MPFL reconstruction: indications and results

Main Article Content

Carlo Dall'Oca
Nicholas Elena
Enrico Lunardelli
Maurizio Ulgelmo
Bruno Magnan

Keywords

Keyword: MPFL; MPFLR; patello-femoral instability; patellar dislocation; MPFL reconstruction

Abstract

Background and aim: The medial patellofemoral ligament (MPFL) is the most important structure commonly injured during lateral patellar dislocation and its rupture accounts for 3% of total knee injuries. MPFL reconstruction (MPFLR) is a reliable procedure with good results but variable rates of recurrent instability. The aim of this study is to underline the proper indications for the MPFLR reconstruction and to explain all the pearls and pitfalls regarding the MPFLR both in our experience and found in the latest literature. Methods: A comprehensive search in the latest literature using various combinations of the keywords MPFL, MPFLR, dislocation, treatment was performed. The following data were extracted: diagnosis methods, indications and contraindications for isolated MPFLR, type of management, recurrence of instability, outcomes and complications. Results: History of multiple patellar dislocations is the most relevant indication for ligament reconstruction especially after a failed course of conservative treatment in presence of persistent patello-femoral instability. Gold standard technique for MPFLR has not been clearly defined yet. Conclusions: There is still poor literature about outcome comparisons, therefore it is challenging to decide which technique is the most appropriate as surgical procedures are continuously developing. The ideal candidates for MPFLR have to be decided after a throughout evaluation and careful planning and, with nowadays knowledge, it is possible to put indication for a reconstruction exposing the patient to minimal risks.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...
Abstract 69 | PDF Downloads 57

References

1. Rosinski A, Chakrabarti M, Gwosdz J, McGahan PJ, Chen JL. Double-Bundle Medial Patellofemoral Ligament Reconstruction With Allograft. Arthrosc Tech. 2019 May;8(5):e513-e520
2. Sillanpaa PJ, First-time patellar dislocation: surgery or conservative treatment? Sport Med Arthrosc. 2012;20(3):128–135
3. Duthon VB. Acute traumatic patellar dislocation. Orthop Traumatol Surg Res. 2015 Feb;101
4. Sanchis-Alfonso V. How to Deal With Chronic Patellar Instability: What Does the Literature Tell Us?. Sports Health. 2016 Jan-Feb;8(1):86-90
5. LaPrade MD, Kallenbach SL, Aman ZS, et al. Biomechanical evaluation of the medial stabilizers of the patella. Am J Sports Med 2018;46:1575-1582
6. Nomura E, Inoue M, Osada N. Anatomical analysis of the medial patellofemoral ligament of the knee, especially the femoral attachment. Knee Surg Sports Traumatol Arthrosc. 2005 Oct;13(7):510-5
7. Kang HJ, Wang F, Chen BC, Su YL, Zhang ZC, Yan CB. Functional bundles of the medial patellofemoral ligament. Knee Surg Sports Traumatol Arthrosc. 2010 Nov;18(11):1511-6
8. Fujino K, Tajima G, Yan J, Kamei Y, Maruyama M, Takeda S, Kikuchi S, Shimamura T.Morphology of the femoral insertion site of the medial patellofemoral ligament. Knee Surg Sports Traumatol Arthrosc. 2015 Apr;23(4):998-1003
9. John P. Fulkerson, M.D Medial Quadriceps Tendon Femoral Ligament: Surgical Anatomy and Reconstruction Technique to Prevent Patella Instability Arth Tech 2013;2(2):125-128
10. Espregueira-Mendes J, Andrade R Combined Soft Tissue Reconstruction of the Medial Patellofemoral Ligament and Medial Quadriceps TendoneFemoral Ligament . Arthroscopy Techniques, in press.
11. Hendawi T, Godshaw B, Flowers C, Stephens I, Haber L, Waldron S. Autograft vs Allograft Comparison in Pediatric Medial Patellofemoral Ligament Reconstruction.Ochsner J. 2019 Summer;19(2):96-101
12. Yeung M, Leblanc MC, Ayeni OR, Khan M, Hiemstra LA, Kerslake S, Peterson D. Indications for Medial Patellofemoral Ligament Reconstruction: A Systematic Review.J Knee Surg. 2016 Oct;29(7):543-554
13. Krebs C, The medial patellofemoral ligament: Review of the literature, J Ortho 15 (2018) 596-599
14. Dejour DRP, Lecoultre B. Douleur et instabilité rotulienne: essai de classification. Med Hyg 1998;5:1466–70.
15. Wang CH, Ma LF, Zhou JW, Ji G, Wang HY, Wang F, Wang J. Double-bundle anatomical versus single-bundle isometric medial patellofemoral ligament reconstruction for patellar dislocation. Int Orthop. 2013 Apr;37(4):617-24
16. W.N.Scott et al. Insall & Scott. Surgery of the knee. Sixth edition (2018)
17. Guerrero P, Medial patellofemoral ligament injury patterns and associated pathology in lateral patella dislocation: an MRI study. Sports Med Arthrosc Rehabil Ther Technol 2009, 1:17
18. Kepler CK, Zone of injury of the medial patellofemoral ligament after acute patellar dislocation in children and adoles- cents. Am J Sports Med 2011, 39:1444–1449
19. Weber-Spickschen TS, The relationship between trochlear dysplasia and medial patellofemoral ligament rupture location after patellar dislocation: an MRI evaluation. Knee 2011, 18(3):185–188
20. Csintalan RP, Latt LD, Fornalski S, Raiszadeh K, Inacio MC, Fithian DC. Medial patellofemoral ligament (MPFL) reconstruction for the treatment of patellofemoral instability. J Knee Surg. 2014 Apr;27(2):139-46
21. Howells NR, Barnett AJ, Ahearn N, Ansari A, Eldridge JD. Medial patellofemoral ligament reconstruction: a prospective outcome assessment of a large single centre series. J Bone Joint Surg Br. 2012 Sep;94(9):1202-8
22. Ma LF, Wang F, Chen BC, Wang CH, Zhou JW, Wang HY. Medial retinaculum plasty versus medial patellofemoral ligament recon- struction for recurrent patellar instability in adults: a randomized controlled trial. Arthroscopy 2013;29(5):891–897
23. Mehta VM, Inoue M, Nomura E, Fithian DC. An algorithm guiding the evaluation and treatment of acute primary patellar dislocations. Sports Med Arthrosc Rev 2007;15(2):78–8
24. Ronga M, Oliva F, Longo UG, Testa V, Capasso G, Maffulli N. Isolated medial patellofemoral ligament reconstruction for recurrent patellar dislocation. Am J Sports Med 2009;37(9):1735–1742
25. Hiemstra LA, Kerslake S, Kupfer N, Lafave M. Patellofemoral Stabilization: Postoperative Redislocation and Risk Factors Following Surgery. Orthop J Sports Med.2019 Jun;7(6):2325967119852627
26. Hiemstra LA, Kerslake S, Kupfer N, Lafave M. Patellofemoral Stabilization: Postoperative Redislocation and Risk Factors Following Surgery. Orthop J Sports Med.2019 Jun;7(6):2325967119852627
27. Drez D Jr, Edwards TB, Williams CS. Results of medial patellofe- moral ligament reconstruction in the treatment of patellar dislo- cation. Arthroscopy 2001;17(3):298–306
28. Lippacher S, Dreyhaupt J, Williams SR, Reichel H, Nelitz M. Reconstruction of the medial patellofemoral ligament: Clinical outcomes and return to sports. Am J Sports Med 2014;42(7): 1661–1668
29. Zhou JW, Wang CH, Ji G, Ma LF, Wang J, Zhang F, Dong JT, Wang F. A minimally invasive medial patellofemoral ligament arthroscopic reconstruction. Eur J Orthop Surg Traumatol. 2014 Feb;24(2):225-30
30. Ellera Gomes JL, Stigler Marczyk LR, César de César P, Jungblut CF. Medial patellofemoral ligament reconstruction with semitendi- nosus autograft for chronic patellar instability: a follow-up study. Arthroscopy 2004;20(2):147–151
31. Hinterwimmer S, Imhoff AB, Minzlaff P, et al. Anatomical two- bundle medial patellofemoral ligament reconstruction with hard- ware-free patellar graft fixation: technical note and preliminary results. Knee Surg Sports Traumatol Arthrosc 2013;21(9): 2147–2154
32. Panni AS, Alam M, Cerciello S, Vasso M, Maffulli N. Medial patellofemoral ligament reconstruction with a divergent patellar transverse 2-tunnel technique. Am J Sports Med 2011;39(12): 2647–2655
33. Raghuveer RK, Mishra CB. Reconstruction of medial patellofe- moral ligament for chronic patellar instability. Indian J Orthop 2012;46(4):447–454
34. Arendt EA, Dahm DL, Dejour D, Fithian DC, Patellofemoral joint: from instability to arthritis. Instr Course Lect. 2014; 63:355-368
35. Schöttle PB, Fucentese SF, Romero J. Clinical and radiological outcome of medial patellofemoral ligament reconstruction with a semitendinosus autograft for patella instability. Knee Surg Sports Traumatol Arthrosc. 2005 Oct;13(7):516-21
36. Smith TO, Donell S, Song F, Hing CB. Surgical versus non-surgical interventions for treating patellar dislocation. Cochrane Database Syst Rev. 2015 Feb 26;(2):CD008106
37. Fujino K, Tajima G, Yan J, Kamei Y, Maruyama M, Takeda S, Kikuchi S, Shimamura T.Morphology of the femoral insertion site of the medial patellofemoral ligament. Knee Surg Sports Traumatol Arthrosc. 2015 Apr;23(4):998-1003
38. Buckens CF, Saris DB. Reconstruction of the medial patellofemoral ligament for treatment of patellofemoral instability: a systematic review. Am J Sports Med. 2010 Jan;38(1):181-8
39. Jibri Z, Jamieson P, Rakhra KS, Sampaio ML, Dervin G. Patellar maltracking: an update on the diagnosis and treatment strategies. Insights Imaging. 2019 Jun 14;10(1):65. doi: 10.1186/s13244-019-0755-1
40. Enderlein D, Nielsen T, Christiansen SE, Faunø P, Lind M. Clinical outcome after reconstruction of the medial patellofemoral ligament in patients with recurrent patella instability. Knee Surg Sports Traumatol Arthrosc. 2014 Oct;22(10):2458-64
41. Schottle PB, Hensler D, Imhoff AB (2010) Anatomical double bundle MPFL reconstruction with an aperture fixation. Knee Surg Sports Traumatol Arthrosc 18:147–151
42. Aframian A, Smith TO, Tennent TD, Cobb JP, Hing CB. Origin and insertion of the medial patellofemoral ligament: a systematic review of anatomy. Knee Surg Sports Traumatol Arthrosc. 2017 Dec;25(12):3755-3772
43. Fujino K, Tajima G, Yan J, Kamei Y, Maruyama M, Takeda S, Kikuchi S, Shimamura T.Morphology of the femoral insertion site of the medial patellofemoral ligament. Knee Surg Sports Traumatol Arthrosc. 2015 Apr;23(4):998-1003
44. Schöttle PB, Schmeling A, Rosenstiel N, Weiler A. Radiographic landmarks for femoral tunnel placement in medial patellofemoral ligament reconstruction. Am J Sports Med.2007 May;35(5):801-4
45. Mayer P, Schuster P, Schlumberger M, Eichinger M, Pfaff M, Immendörfer M, Richter J. Midterm Results after Implant-Free Patellar Fixation Technique for Medial Patellofemoral Ligament Reconstruction. J Knee Surg. 2019 Jul 3
46. Shah JN, Howard JS, Flanigan DC, Brophy RH, Carey JL, Lattermann C. A systematic review of complications and failures associated with medial patellofemoral ligament reconstruction for recurrent patellar dislocation. Am J Sports Med. 2012 Aug;40(8):1916-23

DB Error: Unknown column 'Array' in 'where clause'