Clinical and radiological outcomes after a quasi-anatomical reconstruction of medial patellofemoral ligament with gracilis tendon autograft

Abstract

Purpose: To analyse the clinical and radiological outcomes of a quasi-anatomical reconstruction of the medial patellofemoral ligament (MPFL) with a gracilis tendon autograft.

Methods: Patients with objective recurrent patellar instability that were operated on from 2006 to 2012 were included. A quasi-anatomical surgical technique was performed using a gracilis tendon autograft. It was anatomically attached at the patella, and the adductor magnus tendon was also used as a pulley for femoral fixation (non-anatomical reconstruction). The IKDC, Kujala and Lysholm scores as well as Tegner and VAS for pain were collected preoperatively and at final follow-up. Radiographic measurements of patellar position tilt and signs of osteoarthritis (OA) as well as trochlear dysplasia were also recorded.

Results: Thirty-six patients were included. The mean age at surgery was 25.6 years. After a minimum 27 months of follow-up, all functional scores significantly improved (p < 0.001) with respect to the preoperative values. The VAS dropped from 6 (SD 2.48) to 2 (SD 1.58). No recurrence of dislocation was observed in this series. The apprehension sign was still apparent in one patient. The CT scan evaluation showed a significant decrease in patellar tilt (p < 0.001). On the Crosby and Insall grading scale, there were no changes in the radiological signs of OA.

Conclusion: This specific MPFL reconstruction gives good clinical results and corrects patellar tilt. It did not affect the patellofemoral surfaces at the short term, as shown by the absence of radiological signs of OA in the CT scan. The procedure has been shown to be safe and suitable for the treatment of chronic patellar instability, including in adolescents with open physis. A new effective, inexpensive and easy-to-perform technique is described to reconstruct MPFL in the daily clinical practice.

Level of evidence: Therapeutic case series, Level IV.

Keywords: Medial patellofemoral ligament reconstruction; Patella; Patella dislocation; Patellofemoral joint.