Patella instability is a common problem with many surgical options. We prospectively evaluated the results of medial patella femoral ligament (MPFL) reconstruction with an autogenous gracilis or semitendinous graft. With a minimum follow up of one year patients were reviewed using the Kujala scoring system. Twenty MPFL reconstructions were performed on seventeen patients over a two year period, from January 2004 to December 2005. There were 13 females and 4 males. Three patients had bilateral involvement. Thirteen patients had a lateral release with their MPFL reconstruction and three had a distal realignment procedure as well to correct their patella instability. The mean follow up was 17 months (range 12 to 26 months). The average age was 25 years old at operation (range 13 to 47) and the average age of their first dislocation was 16 (range 0-35). Nine patients had previous surgical treatment for patella instability. The average hypermobility score in the patients was 5/9 and six patients scored 9/9. At follow up 18 out of 20 patients (90%) had stable tracking with no further subluxations/dislocations. Of the two with unstable tracking, one had a stable patella before falling several times onto her knee. An MRI confirmed the ligament was intact but a type 2 trochlear dysplasia was present and a Bereiter trochleoplasty was subsequently performed. The other patient described no frank dislocation but instead subluxations. Eighteen of the twenty reconstructions (90%) achieved a stable patella. Overall Kujala scores increased by a third

Purpose of the study. To determine the outcome after the Semi-tendinosis tendon was used in reconstruction of the Medial Patella-femoral ligament using a fixed dynamic stabilising structure. Method. The Adductor Magnus tendon insertion at the Adductor tubercle of the medial femoral condyle was used as a dynamic and fixed stabilising point preventing patella subluxation. This is a constant landmark in most patients and eliminates the need to find the isometric stabilisation point of the Medial Patella-femoral ligament. The Semi-tendinosus tendon was routed from its distal tibia attachment through a drill hole in the patella from distal to proximal. It was then transferred sub-vastus around the Adductor Magnus femoral attachment and sutured back onto itself at the inferior patella pole. It was tensioned at 30 degrees of knee flexion. Between 2004 and 2011 forty knees were reconstructed using the Semi-tendinosus tendon combined with an extra-synovial lateral release. All had failed conservative therapy for repeated patella instability. Post-operatively the patients followed a strict rehabilitation protocol. At follow-up the patients were questioned for any symptoms of patella instability or dislocation. Any complications of the surgery were documented. Patients were examined for any signs of patella apprehension or abnormal patella tracking. Results. The male to female ratio was 2:3. The mean age was 26 (range13 to 33). The mean follow- up was 44 months. To date no recurrence of instability was noted. Within as early as 4 weeks post-surgery a reduction of patella apprehension was noted in all patients. 90% of patients were able to return to an active life-style. No serious complications were documented. Conclusion. Transferring Semi-tendinosus around the fixed, dynamic distal insertion point of Adductor Magnus provides good results in the medium term and is a technique that may be combined with distal patella tendon realignment procedures. NO DISCLOSURES

The aim of this study is to document the outcome of a large cohort of patients treated with the Bereiter trochleoplasty with between 1 and 12 years of follow up. 215 consecutive cases in 186 patients were recorded prospectively. All patients were offered yearly clinical and radiological review. PROMs were recorded including the IKDC, OKS, Kujala and SF-12. Patients unable to attend clinic were assessed with PROMS and radiographs from their local institutions where possible. There were 133 females and 53 males, with a mean age of 21 (14–38). There were no infections and only 6 patients reported further dislocations. There was one flap breakdown and no identified cases of secondary osteoarthritis. PROMs were available for 194 cases in 167 patients (90% follow up). 84% of patients were satisfied, 87% felt their symptoms had improved and 69% had gone back to sport. All scores improved (all p<0.001) except for the SF-12 mental score (p=0.42), with averages comparable to the results of MPFL reconstruction. Good outcomes were observed despite the difficult patient population in which these cases were performed. The Bereiter trochleoplasty is an effective method of treating recurrent patella instability in patients with severe trochlea dysplasia

Patients with recurrent patella instability, who have an abnormal patellofemoral alignment (patella height or tibial tubercle-trochlear groove (TTTG) distance), benefit from tibial tubercle transfer along with medial patellofemoral ligament (MPFL) reconstruction. Between July 2008 and April 2013, 18 patients (21 knees) with recurrent patellar instability underwent combined MPFL reconstruction and tibial tubercle transfer. All patients had abnormal patellofemoral alignment in addition to MPFL insufficiency. 15 patients (16 knees) with a mean age of 24 years (16–41) had a mean follow up of 26 months (6–55). We assessed the outcome using KOOS, KUJALA, activity level and patient satisfaction scores. All patients had a stable patella. There was a significant improvement in outcome scores in 12 out of 15 patients. At final follow up KOOS score had improved from 68.25(44 to 93.9) to 77.05(48.8 to 96.4) and KUJALA score had improved from 63.3(41–88) to 78.06 (45 to 99). 9 patients showed excellent results and achieved at least a pre-injury level of activity. 4 of these had activity level better then preoperative level. 6 patients had a lower activity level than pre-injury (1 – ongoing physiotherapy, 1 – because of lack of confidence, and 4 – Life style modification). 14 patients were satisfied and happy to recommend this procedure. There were 3 postop complications, with 2 cases of stiffness and 1 case of non-union of the tibial tuberosity. Our prospective study has shown that restoration of tibial tubercle-trochlear groove index, Patella height and Medial Patellofemoral Ligament reconstruction yields good results in carefully selected patients

Introduction. The dysplastic trochlear is a developmental condition characterized by an abnormally flat or dome-shaped trochlea and it is recognized as a significant cause of patella instability. Surgical correction of the shape of the Trochlear Groove is frequently performed. The described methods in the literature involve open arthrotomy to normalize and maintain the trochlear morphology achieving normal alignment and tracking of the patella. Material, methods and results. Open procedures carries a significant risk of arthrofibrosis. We describe an arthroscopic procedure to create a neo-trochlea using gouges, spherical and conical hooded burrs. We studied prospectively a series of 4 consecutive patients with patello-femoral instability secondary to trochlear dysplasia, who were treated by an Arthroscopic trochleoplasty by a single surgeon between 2007 and 2008. Postoperatively the patients were rehabilitated in accordance with our routine Patello-Femoral microfracture protocol. CT scanning at one year showed a complete neo-cortex and cartilage sequenced MRI at 12 months showed complete fill with fibro cartilage. Pre- and post-operative scores (KOOS, Kujala) were assessed by the patients and a satisfaction questionnaire was completed. The results showed a statistical improvement in the outcome at the 3 year follow up. Conclusion. Overall, patients (100%) were satisfied with the outcome of their procedure and there have been no adverse events. To our knowledge this technique has not been described before in the English literature and the early results of arthroscopic trochleoplasty are encouraging and offer an alternative to open approaches. Larger numbers and longer follow ups are needed to confirm the long term benefit