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. 2015 Nov 16;46(6):675-83.
doi: 10.1016/S2255-4971(15)30324-4. eCollection 2011 Nov-Dec.

RANDOMIZED PROSPECTIVE STUDY ON TRAUMATIC PATELLAR DISLOCATION: CONSERVATIVE TREATMENT VERSUS RECONSTRUCTION OF THE MEDIAL PATELLOFEMORAL LIGAMENT USING THE PATELLAR TENDON, WITH A MINIMUM OF TWO YEARS OF FOLLOW-UP

Alexandre Carneiro Bitar  1 , Caio Oliveira D'Elia  1 , Marco Kawamura Demange  2 , Alexandre Christo Viegas  3 , Gilberto Luis Camanho  4
Affiliations

RANDOMIZED PROSPECTIVE STUDY ON TRAUMATIC PATELLAR DISLOCATION: CONSERVATIVE TREATMENT VERSUS RECONSTRUCTION OF THE MEDIAL PATELLOFEMORAL LIGAMENT USING THE PATELLAR TENDON, WITH A MINIMUM OF TWO YEARS OF FOLLOW-UP

Alexandre Carneiro Bitar et al. Rev Bras Ortop. .

Abstract

Objective: The aim of this study was to compare the surgical results from reconstruction of the medial patellofemoral ligament (MPFL) with non-operative treatment of primary patellar dislocation.

Methods: Thirty-nine patients (41 knees) with patellar dislocation were randomized into two groups. One group was treated conservatively (immobilization and physiotherapy) and other was treated surgically with reconstruction of the MPFL, and the results were evaluated with a minimum follow-up of two years. The Kujala questionnaire was applied to assess pain and quality of life, and recurrences were evaluated. Pearson's chi-square test and Fisher's exact test were used in the statistical evaluation.

Results: The statistical analysis showed that the mean Kujala score was significantly lower in the conservative group (70.8), compared with the mean value in the surgical group (88.9), with p = 0.001. The surgical group presented a higher percentage of "good/excellent" Kujala score results (71.43%) than in the conservative group (25.0%), with p = 0.003. The conservative group presented a greater number of recurrences (35% of the cases), while in the surgical group there were no reports of recurrences and/or subluxation.

Conclusions: Treatment with reconstruction of the medial patellofemoral ligament using the patellar tendon produced better results, based on the analysis of post-treatment recurrences and the better final results from the Kujala questionnaire after a minimum follow-up period of two years.

Keywords: Knee; Patellar Dislocation; Patellar Ligament; Reconstruction.

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Figures

Figure 1
Figure 1
Flowchart of the studied patients.
Figure 2
Figure 2
A 2 cm bone fragment is removed in order to detach the medial third of the patellar ligament from the rest of the ligament and to insert it in the patella.
Figure 3
Figure 3
Technique without the use of the bone fragment. Desinsertion is performed by planes up to the peritendon of the patellar ligament.
Figure 4
Figure 4
Diagrammatic view of post-fixation of the medial structures, showing the site between the epicondyle and the adductor tubercles.
Figure 5
Figure 5
Scatter graph between Kujala score and age of the patients, according to group.
See this image and copyright information in PMC

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