Arthroscopic medial patellofemoral ligament reconstruction combined with tibial tuberosity transfer for recurrent patellar dislocation_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHAO Yun ¹ ,  HUANG Jingmin ² , LI Dongchao ¹ , HU Wenjin ¹

1. Department of Orthopedics, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin, 300131, P.R.China;
2. The Second Department of Sport Injury and Arthroscopy, Tianjin Hospital, Tianjin, 300211, P.R.China;

Corresponding author：

HUANG Jingmin, Email: chao13803071201@163.com

Keywords：

Recurrent patellofemoral dislocation; medial patellofemoral ligament; ligament reconstruction; tibial tuberosity transfer; arthroscopy

DOI：

10.7507/1002-1892.201811111

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Objective To investigate the effectiveness of arthroscopic medial patellofemoral ligament (MPFL) reconstruction combined with tibial tuberosity transfer for recurrent patellar dislocation.Methods Between February 2012 and December 2013, 24 patients (24 knees) with recurrent patellar dislocation were treated with arthroscopic MPFL reconstruction combined with tibial tuberosity transfer. There were 7 males and 17 females, with a mean age of 23.2 years (range, 18-37 years). One patient had recurrence dislocation after operation in the other hospital, and the others were the first operation. The disease duration ranged from 6 months to 20 years (mean, 5.6 years). The patellar apprehension tests were positive. The preoperative Lysholm score was 49.79±11.67 and the Kujala score was 49.63±6.28. X-ray films showed that 13 patients had dysplasia of the patella and femoral trochlea; 8 patients had high tibia (Caton-Deschamps index>1.2); the congruence angle was (23.96±5.54)°. CT examination showed that the tibial tuberosity-trochlear groove distance (TT-TG) value was (23.71±2.35) mm.Results All incisions healed by first intention. Twenty-two patients were followed up 59-81 months, with an average of 66.8 months. No dislocation occurred during the follow-up period. The patellar apprehension tests were negative. At 1 week after operation, the results of X-ray films and CT showed that the congruence angle angle was (–1.96±4.65)°, and the TT-TG value was (13.75±1.89) mm, which were significantly lower than those before operation (P<0.05). At 6 months, 1 year, and last follow-up, Lysholm scores were 81.13±17.76, 91.35±3.60, and 92.23±2.71, respectively; and Kujala scores were 84.04±3.98, 91.48±3.64, and 91.45±3.29, respectively. The Lysholm and Kujala scores were significantly increased after operation when compared with the preoperative scores (P<0.05). At last follow-up, the effectiveness was excellent in 11 cases, good in 8 cases, and fair in 3 cases, with an excellent and good rate of 86%.Conclusion Arthroscopic MPFL reconstruction combined with tibial tuberosity transfer for recurrent patellar dislocation can effectively improve the patellofemoral joint matching relationship and has a satisfactory short- and medium-term effectiveness.

Citation： ZHAO Yun, HUANG Jingmin, LI Dongchao, HU Wenjin. Arthroscopic medial patellofemoral ligament reconstruction combined with tibial tuberosity transfer for recurrent patellar dislocation. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(8): 960-964. doi: 10.7507/1002-1892.201811111 Copy

1.	张辉, 冯华. 髌骨脱位的治疗方案. 中国骨伤, 2017, 30(11): 979-981.
2.	Koh JL, Stewart C. Patellar instability. Clin Sports Med, 2014, 33(3): 461-476.
3.	Song JG, Kang SB, Oh SH, et al. Medial soft-tissue realignment versus medial patellofemoral ligament reconstruction for recurrent patellar dislocation: Systematic review. Arthroscopy, 2016, 32(3): 507-516.
4.	Duthon VB. Acute traumatic patellar dislocation. Orthop Trauma Surg Res, 2015, 101(1 Suppl): S59-S67.
5.	Lee DY, Park YJ, Song SY, et al. Which technique is better for treating patellar dislocation? A systematic review and meta-analysis. Arthroscopy, 2018, 34(11): 3082-3093.
6.	Feller A, Amis AA, Andrish T, et al. Surgical biomechanics of the patellofemoral joint. Arthroscopy, 2007, 23(5): 542-553.
7.	Riegler HF. Recurrent dislocations and subluxations of the patella. Clin Orthop Relat Res, 1988, 227: 201-209.
8.	Gravesen KS, Kallemose T, Blond L, et al. High incidence of acute and recurrent patellar dislocations: a retrospective nationwide epidemiological study involving 24.154 primary dislocations. Knee Surg Sports Traumatol Arthrosc, 2018, 26(4): 1204-1209.
9.	Kang HJ, Wang F, Chen BC, et al. Functional bundles of the medial patellofemoral ligament. Knee Surg Sports Traumatol Arthrosc, 2010, 18(11): 511-1516.
10.	Kim KE, Hsu SL, Woo SL. Tensile properties of the medial patellofemoral ligament: the effect of specimen orientation. J Biomech, 2014, 47(2): 592-595.
11.	Sally PI, Poggi J, Speer KP, et al. Acute dislocation of the patella. A correlative pathoanatomic study. Am J Sports Med, 1996, 24(1): 52-60.
12.	张其川, 王素芳, 付新生. 关节镜下内侧髌股韧带重建和外侧支持带松解治疗复发性髌骨脱位. 中国骨伤, 2015, 28(7): 599-602.
13.	Yang YM, Zhang Q. Reconstruction of the medial patellofemoral ligament and reinforcement of the medial patellotibial ligament is an effective treatment for patellofemoral instability with patella alta. Knee Surg Sports Traumatol Arthrosc, 2018, 12(10): 1-9.
14.	Sim JA, Lim JK, Lee BH. Anatomic double-bundle medial patellofemoral ligament reconstruction with aperture fixation using an adjustable-length loop device: a 2-year follow-up study. BMC Musculoskelet Disord, 2018, 19(1): 346.
15.	Placella G, Speziali A, Sebastiani E, et al. Biomechanical evaluation of medial patella-femoral ligament reconstruction: comparison between a double-bundle converging tunnels technique versus a single-bundle technique. Musculoskelet Surg, 2016, 100(2): 103-107.
16.	Csintalan P, Latt D, Fornalski S, et al. Medial patellofemoral ligament (MPFL) reconstruction for the treatment of patellofemoral instability. J Knee Surg, 2014, 27(2): 139-146.
17.	Neri T, Parker DA, Beach A, et al. Medial patellofemoral ligament reconstruction with or without tibial tubercle transfer is an effective treatment for patellofemoral instability. Knee Surg Sports Traumatol Arthrosc, 2019, 27(3): 805-813.
18.	Pinheiro Junior LFB, Cenni MHF, Nicolai OP, et al. Outcomes of medial patellofemoral reconstruction in patients with patella alta. Rev Bras Ortop, 2018, 53(5): 570-574.

1. 张辉, 冯华. 髌骨脱位的治疗方案. 中国骨伤, 2017, 30(11): 979-981.
2. Koh JL, Stewart C. Patellar instability. Clin Sports Med, 2014, 33(3): 461-476.
3. Song JG, Kang SB, Oh SH, et al. Medial soft-tissue realignment versus medial patellofemoral ligament reconstruction for recurrent patellar dislocation: Systematic review. Arthroscopy, 2016, 32(3): 507-516.
4. Duthon VB. Acute traumatic patellar dislocation. Orthop Trauma Surg Res, 2015, 101(1 Suppl): S59-S67.
5. Lee DY, Park YJ, Song SY, et al. Which technique is better for treating patellar dislocation? A systematic review and meta-analysis. Arthroscopy, 2018, 34(11): 3082-3093.
6. Feller A, Amis AA, Andrish T, et al. Surgical biomechanics of the patellofemoral joint. Arthroscopy, 2007, 23(5): 542-553.
7. Riegler HF. Recurrent dislocations and subluxations of the patella. Clin Orthop Relat Res, 1988, 227: 201-209.
8. Gravesen KS, Kallemose T, Blond L, et al. High incidence of acute and recurrent patellar dislocations: a retrospective nationwide epidemiological study involving 24.154 primary dislocations. Knee Surg Sports Traumatol Arthrosc, 2018, 26(4): 1204-1209.
9. Kang HJ, Wang F, Chen BC, et al. Functional bundles of the medial patellofemoral ligament. Knee Surg Sports Traumatol Arthrosc, 2010, 18(11): 511-1516.
10. Kim KE, Hsu SL, Woo SL. Tensile properties of the medial patellofemoral ligament: the effect of specimen orientation. J Biomech, 2014, 47(2): 592-595.
11. Sally PI, Poggi J, Speer KP, et al. Acute dislocation of the patella. A correlative pathoanatomic study. Am J Sports Med, 1996, 24(1): 52-60.
12. 张其川, 王素芳, 付新生. 关节镜下内侧髌股韧带重建和外侧支持带松解治疗复发性髌骨脱位. 中国骨伤, 2015, 28(7): 599-602.
13. Yang YM, Zhang Q. Reconstruction of the medial patellofemoral ligament and reinforcement of the medial patellotibial ligament is an effective treatment for patellofemoral instability with patella alta. Knee Surg Sports Traumatol Arthrosc, 2018, 12(10): 1-9.
14. Sim JA, Lim JK, Lee BH. Anatomic double-bundle medial patellofemoral ligament reconstruction with aperture fixation using an adjustable-length loop device: a 2-year follow-up study. BMC Musculoskelet Disord, 2018, 19(1): 346.
15. Placella G, Speziali A, Sebastiani E, et al. Biomechanical evaluation of medial patella-femoral ligament reconstruction: comparison between a double-bundle converging tunnels technique versus a single-bundle technique. Musculoskelet Surg, 2016, 100(2): 103-107.
16. Csintalan P, Latt D, Fornalski S, et al. Medial patellofemoral ligament (MPFL) reconstruction for the treatment of patellofemoral instability. J Knee Surg, 2014, 27(2): 139-146.
17. Neri T, Parker DA, Beach A, et al. Medial patellofemoral ligament reconstruction with or without tibial tubercle transfer is an effective treatment for patellofemoral instability. Knee Surg Sports Traumatol Arthrosc, 2019, 27(3): 805-813.
18. Pinheiro Junior LFB, Cenni MHF, Nicolai OP, et al. Outcomes of medial patellofemoral reconstruction in patients with patella alta. Rev Bras Ortop, 2018, 53(5): 570-574.

Chinese Journal of Reparative and Reconstructive Surgery

Arthroscopic medial patellofemoral ligament reconstruction combined with tibial tuberosity transfer for recurrent patellar dislocation

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