Effective patellofemoral joint stabilization and low complication rates using a hardware-free MPFL reconstruction technique with an intra-operative adjustment of the graft tension

Abstract

Purpose: Even if medial patellofemoral ligament (MPFL) reconstruction is a proven method, complications such as implant loosening, patella fractures, recurrent luxations, knee pain or knee stiffness are frequently described. Besides a correct tunnel positioning and implant-specific complications, this might be caused by difficulties with an appropriate graft tensioning. The study presented here is a necessary first step in exploring our technique of a double-limbed, hardware-free MPFL reconstruction, which provides another way to test and adjust the graft tension before permanent fastening.

Methods: Thirty consecutive patients (m/f = 18/12) with recurrent dislocations were evaluated after a mean follow-up of 24 months. Patients who had additional procedures such as a trochleoplasties, tibial tubercle transfers and derotational osteotomies were not included. Besides a standardized clinical examination, different scorings and possible complications were evaluated.

Results: The mean Kujala score improved significantly from 57 ± 15 to 92 ± 10. The Lysholm and IKDC score increased significantly from 59 ± 11 to 95 ± 6 and from 49 ± 9 to 89 ± 9, respectively. No patient reported a re-dislocation, subluxation or showed a positive apprehension. A total of 23 patients were engaged in regular physical activities. All but one, who lost interest, returned to the same sports. Because some did not follow our recommendation to return to sports after a rehab of at least 10-12 weeks, the period for a return was relatively short (median of 12 weeks, range 3-25 weeks). Four patients reported a moderate anterior knee pain only occurring after increased loads such as longer runs or workouts. One of these showed a slight flexion deficit of less than 20°. A severe motion deficit or stiffness was not noticed.

Conclusions: Even if a larger, clinical outcome study is needed to ensure the efficacy and safety of our method, it seems to provide a good clinical outcome, a correspondingly high satisfaction and a low incidence of complications. The possibility to adjust graft tension might help in minimizing complications caused by difficulties with an appropriate graft tension.

Level of evidence: IV.

Keywords: Anatomic MPFL plastic; Anterior knee pain; Knee pain; MPFL reconstruction; Patella luxation.