Medial patellofemoral ligament reconstruction using a digital tensiometer to determine graft tension: Surgical technique and mid-term follow-up

• Published in: Journal of orthopaedic surgery (Hong Kong) Vol. 31; no. 1; p. 10225536231167649
• Main Authors: Zhang, Wenhao, Mou, Limin, Deng, Yingjie, Xiang, Wenyuan, Zhang, Shiping, Aimaiti, Remila, Yuan, Zhiyu, Fang, Rui
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01-01-2023; Sage Publications Ltd; SAGE Publishing
• Subjects: Adolescent; Adult; Female; Follow-Up Studies; Humans; Joint Instability - diagnostic imaging; Joint Instability - surgery; Ligaments; Ligaments, Articular - surgery; Male; Patellar Dislocation - diagnostic imaging; Patellar Dislocation - surgery; Patellofemoral Joint - diagnostic imaging; Patellofemoral Joint - surgery; Young Adult; patellofemoral track; Medial patellofemoral ligament reconstruction; patellofemoral instability; tensiometer; surgery
• ISSN: 1022-5536; 2309-4990
• DOI: 10.1177/10225536231167649

Purpose
The optimal method for achieving proper graft tension during patellofemoral ligament reconstruction is a topic of debate. In the past, a digital tensiometer was used to simulate the knee structure, and a tension of approximately 2N was identified as suitable for restoring the patellofemoral track. However, it is unclear whether this tension level is sufficient during the actual surgery. The objective of this study was to verify the efficacy of graft tension using a digital tensiometer for medial patellofemoral ligament (MPFL) reconstruction and to conduct a mid-term follow-up.
Methods
The study enrolled 39 patients who had experienced recurrent patellar dislocation. Preoperative computed tomography scans and X-rays confirmed patellar instability, patellar tilt angle patellar congruence angle and the history of dislocation and patellar apprehension test. Knee function was evaluated using preoperative and postoperative Lysholm and Kujala scores.
Results
The study included 39 knees, comprising 22 females and 17 males, with an average age of 21.10 ± 7.26. The patients were followed up for at least 24 months through telephone or face-to-face questionnaires. All patients had a preoperative history of ≥2 patellar dislocations, none of which were surgically treated. During surgery, all patients underwent isolated MPFL reconstruction and lateral retinacula release. The mean Kujala and Lysholm scores were 91.28 ± 4.90 and 90.67 ± 5.15, respectively. The mean PTA and PCA were 11.5 ± 2.63 and 2.38 ± 3.58, respectively. The study found that a tension of approximately 27.39 ± 5.57N (14.3–33.5N) was required to restore the patellofemoral track in patients with recurrent patellar dislocation. No patients required reoperation during the follow-up period. Overall, 36 out of 39 patients (92.31%) reported no pain when completing daily activities at the last follow-up.
Conclusion
In conclusion, a tension level of approximately 27.39 ± 5.57N is necessary to restore normal patellofemoral relationships during clinical practice, which indicates that using a tension of 2N is too low. The use of a tensiometer during patellofemoral ligament reconstruction is a more accurate and reliable surgical procedure for treating recurrent patellar dislocation.