Medial patellofemoral ligament reconstruction: clinical and radiographic results in a series of 90 cases

Abstract

Introduction: Among the numerous techniques available, medial patellofemoral ligament (MPFL) reconstruction is increasingly used for the surgical treatment of objective patellar instability. The main objective of the present study was to assess efficacy in preventing recurrence of patellar dislocation and in correcting radiographic patellar tilt. The study hypothesis was that MPFL reconstruction, isolated or with associated bone surgery, by restoring "favorable" graft anisometry, provides a good trade-off between patellar stability and absence of postoperative stiffness.

Materials and methods: Eighty-seven patients (90 reconstructions) presenting with objective patellar instability were prospectively included. The standardized procedure comprised MPFL reconstruction using the gracilis tendon. Femoral fixation used an interference screw in a blind tunnel between the adductor magnus tubercle and the medial epicondyle; patellar fixation used 2 anchors. Complementary distal bone graft was associated in 21 patients due to a preoperative tibial tubercle-trochlear groove (TT-TG) distance exceeding 20mm or to patella alta. Functional IKDC and Kujala scores and radiographic measurement of patellar tilt and femoral tunnel position were assessed preoperatively and at end of follow-up.

Results: Mean follow-up was 24.3months (range, 6-49months). Three patients showed recurrence of patellar dislocation. Mean Kujala score rose from 53.88 preoperatively to 86.24 postoperatively, and mean real IKDC score from 45.15 to 73.92 (P<0.001). Patellar tilt decreased significantly between pre- and postoperative X-ray (P<0.001).

Discussion: MPFL gracilis reconstruction provides good clinical results and good radiologic correction of patellar tilt, making it a technique of choice in the treatment of objective patellar instability.

Level of evidence: Level IV. Retrospective case series study.

Keywords: Ligament reconstruction; Medial patellofemoral ligament; Objective patellar instability; Patella; Patellar dislocation.