Abstract
Background: The medial patellofemoral ligament (MPFL) is the principle medial stabilizer of the patella. It is damaged after traumatic patella dislocation. We describe a reproducible technique for MPFL reconstruction and our preliminary results at 12 months.
Material-methods: 25 patients (19 men, 6 women; average age 26.9 years-old) with post-traumatic patellar instability underwent MPFL reconstruction at a mean post-injury interval of 22.3 months. Five patients had evidence of generalized laxity, 3 had trochlear dysplasia and 16 (64%) more than two episodes of dislocation. Arthroscopic assessment revealed associated chondral lesions in 88% and marked lateralization. The reconstruction was performed using ipsilateral semitendinosus tendon. With the distal attachment preserved, the proximal end is passed through the medial intermuscular membrane and secured to the medial border of the patella. Clinical pre- and post-operative assessments included IKDC, Tegner, Lysholm and Kujala scores. ICRS documentation recorded the contribution of articular cartilage damage, whereas Merchant views and MRI scans documented the abnormal radiological parameters and the damaged structures of the medial retinaculum respectively.
Results: At a mean follow up period of 12 months (8–18 months) no cases of re-dislocation were recorded. The Tegner and IKDC scores averaged 4.2 and 46.9 pre-injury. Postoperatively they had improved to 7.7 and 86.5. The average postoperative Lyshom- and Kujala scores were 87 and 89 respectively. Re-operation was required in one patient after patellar fracture 8 weeks post reconstruction.
Conclusion: Our preliminary results suggest surgical reconstruction of the MPFL provide a favorable early outcome for the treatment of post-traumatic patellofemoral instability and will form the basis for longer follow up in a larger cohort.
Correspondence should be addressed to Mr Tim Wilton, BASK at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE.
