CLINICAL RESULTS FOLLOWING MEDIAL PATELLOFEMORAL LIGAMENT RECONSTRUCTION WITH HAMSTRING TENDON ANCHORED TO THE MEDIAL SIDE OF PATELLA USING BIOTENODESIS SCREWS.

Abstract

Recurrent patellar instability and anterior knee pain is a common problem after patellar dislocation. The medial patellofemoral ligament (MPFL) which contributes 40–80% of the total restraining forces is either attenuated or ruptured in these patients. Various techniques have been described in reconstructing this MPFL using hamstrings tendons. We wish to share our experience in treating these patients using ipsilateral semitendinosus tendon anchored to the medial femoral condyle and medial side of the patella using biotenodesis screws.

Study design and methods: 15 patients were assessed with a mean follow up of 12 months. All patients had pre-operative true lateral knee x-ray, MRI or CT scan to look at trochlear dysplasia and the sulcus tuberosity distance. They all under went MPFL reconstruction using ipsilateral semitendinosus tendon. Two patients had sulcus tuberosity distance greater than 20 mm and they under went a tibial tubercle transfer in addition. Two patients had trochlear dysplasia and hence a trochleaplasty was also done. In skeletally mature patients the hamstrings tendon was anchored to the medial side of the patella in a 5x15mm blind tunnel using biotenodesis screw. This significantly reduces the risk of having patella fracture. In. children the graft was sutures to the soft tissues along the medial side of the patella and the medial femoral condyle. All patients were treated by the same surgeon and assessments were performed by a different surgeon based . on Kujala scores and Tegner scores.

Results: Symptom relief was noted in all patients with in 3 months. No patient had patella dislocation or fracture after this procedure. They all had full range of movements and their Kujala scores and Tegner scores were good to excellent.

Conclusion: MPFL reconstruction using hamstrings tendon anchored to the medial side of the patella and femur using biotenodesis screw gave a good result clinically and is associated with fewer complications including patellar fractures.