%) and 5 C (26%); IKDC at follow-up 15 A (83%) and 3 B (17%) [excluding the patient who experienced failure]. Radiographic measurements showed a normal patellar tracking with no significant osteoarthritic changes at follow-up.

Discussion And Conclusion

Reconstruction of the MPFL using fascia lata allograft, alone or combined with other procedures, was technically safe, showed low morbidity and was able to stabilize the patella and improve the knee function in 95% of patients at 24 months minimum follow-up.
References:
1. Zaffagnini et al; Knee Surg Sports Traumatol Arthrosc. 2014;22:2426–2430.