Medial patellofemoral ligament reconstruction: A PROSPECTIVE OUTCOME ASSESSMENT OF A LARGE SINGLE CENTRE SERIES

• Published in: Journal of bone and joint surgery. British volume Vol. 94; no. 9; pp. 1202 - 1208
• Main Authors: HOWELLS, N. R, BARNETT, A. J, AHEARN, N, ANSARI, A, ELDRIDGE, J. D
• Format: Journal Article
• Language: English
• Published: London British Editorial Society of Bone and Joint Surgery 01-09-2012
• Subjects: Adolescent; Adult; Arthroscopy; Biological and medical sciences; Comorbidity; Diseases of the osteoarticular system; Female; Follow-Up Studies; Humans; Joint Instability - epidemiology; Joint Instability - surgery; Knee Dislocation - epidemiology; Knee Injuries - epidemiology; Knee Injuries - surgery; Ligaments, Articular - surgery; Male; Medical sciences; Middle Aged; Monitoring, Intraoperative; Orthopedic surgery; Patellofemoral Joint - surgery; Prospective Studies; Reconstructive Surgical Procedures - methods; Recurrence; Reoperation; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tendons - transplantation; Treatment Outcome; Young Adult; Anatomical reconstruction; Orthopedic surgery; Prognosis; Treatment
• ISSN: 0301-620X; 2044-5377
• DOI: 10.1302/0301-620X.94B9.28738

We report a prospective analysis of clinical outcome in patients treated with medial patellofemoral ligament (MPFL) reconstruction using an autologous semitendinosus graft. The technique includes superolateral portal arthroscopic assessment before and after graft placement to ensure correct graft tension and patellar tracking before fixation. Between October 2005 and October 2010, a total of 201 consecutive patients underwent 219 procedures. Follow-up is presented for 211 procedures in 193 patients with a mean age of 26 years (16 to 49), and mean follow-up of 16 months (6 to 42). Indications were atraumatic recurrent patellar dislocation in 141 patients, traumatic recurrent dislocation in 50, pain with subluxation in 14 and a single dislocation with persistent instability in six. There have been no recurrent dislocations/subluxations. There was a statistically significant improvement between available pre- and post-operative outcome scores for 193 patients (all p < 0.001). Female patients with a history of atraumatic recurrent dislocation and all patients with history of previous surgery had a significantly worse outcome (all p < 0.05). The indication for surgery, degree of dysplasia, associated patella alta, time from primary dislocation to surgery and evidence of associated cartilage damage at operation did not result in any significant difference in outcome. This series adds considerably to existing evidence that MPFL reconstruction is an effective surgical procedure for selected patients with patellofemoral instability.