Aditya Khemka1, Sarah J Lord2, Zelda Doyle3, Belinda Bosley4, Munjed Al Muderis5. 1. School of Medicine, University of Notre Dame Australia; Norwest Private Hospital, Australia. Electronic address: aditya.khemka1@my.nd.edu.au. 2. School of Medicine, University of Notre Dame Australia; National Health and Medical Research Council (NHMRC) Clinical Trials Centre, The University of Sydney, Australia. Electronic address: sally.lord@nd.edu.au. 3. Rural Clinical School, University of Notre Dame Australia, Australia. Electronic address: zelda.doyle@nd.edu.au. 4. Rural Clinical School, University of Notre Dame Australia, Australia. Electronic address: belindabosley@gmail.com. 5. School of Medicine, University of Notre Dame Australia; Norwest Private Hospital, Australia; The Australian School of Advanced Medicine, Macquarie University, Australia. Electronic address: munjed@me.com.
Abstract
BACKGROUND: Recurrence of acute patellar dislocation affects approximately 30% of individuals, and up to 75% of those with grade IV instability. The medial patellofemoral ligament (MPFL) is considered to be critical for patellar stabilization. MPFL reconstruction with allografts has been proposed to reduce risk of recurrence, but there is limited evidence about the safety and effectiveness of techniques using synthetic allografts. METHODS: We present a retrospective case series of 29 individuals who underwent a MPFL reconstruction between 2009 and 2012, using an artificial ligament for patellar instability by a single surgeon. Clinical, radiological and functional outcomes were measured at a minimum of 24 months. RESULTS: 31 knees (29 individuals) were followed up for a median of 43 (range: 24-68) months. Using the Crosby and Insall grading system, 21 (68%) were graded as excellent, nine (29%) were good, one (3%) as fair and none as worse at 24 months. The mean improvement in Lysholm knee score for knee instability was 68 points (standard deviation 10). Ligamentous laxity was seen in 17 (55%) of individuals. In this subset, 12 were graded as excellent, four as good and one as fair. The mean improvement in patellar height was 11% at three months follow-up. All knees had a stable graft fixation with one re-dislocation following trauma. CONCLUSIONS: We propose a minimally invasive technique to reconstruct the MPFL using an artificial ligament allowing early mobilization without bracing. This study indicates the procedure is safe, with a low risk of re-dislocation in all grades of instability. LEVEL OF EVIDENCE: Level IV Case Series.
BACKGROUND: Recurrence of acute patellar dislocation affects approximately 30% of individuals, and up to 75% of those with grade IV instability. The medial patellofemoral ligament (MPFL) is considered to be critical for patellar stabilization. MPFL reconstruction with allografts has been proposed to reduce risk of recurrence, but there is limited evidence about the safety and effectiveness of techniques using synthetic allografts. METHODS: We present a retrospective case series of 29 individuals who underwent a MPFL reconstruction between 2009 and 2012, using an artificial ligament for patellar instability by a single surgeon. Clinical, radiological and functional outcomes were measured at a minimum of 24 months. RESULTS: 31 knees (29 individuals) were followed up for a median of 43 (range: 24-68) months. Using the Crosby and Insall grading system, 21 (68%) were graded as excellent, nine (29%) were good, one (3%) as fair and none as worse at 24 months. The mean improvement in Lysholm knee score for knee instability was 68 points (standard deviation 10). Ligamentous laxity was seen in 17 (55%) of individuals. In this subset, 12 were graded as excellent, four as good and one as fair. The mean improvement in patellar height was 11% at three months follow-up. All knees had a stable graft fixation with one re-dislocation following trauma. CONCLUSIONS: We propose a minimally invasive technique to reconstruct the MPFL using an artificial ligament allowing early mobilization without bracing. This study indicates the procedure is safe, with a low risk of re-dislocation in all grades of instability. LEVEL OF EVIDENCE: Level IV Case Series.
Authors: Felix Zimmermann; Mareike Schonhoff; Sebastian Jäger; Danko Dan Milinkovic; Jochen Franke; Paul Alfred Grützner; Peter Balcarek; Sven Vetter Journal: Knee Surg Sports Traumatol Arthrosc Date: 2022-08-22 Impact factor: 4.114