Abstract
Objective: Prospective analysis of early clinical outcome in patients treated with medial patellofemoral ligament reconstruction using an autologous semitendinosus graft plus objective arthroscopic assessment of graft tension and subsequent patella tracking.
Method: 47 consecutive patients underwent 48 procedures between September 2005 and February 2008. All procedures were performed by the senior author using a standardised technique. A semitendinosus autograft is passed extrasynovially between the isometric attachments to the patella and femur and secured with an endobutton and interference screw. The technique includes arthroscopic assessment through a superolateral portal before and after graft placement ensuring correct graft tension and patella tracking before graft fixation. Patients received pre and post operative clinical evaluation, radiological assessment, outcome scoring systems and a satisfaction questionnaire.
Results: 47 patients were followed up with mean age 26 (range 16–49) and minimum follow up of 6 months (mean 13, range 6–35). 26 were male and 22 female. Indications were atraumatic recurrent patella dislocation in 30 patients, traumatic recurrent dislocation in 15 patients, instability in 2 and anterior knee pain in 1 patient. There have been no recurrent dislocations/ subluxations, 2 have had intermittent feelings of instability 6 have complained of medial knee pain and 3 have required further surgery. Kujala Scores improved from 53 (95%CI 28–78) to 78 (95%CI 70–85) and this was statistically significant (p< 0.05). This improvement is mirrored by the other scoring systems used. 94% of patients were satisfied with their operation.
Conclusions: This technique of medial patellofemoral ligament reconstruction is the first described which allows for objective intraoperative evaluation of the required graft tension to optimise patella tracking. The early results of this technique are encouraging.
Correspondence should be addressed to: BASK c/o BOA, at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London, WC2A 3PE, England.
