Medial patellotibial ligament (MPTL) reconstruction for patellar instability

• Published in: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA sports traumatology, arthroscopy : official journal of the ESSKA, 2014-10, Vol.22 (10), p.2491-2498
• Main Authors: Zaffagnini, Stefano, Grassi, Alberto, Marcheggiani Muccioli, Giulio Maria, Luetzow, William F., Vaccari, Vittorio, Benzi, Andrea, Marcacci, Maurilio
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Arthroplasty - methods; Body mass index; Cartilage; Child; Female; Humans; Joint Instability - surgery; Knee; Knee Joint - diagnostic imaging; Knee Joint - surgery; Ligaments; Male; Medicine; Medicine & Public Health; Orthopedics; Pain - surgery; Patella - diagnostic imaging; Patellar Dislocation - surgery; Patellar Ligament - surgery; Radiography; Reconstructive Surgical Procedures - methods; Retrospective Studies; Treatment Failure; Treatment Outcome; Young Adult
• ISSN: 0942-2056; 1433-7347
• DOI: 10.1007/s00167-013-2751-1

Purpose To evaluate mid-term clinical and radiographic outcomes after an original medial patellotibial ligament reconstruction in patients with patellar dislocation. Methods Twenty-nine knees (27 patients, 8 males and 19 females) treated for patellar dislocation with medialization of the patellar tendon medial third combined with medial and lateral release were evaluated clinically and radiographically at a mean follow-up of 6.1 ± 2.5 years. Trochleoplasty was performed in case of severe flat trochlea (6 knees, 21 %). Aetiology of patellofemoral instability was traumatic in 6 (21 %) and atraumatic in 23 (79 %) knees. The mean age at first dislocation was 19.2 ± 10.1 years. WOMAC, subjective and objective IKDC, Kujala, VAS for pain, Tegner activity and EQ-5D scores were used. Anteroposterior, lateral and 30° axial views were performed for radiographic monitoring. Results There was a significant improvement of all clinical scores and significant reduction in knee pain. Twenty-four knees (83 %) were normal or nearly normal by objective IKDC score at final follow-up. Radiographs showed a higher incidence of patella alta and flat trochlea in the atraumatic group. Severe signs of patellar osteoarthritis were found in 1 knee (3 %). A higher body mass index (BMI) was correlated with worse pre-operative scores. Four knees (14 %) were considered failures (2 further dislocations, 2 revision surgeries). The overall survival rate at 6 years was 0.811. Conclusions The presented techniques produced good clinical and radiographic results at mean 6.1 years follow-up, with 14 % failures. Signs of patellofemoral dysplasia were found in patients with atraumatic patellar dislocation. BMI was related to worse pre-operative clinical status. Level of evidence Retrospective study, Level IV.