Enhanced early rehabilitation and pain management with all-arthroscopic medial patellofemoral ligament reconstruction: A comparative study

Abstract

Purpose: The purpose of this study was to evaluate the accuracy of femoral tunnel location, post-operative pain management, functional rehabilitation and clinical outcomes in medial patellofemoral ligament (MPFL) reconstruction using all-arthroscopic technique.

Methods: Between 2020 and 2021, 160 patients with recurrent patellar dislocation undergoing MPFL reconstruction were categorized into control (traditional surgery) and study (all-arthroscopic technique) groups. Femoral tunnel accuracy was assessed via computed tomography scans, pain management, functional rehabilitation, knee range of motion and daily activities were evaluated up to 6 months post-operatively. Knee function was assessed using Kujala and Lysholm scores at post-operative 12 months.

Results: Seventy-one patients in the control group and 69 patients in the study group reached the final follow-up with no demographic differences. Follow-up duration was 12.65 ± 0.68 vs 12.77 ± 0.73 months in the control and study groups (p = 0.3145). The intra-class correlation coefficient was excellent (r = 0.97). In femoral tunnels, 93.5% in the control group and 92.4% in the study group were correctly localized. In patellar tunnels, 96.1% in the control group and 96.2% in the study group were correctly localized (p > 0.9999). Post-operative strong opioid analgesics were used 25.9 ± 31.0 versus 12.0 ± 22.2 mg/day in the control and study groups (p = 0.0016). The pain score was 3.4 ± 1.1 versus 2.7 ± 1.2 in the control and study groups (p = 0.0006) during post-operative functional rehabilitation. Time to resume daily living was 8.2 ± 0.6 versus 7.6 ± 0.6 weeks in the control and study groups (p < 0.0001). Time to resume low-intensity exercise was 12.3 ± 0.6 versus 11.7 ± 0.6 weeks in the control and study groups (p < 0.0001). In the more than 1-year follow-up, no significant difference was found in the Kujala and Lysholm scores.

Conclusions: The all-arthroscopic technique for MPFL reconstruction in recurrent patellar dislocation ensures precise femoral tunnel placement. It offers advantages in early post-operative pain management and functional recovery, enabling faster rehabilitation compared to traditional non-all-arthroscopic techniques.

Level of evidence: Level III.

Keywords: arthroscopy; dislocation; knee; patellar.

Figure 1

Incisions and arthroscopic portals. (a) Incisions and arthroscopic portals in control group. (b) Incision and arthroscopic portals in study group. AHI, autograft harvesting incision; ALP, anterolateral portal; AMP, anteromedial portal; FP, femoral portal; MI, medial incision; MSP, medial superior portal; PP, patellar portal.

Figure 2

Patellar tunnel locating method. (a) Locating patellar tunnel in control group. (b) Locating patellar tunnel in study group. IP, inferior pole; SP, superior pole.

Figure 3

Femoral tunnel locating method. (a and b) Femoral tunnel was located at 8 mm distal to the apex of the AT and 8 mm anterior to the PE in control group. (c and d) Femoral tunnel was located at 8 mm distal to the apex of the AT and 8 mm anterior to the PE in study group. (e) Medial superior portal (MSP) and femoral portal (FP) were used to locate femoral tunnel. AT, adductor tubercle; FT, femoral tunnel; PE, posterior edge.

Figure 4

Post‐operative femoral tunnel assessment. The blue dot is Schöttle's point. Line 1 is the extension of the posterior cortical line. Line 2 is the perpendicular line of Line 1 intersecting the posterior origin of the medial femoral condyle. Schöttle's point was located at 1.3 mm anterior to the Line 1, 2.5 mm distal to the Line 2. The red dot is Schöttle's point. The area in the blue circle was the proper zone of the femoral tunnel (8.5 mm in radius). The area in the blue circle was Schöttle's zone (5 mm in diameter). FT, femoral tunnel; PT, patellar tunnel; SP, Schöttle's point.

Figure 5

Pain management. (a) Potent opioid analgesics usage. (b) Post‐operative functional rehabilitation (**p < 0.01; ***p < 0.001).

Figure 6

Knee functional rehabilitation progress. (a) Post‐operative ROM rehabilitation, including 90°, 120° and full knee ROM. (b) Post‐operative activities of daily living, including low‐intensity exercise (****p < 0.0001). ROM, range of motion.