Felix Zimmermann1, Danko D Milinkovic2, Juliane Börtlein2, Peter Balcarek2,3. 1. BG Klinik Ludwigshafen, Ludwig-Guttmann-Straße 13, 67071, Ludwigshafen am Rhein, Germany. felix.o.zimmermann@googlemail.com. 2. Arcus Sportklinik, Pforzheim, Germany. 3. Abteilung für Unfallchirugie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Göttingen, Germany.
Abstract
PURPOSE: Medial patellofemoral ligament reconstruction (MPFL-R) is an important treatment for recurrent patellar instability. Although complications such as redislocation, patellofemoral pain (PFP) and restricted knee range of motion have been reported, few studies have investigated the results of revision surgery for failed MPFL-R. Thus, the aim of this study was to determine the results of the tailored revision surgery after considering the cause of the reconstruction failure. MATERIALS AND METHODS: Between 2015 and 2019, 28 patients (male/female 9/19; age 26.2 ± 6.4 years) underwent revision surgery for failed MPFL-R. The patients were grouped into the "recurrent instability" (SG1) group and "PFP" and/or "restricted range of motion" (SG2) group. Preoperatively, the clinical data, anatomical risk factor profile, and position of the femoral MPFL tunnel were determined for each patient. The Banff Patella Instability Instrument 2.0 (BPII 2.0) and numerical analogue scale (NAS 0-10) were administered preoperatively and at the final follow-up for the subjective assessment of the PFP and knee joint function. RESULTS: Overall, the BPII 2.0 score improved from 28.8 ± 16.6 points preoperatively to 68.0 ± 22.7 points (p < 0.0001) postoperatively. SG1 exhibited an increase in the BPII 2.0 score from 28.9 ± 20.2 points to 75.7 ± 23 points (p < 0.0001). PFP decreased from 6.8 ± 2.4 to 1.6 ± 1.9 (p < 0.0001), while the knee joint function increased from 4.3 ± 2.5 to 8.8 ± 1.6 (p < 0.0001). In SG2, the BPII 2.0 score increased from 28.7 ± 12.6 points preoperatively to 57.7 ± 19.7 points (p = 0.0002) postoperatively and was thus significantly lower than that in SG1 (p = 0.038). The intensity of PFP decreased from 6.6 ± 3.0 preoperatively to 2.1 ± 1.9 postoperatively (p = 0.0006), while the subjective knee joint function improved from 3.2 ± 1.4 preoperatively to 7.6 ± 2.3 postoperatively (p < 0.0001). The differences between the groups were not significant. CONCLUSION: Tailored revision surgery for failed MPFL-R significantly improves the patient-reported disease-specific quality of life. The study results indicate that patients undergoing revision surgery as a consequence of patellar redislocation appear to benefit more from revision surgery than those patients undergoing revision due to postoperative PFP and/or a limited knee joint range of motion. LEVEL OF EVIDENCE: Level IV.
PURPOSE: Medial patellofemoral ligament reconstruction (MPFL-R) is an important treatment for recurrent patellar instability. Although complications such as redislocation, patellofemoral pain (PFP) and restricted knee range of motion have been reported, few studies have investigated the results of revision surgery for failed MPFL-R. Thus, the aim of this study was to determine the results of the tailored revision surgery after considering the cause of the reconstruction failure. MATERIALS AND METHODS: Between 2015 and 2019, 28 patients (male/female 9/19; age 26.2 ± 6.4 years) underwent revision surgery for failed MPFL-R. The patients were grouped into the "recurrent instability" (SG1) group and "PFP" and/or "restricted range of motion" (SG2) group. Preoperatively, the clinical data, anatomical risk factor profile, and position of the femoral MPFL tunnel were determined for each patient. The Banff Patella Instability Instrument 2.0 (BPII 2.0) and numerical analogue scale (NAS 0-10) were administered preoperatively and at the final follow-up for the subjective assessment of the PFP and knee joint function. RESULTS: Overall, the BPII 2.0 score improved from 28.8 ± 16.6 points preoperatively to 68.0 ± 22.7 points (p < 0.0001) postoperatively. SG1 exhibited an increase in the BPII 2.0 score from 28.9 ± 20.2 points to 75.7 ± 23 points (p < 0.0001). PFP decreased from 6.8 ± 2.4 to 1.6 ± 1.9 (p < 0.0001), while the knee joint function increased from 4.3 ± 2.5 to 8.8 ± 1.6 (p < 0.0001). In SG2, the BPII 2.0 score increased from 28.7 ± 12.6 points preoperatively to 57.7 ± 19.7 points (p = 0.0002) postoperatively and was thus significantly lower than that in SG1 (p = 0.038). The intensity of PFP decreased from 6.6 ± 3.0 preoperatively to 2.1 ± 1.9 postoperatively (p = 0.0006), while the subjective knee joint function improved from 3.2 ± 1.4 preoperatively to 7.6 ± 2.3 postoperatively (p < 0.0001). The differences between the groups were not significant. CONCLUSION: Tailored revision surgery for failed MPFL-R significantly improves the patient-reported disease-specific quality of life. The study results indicate that patients undergoing revision surgery as a consequence of patellar redislocation appear to benefit more from revision surgery than those patients undergoing revision due to postoperative PFP and/or a limited knee joint range of motion. LEVEL OF EVIDENCE: Level IV.
Authors: Christoph Becher; René Attal; Peter Balcarek; Florian Dirisamer; Michael Liebensteiner; Geert Pagenstert; Philip Schöttle; Gerd Seitlinger; Daniel Wagner Journal: Knee Surg Sports Traumatol Arthrosc Date: 2017-08-07 Impact factor: 4.342
Authors: Peter Balcarek; Stephan Rehn; Nick R Howells; Jonathan D Eldridge; Keisuke Kita; David Dejour; Manfred Nelitz; Ingo J Banke; Delphine Lambrecht; Markus Harden; Tim Friede Journal: Knee Surg Sports Traumatol Arthrosc Date: 2016-10-27 Impact factor: 4.342
Authors: Nicole S Belkin; Kathleen N Meyers; Lauren H Redler; Suzanne Maher; Joseph T Nguyen; Beth E Shubin Stein Journal: Arthroscopy Date: 2020-02-05 Impact factor: 4.772
Authors: Peter Balcarek; Swantje Oberthür; Stephanie Hopfensitz; Stephan Frosch; Tim Alexander Walde; Martin Michael Wachowski; Jan Philipp Schüttrumpf; Klaus Michael Stürmer Journal: Knee Surg Sports Traumatol Arthrosc Date: 2013-09-05 Impact factor: 4.342
Authors: David C Flanigan; Scott Shemory; Nathaniel Lundy; Michael Stitgen; Joseph M Long; Robert A Magnussen Journal: Knee Surg Sports Traumatol Arthrosc Date: 2020-03-17 Impact factor: 4.342