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Zhang J, Lai S, Li J, Zhang C, Yao L, Zhang Y, Chen K, Cai W, Li J, Li Q. Early Postoperative Rapid Rehabilitation Yields More Favorable Short-term Outcomes in Patients Undergoing Patellar Realignment Surgery for Recurrent Patellar Dislocation: A Prospective Randomized Controlled Study. Am J Sports Med 2024:3635465241254524. [PMID: 38884318 DOI: 10.1177/03635465241254524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
BACKGROUND Use of a rapid rehabilitation protocol for postoperative recovery after recurrent patellar dislocation (RPD) has gradually gained attention; nonetheless, evidence of its safety and effectiveness is lacking. PURPOSE To compare the short-term postoperative outcomes of early rapid rehabilitation with those of conservative rehabilitation in patients with RPD. STUDY DESIGN Randomized controlled trial; Level of evidence, 2. METHODS A total of 50 patients with RPD who underwent tibial tubercle osteotomy combined with medial patellofemoral ligament reconstruction were enrolled between January 2018 and February 2019. Postoperatively, the patients were randomly assigned to either the early rapid group (rapid group; n = 25 patients) or the conservative group (control group; n = 25 patients) for rehabilitation training. The rapid group underwent faster progression in weightbearing and range of motion (ROM) training. Knee joint functional scores, ROM, bilateral thigh circumference differences, and imaging data were recorded preoperatively and at 6 weeks and 3, 6, 12, and 24 months postoperatively for comparison. Postoperative complications were recorded over the 24-month follow-up period. RESULTS The baseline data did not significantly differ between the 2 groups. Postoperatively, compared with the control group, the rapid group had higher Tegner scores at 6 weeks and 3 months; higher Lysholm scores at 3 and 6 months; higher International Knee Documentation Committee scores at 6 weeks, 3 months, and 12 months; better ROM; and smaller bilateral thigh circumference differences at 24 months (P < .05 for all). However, no differences were observed in the Tegner, Lysholm, and International Knee Documentation Committee scores at 24 months postoperatively. At the 6-week and subsequent follow-up visits, the Caton and Insall indices were lower in the control group than in the rapid group (P < .01 for all). Moreover, compared with the control group, the rapid group had a lower incidence of patella baja at 24 months (0% vs 17%) and fewer complications during the whole follow-up period (P < .01). CONCLUSION Early rapid postoperative rehabilitation appears to be safe and effective for patients who undergo tibial tubercle osteotomy combined with medial patellofemoral ligament reconstruction to treat RPD. In the short term, this approach was shown to be more advantageous than conservative rehabilitation in improving functional scores, allowing an earlier return to daily activities, although the lack of difference at 24 months implies no long-term benefits. In addition, it potentially helped to prevent the occurrence of complications, including patella baja. REGISTRATION ChiCTR1800014648 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Jiayao Zhang
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Sike Lai
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Junqiao Li
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Chenghao Zhang
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Lei Yao
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yuyan Zhang
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Kunhao Chen
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Wufeng Cai
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jian Li
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Qi Li
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610041, China
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Tanos P, Neo C, Tong E, Volpin A. The Use of Synthetic Graft for MPFL Reconstruction Surgery: A Systematic Review of the Clinical Outcomes. Med Sci (Basel) 2023; 11:75. [PMID: 38132916 PMCID: PMC10744733 DOI: 10.3390/medsci11040075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/04/2023] [Accepted: 11/23/2023] [Indexed: 12/23/2023] Open
Abstract
(1) Background: Acute patella dislocation (APD) is a prevalent knee injury, with rates between 5.8-77.8 per 100,000. APD often results in repeat lateral patella dislocations due to the instability of the medial patellofemoral ligament (MPFL). Non-operative treatments have a 50% recurrence rate. While autologous grafting for MPFL has been favored, surgeons are now exploring synthetic grafts. We aimed to assess the effectiveness of synthetic grafts in MPFL reconstruction surgeries for repeated patellar dislocations; (2) Methods: Our research was based on a thorough search from the National Institute of Health and Clinical Excellence Healthcare Databases, using the Modified Coleman Methodology Score for quality assessment; (3) Results: Six studies met the inclusion criteria. A total of 284 patients and 230 knees were included. Seventy-five percent of patients were graded to have excellent-good clinical outcomes using the Crosby and Insall Grading System. International Knee Documentation Committee score and Knee injury and Osteoarthritis Outcome Score scores showed 59% and 60% post-operative improvement, respectively; (4) Conclusions: All studies showed improvement in post-operative functional outcomes and report no serious adverse events. The 6 mm, LARS (Orthomedic Ltd., Dollard-des-Ormeaux, QC, Canada) proved to have the most improvement in post-operative outcomes when used as a double bundle graft.
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Affiliation(s)
- Panayiotis Tanos
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB24 3FX, UK;
| | - Chryssa Neo
- Queen Elizabeth Hospital Gateshead, Gateshead Health NHS Foundation Trust, Gateshead NE9 6SX, UK;
| | - Edwin Tong
- Aberdeen Royal Infirmary, NHS Grampian, Aberdeen AB25 2ZN, UK;
| | - Andrea Volpin
- Trauma and Orthopaedics, Dr Gray’s Hospital, NHS Grampian, Elgin IV30 1SN, UK
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Migliorini F, Maffulli N, Söllner S, Pasurka M, Kubach J, Bell A, Betsch M. Allografts for Medial Patellofemoral Ligament (MPFL) Reconstruction in Adolescent Patients with Recurrent Patellofemoral Instability: A Systematic Review. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10050840. [PMID: 37238388 DOI: 10.3390/children10050840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/27/2023] [Accepted: 05/04/2023] [Indexed: 05/28/2023]
Abstract
This systematic review updates the currently available evidence on medial patella-femoral ligament (MPFL) reconstruction using allografts. The outcomes were measured with patient-reported outcome measures (PROMs), redislocation and complication rates. This study was performed according to the 2020 PRISMA guidelines using the PubMed, Scopus, Web of Science databases, accessed in February 2023. Studies examining the clinical outcomes of MPFL reconstruction with allografts in adolescents and children with recurrent patellofemoral instability (PFI) were included. Data from three trials, including 113 surgical procedures in 121 children, were retrieved. 40% (48/121) of the included patients were girls. The mean age of the patients was 14.7 ± 0.8 years, and the mean follow-up length was 38.1 ± 16.5 months. With MPFL allograft reconstruction, the Kujala score improved by 14.7% (p < 0.0001) and the IKDC by 38.8% (p < 0.0001). The rate of dislocations was 5% (6 of 121), reoperation for instability was 11% (13 of 121), and subluxation was 2% (1 of 47). Conclusion: These results encourage the use of allografts for MPFL reconstruction in adolescent patients with recurrent patellofemoral instability. Though patellofemoral instability is common in clinical practice, the current literature lacks clinical evidence on allograft MPFL reconstruction. Additional high-quality investigations are required to properly establish the long-term advantages of allograft MPFL and its complication rate.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, 52074 Aachen, Germany
- Department of Orthopaedic and Trauma Surgery, Eifelklinik St. Brigida, 52152 Simmerath, Germany
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
- School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Stoke-on-Trent ST4 7QB, UK
- Barts and The London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Queen Mary University of London, Mile End Hospital, London E1 4DG, UK
| | - Stefan Söllner
- Department of Orthopaedic and Trauma Surgery, University Hospital of Erlangen, 91054 Erlangen, Germany
| | - Mario Pasurka
- Department of Orthopaedic and Trauma Surgery, University Hospital of Erlangen, 91054 Erlangen, Germany
| | - Joshua Kubach
- Department of Orthopaedic and Trauma Surgery, University Hospital of Erlangen, 91054 Erlangen, Germany
| | - Andreas Bell
- Department of Orthopaedic and Trauma Surgery, Eifelklinik St. Brigida, 52152 Simmerath, Germany
| | - Marcel Betsch
- Department of Orthopaedic and Trauma Surgery, University Hospital of Erlangen, 91054 Erlangen, Germany
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Milinkovic DD, Zimmermann F, Balcarek P. Medial patellofemoral ligament reconstruction using nonresorbable sutures yields comparable outcomes to reconstruction with a pedicled quadriceps tendon autograft when performed in addition to bony risk factor correction. Knee Surg Sports Traumatol Arthrosc 2023; 31:264-271. [PMID: 35972519 PMCID: PMC9859873 DOI: 10.1007/s00167-022-07104-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 08/03/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE To evaluate the results for reconstruction of the medial patellofemoral ligament using synthetic nonresorbable sutures (S-MPFL-R) in comparison to MPFL-R using quadriceps tendon autograft (QT-MPFL-R) in patients undergoing simultaneous correction of anatomic risk factors for lateral patellar instability (LPI) at a minimum of 2 years of follow-up. METHODS Between November 2018 and June 2019, 19 patients (male/female 8/11; mean age 26 ± 7 years) underwent S-MPFL-R (FiberTape®) in combination with the correction of predisposing risk factors for LPI. The control group of 38 patients (male/female 16/22, mean age 26 ± 6 years) who underwent QT-MPFL-R was matched 1:2 by sex, age, anatomic risk factors, and concomitant surgical correction of bony risk factors. The Banff Patella Instability Instrument 2.0 (BPII 2.0) and a numerical analog scale (NAS 0-10) for patellofemoral pain and subjective knee joint function were used to assess patients' reported quality of life before and after surgery. RESULTS The BPII 2.0 score increased from 35.0 ± 21.7 points to 79.7 ± 13.3 points (p < 0.0001) in the S-MPRL-R group and from 44.3 ± 19.6 points to 80.9 ± 15 points (p < 0.0001) in the QT-MPFL-R group from preoperatively to postoperatively, respectively, without any significant difference between the groups. In the S-MPFL-R group and QT-MPFL-R group, 95% (18/19) and 92% (35/38) of patients, respectively, crossed the minimally clinically important difference reported for the BPII 2.0. NAS values for pain and subjective knee joint function improved significantly in both groups (p < 0.0001, p < 0.0001) without any significant difference between the groups at the final follow-up. CONCLUSIONS This study demonstrates that nonresorbable sutures can serve as a viable option for MPFL-R, yielding comparable outcomes compared to quadriceps tendon autograft reconstruction when performed concomitantly with the correction of anatomic risk factors for LPI. This option reduces the need for autologous tendon harvesting or the use of allografts for MPFL-R. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Danko Dan Milinkovic
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Luisenstrasse 64, 10117, Berlin, Germany.
| | - Felix Zimmermann
- Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Ludwigshafen am Rhein, Germany
| | - Peter Balcarek
- Arcus Sportklinik, Pforzheim, Germany ,Department of Trauma Surgery, Orthopaedics, and Plastic Surgery, University Medicine Göttingen, Göttingen, Germany
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Migliorini F, Eschweiler J, Spiezia F, Knobe M, Hildebrand F, Maffulli N. Synthetic graft for medial patellofemoral ligament reconstruction: a systematic review. J Orthop Traumatol 2022; 23:41. [PMID: 35996063 PMCID: PMC9395552 DOI: 10.1186/s10195-022-00660-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 08/03/2022] [Indexed: 11/23/2022] Open
Abstract
Background This systematic review investigates the role of synthetic graft for primary medial patellofemoral ligament (MPFL) reconstruction in patients with recurrent patellofemoral instability, focusing on clinical scores and the rate of complications. Methods This systematic review was conducted according to the PRISMA statement. The main online databases were accessed in January 2022 without time constraints. All clinical studies investigating the use of synthetic grafts for MPFL reconstruction were accessed. Revision settings were not considered. Only articles reporting data on patients with recurrent patellofemoral instability were eligible. Studies regarding congenital or acute patellofemoral dislocation were excluded. Only studies performing a follow-up longer than 24 months were considered. Results Data on 199 patients [mean age 22.3 (range 19.0–28.0) years] were collected. The mean follow-up was 60.5 (39.0–142.8) months. All the scores of interest improved at last follow-up: Kujala (+ 24.8; P = 0.0002), Lysholm (+ 42.0; P = 0.02), Tegner (+ 1.2; P = 0.03), IKDC (+ 20.9; P = 0.02). Post-operatively, a positive apprehension test was detected in 6.1% (7/115) of patients, and a sensation of instability was reported by 1.5% (3/199) of patients. The rate of re-dislocations was 2.5% (5 of 199 patients), and revision procedures were performed in less than 1% (1 of 199) of patients. Conclusion Synthetic graft may be reliable and feasible for primary MPFL reconstruction in patients with recurrent patellofemoral instability.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Jörg Eschweiler
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Filippo Spiezia
- Department of Orthopaedic and Trauma Surgery, San Carlo Hospital, Potenza, Italy
| | - Matthias Knobe
- Department of Orthopaedic and Trauma Surgery, Cantonal Hospital, 6000, Lucerne, Switzerland
| | - Frank Hildebrand
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy.,School of Pharmacy and Bioengineering, Keele University School of Medicine, Thornburrow Drive, Stoke on Trent, England.,Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Queen Mary University of London, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, England
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Shimodaira H, Tensho K, Koyama S, Iwaasa T, Kumaki D, Horiuchi H, Takahashi J. Simultaneous Medial Patellofemoral Ligament and Medial Quadriceps Tendon-Femoral Ligament Reconstructions Using an Artificial Ligament for Lateral Patella Instability. Arthrosc Tech 2022; 11:e1021-e1026. [PMID: 35782857 PMCID: PMC9244637 DOI: 10.1016/j.eats.2022.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 02/05/2022] [Indexed: 02/03/2023] Open
Abstract
Recent studies on the detailed anatomy of the medial patellar stabilizer have revealed that the medial patellofemoral ligament (MPFL) not only attaches to the patella but also has fibers that attach to the quadriceps muscle, known as the medial quadriceps tendon femoral ligament (MQTFL). Reconstruction of the medial stabilizer for patellar dislocation that includes both the MPFL and MQTFL may achieve better anatomical and physiological correction. In this Technical Note, we will describe a simultaneous reconstruction technique of the MPFL and MQTFL for patellar dislocation using an artificial ligament.
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Affiliation(s)
| | - Keiji Tensho
- Address correspondence to Keiji Tensho, M.D., Ph.D., Department of Orthopedic Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, 390-8621, Japan.
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Migliorini F, Eschweiler J, Betsch M, Knobe M, Tingart M, Maffulli N. Prognostic factors for isolated medial patellofemoral ligament reconstruction: A systematic review. Surgeon 2021; 20:e112-e121. [PMID: 33962891 DOI: 10.1016/j.surge.2021.03.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 02/28/2021] [Accepted: 03/16/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND Evidence concerning the influence gender, age, and the time elapsed from the first dislocation to surgery in the outcomes of Medial Patella Femoral Ligament (MPFL) reconstruction are lacking. This systematic review was conducted to investigate whether patient characteristics have an influence in the clinical outcomes of MPFL reconstruction for patients with patellofemoral instability. MATERIAL AND METHODS This study followed the PRISMA guidelines. The main databases were accessed in February 2021. All the studies reporting outcomes of primary MPFL reconstruction in patients with recurrent patellofemoral instability were considered for inclusion. A multivariate analysis diagnostic tool was used to analyse the association between age, gender and time from injury to surgery and the surgical outcomes at last follow-up. RESULTS A total of 50 articles (2037 procedures) were included. The mean follow-up was 40.90 ± 24.8 months. The mean age was 23.6 ± 3.9 years. 64.3% (1309 of 2037 patients) were female. The mean time from injury to surgery was 64.5 ± 48.9 months. Women showed no statistically significant association with the Kujala score or complications. Older patients had a reduced risk to incur re-dislocations (P = 0.01) and revisions (P = 0.01). Longer time from injury to surgery was associated with greater risk to incur re-dislocations (P = 0.01), and with lower Kujala score (P < 0.0001). No other statistically significant association was evidenced. CONCLUSION The time span from the first patellar dislocation to the surgical reconstruction was a negative prognostic factor, while sex had no influence on surgical outcomes. The role of patients age on surgical outcomes remains unclear.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany.
| | - Jörg Eschweiler
- Department of Orthopaedic, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany.
| | - Marcel Betsch
- Department of Orthopedics and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland.
| | - Matthias Knobe
- Department of Orthopaedics and Trauma Surgery, University Medical Centre Mannheim of the University Heidelberg, 68167 Mannheim, Germany
| | - Markus Tingart
- Department of Orthopaedic, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany.
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, SA, Italy; School of Pharmacy and Bioengineering, Keele University School of Medicine, Thornburrow Drive, Stoke on Trent, England, UK; Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, England, UK.
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Migliorini F, Oliva F, Maffulli GD, Eschweiler J, Knobe M, Tingart M, Maffulli N. Isolated medial patellofemoral ligament reconstruction for recurrent patellofemoral instability: analysis of outcomes and risk factors. J Orthop Surg Res 2021; 16:239. [PMID: 33823887 PMCID: PMC8022360 DOI: 10.1186/s13018-021-02383-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 03/24/2021] [Indexed: 12/17/2022] Open
Abstract
Background The medial patellofemoral ligament (MPFL) is always damaged after patellar dislocation. In selected patients, MPFL reconstruction is necessary to restore a correct patellar tracking. Despite the large number of different techniques reported to reconstruct the MPFL, there is no consensus concerning the optimal procedure, and debates is still ongoing. The present study analysed the results after isolated MPFL reconstruction in patients with patellofemoral instability. Furthermore, a subgroup analysis of patients presenting pathoanatomical risk factors was made. Methods In November 2020, the main electronic databases were accessed. All articles reporting the results of primary isolated MPFL reconstruction for recurrent patellofemoral instability were considered for inclusion. Only articles reporting a minimum 12-month follow-up were eligible. Results Data from a total of 1777 knees were collected. The mean age of the patients involved was 22.8 ± 3.4 years. The mean follow-up was 40.7 ± 25.8 months. Overall, the range of motion (+ 27.74; P < 0.0001) and all the other scores of interests improved at last follow-up: Kujala (+ 12.76; P = 0.0003), Lysholm (+ 15.69; P < 0.0001), Tegner score (+ 2.86; P = 0.006). Seventy-three of 1780 patients (4.1%) showed a positive apprehension test. Thirty of 1765 patients (1.7%) experienced re-dislocations, while 56 of 1778 patients (3.2%) showed persisting joint instability. Twenty-five of 1786 patients (1.4%) underwent revision surgeries. Conclusion Isolated MPFL reconstruction for recurrent patellofemoral instability provides reliable surgical outcomes. Patients with pathoanatomical predisposing factors reported worse surgical outcomes.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedics, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Francesco Oliva
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy
| | | | - Jörg Eschweiler
- Department of Orthopaedics, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Matthias Knobe
- Department of Orthopedics and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Markus Tingart
- Department of Orthopaedics, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy.,Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Queen Mary University of London, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, UK.,School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Thornburrow Drive, Stoke on Trent, UK
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Yang YP, Ling YD, Pang CN, Li N, Gong YN, Cui GQ, Gong X, Ao YF. Novel method for diagnosing lateral patellar compression syndrome using X-ray: a retrospective case-control study. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:445. [PMID: 33850842 PMCID: PMC8039637 DOI: 10.21037/atm-20-6410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background A well-established reference is lacking for diagnosing lateral patellar compression syndrome (LPCS), and this diagnosis currently depends on clinicians' subjective judgment and several examination results. X-rays are primarily used to diagnose LPCS, but they have low detection rates of patellar tilt using the congruence angle (CA) and patellar tilting angle (PTA). Methods We enrolled 87 patients (31 men and 56 women; mean age: 42.11±15.33 years) between 2016 and 2019 and divided them as per diagnosis into three groups of 29 each: LPCS, patellar dislocation (PD, control), and meniscus tear (MT, negative control) groups. A senior radiologist and the chief physician of sports medicine examined their patellar axial radiographs of the knee in 30° flexion using a computer imaging system, measuring LPCA, CA and PTA. Univariate analysis of variance and Kruskal-Wallis H test were used to compare measurement data with normal distribution and non-normal distribution, respectively. Bonferroni correction was used to analyze different indicators for different groups. The area under the curve (AUC) was calculated to verify the value of LPCA in the initial diagnosis of LPCS. Results LPCA (19.88±7.49) was significantly higher in LPCS group than in MT (13.68±4.69) and PD groups (10.16±4.43) (P<0.01) and was also significantly higher on affected side than on healthy side (16.44±5.00) (P=0.04). LPCA >13.9° had sensitivity and specificity of 89.66% and 68.97%, respectively, for LPCS diagnosis (AUC: 0.82, 95% confidence interval: 0.719-0.891, P<0.001). Conclusions We demonstrated that LPCA measured using an axial patellar radiograph of the knee in 30° flexion is high in patients with LPCS, and it may be used for diagnosing LPCS.
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Affiliation(s)
- Yu-Ping Yang
- Department of Sports Medicine, Peking University Third Hospital. Institute of Sports Medicine of Peking University. Beijing Key Laboratory of Sports Injuries, Beijing, China.,Peking University Third Hospital, Beijing, China
| | - Yu-Dong Ling
- Peking University Health Science Center, Beijing, China
| | - Chao-Nan Pang
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Nan Li
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Yi-Ning Gong
- Peking University Health Science Center, Beijing, China
| | - Guo-Qing Cui
- Department of Sports Medicine, Peking University Third Hospital. Institute of Sports Medicine of Peking University. Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Xi Gong
- Department of Sports Medicine, Peking University Third Hospital. Institute of Sports Medicine of Peking University. Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Ying-Fang Ao
- Department of Sports Medicine, Peking University Third Hospital. Institute of Sports Medicine of Peking University. Beijing Key Laboratory of Sports Injuries, Beijing, China
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Hartanto J, Leow WK, Yew AKS, Koh JSB, Howe TS. Studies of the criteria for determining optimal location of medial patellofemoral ligament attachment sites. Med Biol Eng Comput 2021; 59:693-702. [PMID: 33598884 DOI: 10.1007/s11517-021-02330-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 01/29/2021] [Indexed: 11/30/2022]
Abstract
Identifying appropriate attachment sites is important in the planning of medial patellofemoral ligament (MPFL) reconstruction. Two criteria are advanced to describe normal MPFL function, namely isometric criterion and desired pattern criterion. Subsequently, computational methods have applied these criteria to determine optimal attachment sites. So far, there is no study that compares the outcomes of these two criteria. For five subjects' 3D models of the patella and femur, three patellar sites and many femoral sites were identified as pairs of candidate attachment sites. For each patellar site, the criteria were applied to identify the matching femoral sites that satisfy them. The matching femoral site with the smallest length change was identified as the optimal femoral site. The desired pattern criterion finds fewer matching sites compared to the isometric criterion. In contrast, the isometric criterion can always find matching sites. The optimal femoral sites obtained vary significantly across different subjects. For most subjects, the optimal sites obtained using the isometric criterion are closer to known anatomical sites than those obtained using the desired pattern criterion. This study reaffirms that MPFL reconstruction is subject specific. The isometric criterion may be more reliable than the desired pattern criterion for determining optimal attachment sites. Graphical Abstract. Highlight of the paper. The location of the patella site significantly affects the location of the optimal femoral site. The isometric criterion option 1, with length at 0° regarded as MPFL's natural length, may be more reliable than other criteria or options for the planning of MPFL surgery because the optimal sites that it finds are closest to known anatomical sites.ᅟ.
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Affiliation(s)
- Jeffry Hartanto
- Department of Computer Science, National University of Singapore, Singapore, Singapore.
| | - Wee Kheng Leow
- Department of Computer Science, National University of Singapore, Singapore, Singapore
| | - Andy Khye Soon Yew
- Department of Orthopaedics, Singapore General Hospital, Singapore, Singapore
| | - Joyce Suang Bee Koh
- Department of Orthopaedics, Singapore General Hospital, Singapore, Singapore
| | - Tet Sen Howe
- Department of Orthopaedics, Singapore General Hospital, Singapore, Singapore
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Migliorini F, Maffulli N, Eschweiler J, Quack V, Tingart M, Driessen A. Lateral retinacular release combined with MPFL reconstruction for patellofemoral instability: a systematic review. Arch Orthop Trauma Surg 2021; 141:283-292. [PMID: 33315122 PMCID: PMC7886734 DOI: 10.1007/s00402-020-03689-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 11/11/2020] [Indexed: 01/03/2023]
Abstract
INTRODUCTION The role of the lateral retinaculum in patellofemoral instability is still debated. Lateral retinacular release (LRR), has been extensively performed in combination with different surgical procedures, including reconstruction of medio-patellofemoral ligament (MPFL). Despite controversial indications, the results from these studies seem promising. The present study conducts a systematic review about current biomechanical and clinical evidence concerning the role of LRR in combination with MPFL reconstruction. We performed a comprehensive literature research, comparing the outcomes of MPFL reconstruction with and without LRR. MATERIALS AND METHODS This systematic review was conducted according to the PRISMA guidelines. The literature search was performed in August 2020. All articles describing the outcome of isolated MPFL reconstruction alone or in combination with a LRR in patients with recurrent patellofemoral instability were considered for inclusion. Only articles reporting data on patients with a minimum of 12-month follow-up were included. Only articles reporting quantitative data under the outcomes of interest were included. RESULTS A total of 63 articles were eligible for this systematic review, including 2131 knees. The mean follow-up was 40.87 ± 24.1 months. All scores of interests improved in favour of the combined group: Kujala + 3.8% (P = 0.01), Lysholm + 4.2% (P = 0.004), Tegner + 0.8 points (P = 0.04), IKDC + 9.8% (P = 0.02). The ROM was comparable between the two groups (P = 0.4). Similarity was found in terms of positivity to the apprehension test (P = 0.05), rate of complications (P = 0.1), re-dislocations (P = 0.8), and revision surgeries (P = 0.1). CONCLUSION There is no evidence that adding a lateral release impacts positively on the outcome of MPFL reconstruction. LEVEL OF EVIDENCE IV, Systematic review.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, SA Italy ,School of Pharmacy and Bioengineering, Keele University School of Medicine, Thornburrow Drive, Stoke on Trent, England ,Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Queen Mary University of London, Mile End Hospital, 275 Bancroft Road, London, E1 4DG England
| | - Jörg Eschweiler
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Valentin Quack
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Markus Tingart
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Arne Driessen
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074 Aachen, Germany
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12
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Huber C, Zhang Q, Taylor WR, Amis AA, Smith C, Hosseini Nasab SH. Properties and Function of the Medial Patellofemoral Ligament: A Systematic Review. Am J Sports Med 2020; 48:754-766. [PMID: 31091114 DOI: 10.1177/0363546519841304] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND As the main passive structure preventing patellar lateral subluxation, accurate knowledge of the anatomy, material properties, and functional behavior of the medial patellofemoral ligament (MPFL) is critical for improving its reconstruction. PURPOSE To provide a state-of-the-art understanding of the properties and function of the MPFL by undertaking a systematic review and statistical analysis of the literature. STUDY DESIGN Systematic review. METHODS On June 26, 2018, data for this systematic review were obtained by searching PubMed and Scopus. Articles containing numerical information regarding the anatomy, mechanical properties, and/or functional behavior of the MPFL that met the inclusion criteria were reviewed, recorded, and statistically evaluated. RESULTS A total of 55 articles met the inclusion criteria for this review. The MPFL presented as a fanlike structure spanning from the medial femoral epicondyle to the medial border of the patella. The reported data indicated ultimate failure loads from 72 N to 208 N, ultimate failure elongation from 8.4 mm to 26 mm, and stiffness values from 8.0 N/mm to 42.5 N/mm. In both cadaveric and in vivo studies, the average elongation pattern demonstrated close to isometric behavior of the ligament in the first 50° to 60° of knee flexion, followed by progressive shortening into deep flexion. Kinematic data suggested clear lateralization of the patella in the MPFL-deficient knee during early knee flexion under simulated muscle forces. CONCLUSION A lack of knowledge regarding the morphology and attachment sites of the MPFL remains. The reported mechanical properties also lack consistency, thus requiring further investigations. However, the results regarding patellar tracking confirm that the lack of an MPFL leads to lateralization of the patella, followed by delayed engagement of the trochlear groove, plausibly leading to an increased risk of patellar dislocations. The observed isometric behavior up to 60° of knee flexion plausibly suggests that reconstruction of the ligament can occur at flexion angles below 60°, including the 30° and 60° range as recommended in previous studies.
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Affiliation(s)
| | - Qiang Zhang
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | | | - Andrew A Amis
- Department of Mechanical Engineering, Imperial College London, London, UK
| | - Colin Smith
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
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13
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Migliorini F, Trivellas A, Colarossi G, Eschweiler J, Tingart M, Rath B. Single- versus double-bundle patellar graft insertion for isolated MPFL reconstruction in patients with patellofemoral instability: a systematic review of the literature. Arch Orthop Trauma Surg 2020; 140:769-776. [PMID: 32086557 PMCID: PMC8289805 DOI: 10.1007/s00402-020-03376-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The MPFL reconstruction is performed either via a single-bundle (SB) or double-bundle (DB) procedure. The purpose of this study is to perform a systematic review comparing SB versus DB graft for recurrent patellofemoral instability, to summarize current evidence, and to clarify the role of both techniques. We focused on clinical scores, physical examination, complications, revision surgeries, and failures. MATERIAL AND METHODS In May of 2019 the main online databases were accessed. All the clinical studies treating isolated MPFL reconstruction for patellofemoral instability through a single and/or double-bundle graft were enrolled in the present systematic review. Only articles reporting primary isolated MPFL reconstruction, reporting a minimum of 12-months follow-up were considered for inclusion. RESULTS The scores of interest were in favour of the DB cohort: Kujala (+ 3.2, P = 0.03), Lysholm (+ 5.1, P = 0.001), Tegner (+ 0.3, P = 0.2), IKDC (+ 5.4, P = 0.01), VAS (+ 0.8, P = 0.3), ROM (+ 9.96, P = 0.04). In the DB graft, a reduction of overall complications (OR 0.59; P = 0.1), further surgeries (OR 0.64; P = 0.12) and re-dislocations (OR 0.61; P = 0.16) was observed. The SB group reported a reduction in the post-operative apprehension test (OR 2.42; P = 0.24). CONCLUSION Current study support the use of double-bundle tendon graft for isolated MPFL reconstruction in selected patients with recurrent patellofemoral instability.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedics, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Andromahi Trivellas
- Department of Orthopaedics, David Greffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Giorgia Colarossi
- Department of Cardiosurgery, RWTH Aachen University Clinic, Aachen, Germany
| | - Jörg Eschweiler
- Department of Orthopaedics, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Markus Tingart
- Department of Orthopaedics, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Björn Rath
- Department of Orthopaedics, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074, Aachen, Germany
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14
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Zaman S, White A, Shi WJ, Freedman KB, Dodson CC. Return-to-Play Guidelines After Medial Patellofemoral Ligament Surgery for Recurrent Patellar Instability: A Systematic Review. Am J Sports Med 2018; 46:2530-2539. [PMID: 28678520 DOI: 10.1177/0363546517713663] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Medial patellofemoral ligament (MPFL) reconstruction and repair continue to gain acceptance as viable treatment options for recurrent patellar instability in patients who wish to return to sports after surgery. Return-to-play guidelines with objective or subjective criteria for athletes after MPFL surgery, however, have not been uniformly defined. PURPOSE To determine whether a concise and objective protocol exists that may help athletes return to their sport more safely after MPFL surgery. STUDY DESIGN Systematic review. METHODS The clinical evidence for return to play after MPFL reconstruction was evaluated through a systematic review of the literature. Studies that measured outcomes for isolated MPFL surgery with greater than a 12-month follow-up were included in our study. We analyzed each study for a return-to-play timeline, rehabilitation protocol, and any measurements used to determine a safe return to play after surgery. RESULTS Fifty-three studies met the inclusion criteria, with a total of 1756 patients and 1838 knees. The most commonly cited rehabilitation guidelines included weightbearing restrictions and range of motion restrictions in 90.6% and 84.9% of studies, respectively. Thirty-five of 53 studies (66.0%) included an expected timeline for either return to play or return to full activity. Ten of 53 studies (18.9%) in our analysis included either objective or subjective criteria to determine return to activity within their rehabilitation protocol. CONCLUSION Most studies in our analysis utilized time-based criteria for determining return to play after MPFL surgery, while only a minority utilized objective or subjective patient-centric criteria. Further investigation is needed to determine safe and effective guidelines for return to play after MPFL reconstruction and repair.
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Affiliation(s)
| | - Alex White
- Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Weilong J Shi
- Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Kevin B Freedman
- Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Tucker A, McMahon S, McArdle B, Rutherford B, Acton D. Synthetic versus autologous reconstruction (Syn-VAR) of the medial patellofemoral ligament: a study protocol for a randomised controlled trial. Trials 2018; 19:268. [PMID: 29724252 PMCID: PMC5934878 DOI: 10.1186/s13063-018-2622-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 03/28/2018] [Indexed: 11/10/2022] Open
Abstract
Background Recurrent patellar instability incidence is 5.8/100,000 population, and recurrent dislocations are reported in the range of 15–80%. Recurrent instability is multifactorial and can be associated with disorder of limb alignment, osseous development, congruity of the patella in the trochlea and soft tissue static and dynamic constraints. The multifactorial aetiology makes management challenging, and a lack studies in a heterogeneous population with robust clinical outcomes compounds this further. The options for medial patellofemoral ligament (MPFL) reconstruction include autologous graft reconstruction with semitendinosus tendon, or synthetic polyester woven grafts. In theory, in the young active patient, the surgeon may wish to preserve the hamstring tendons to reduce postoperative morbidity to the patient, reduce delay in recovery from donor site morbidity and preserve the hamstring tendons. There have been no randomised controlled trials (RCTs) to date that directly compare autologous hamstring and synthetic reconstruction methods. This trial aims to assess the functional outcomes in those undergoing MPFL reconstruction with either autologous hamstring graft reconstruction, or a commercially available synthetic polyester open woven tape. Methods Following a power calculation using previous studies as the pilot data, a total of 30 patients will be included in the study. Enrolment is based upon strict inclusion/exclusion criteria outlined in the “Methods”. Participants will be randomized to receive either autograft or synthetic graft reconstruction. We aim to recruit 15 patients to each arm of the study. Surgery is performed by a single consultant surgeon experienced in both reconstructive options, using the default surgical technique for each. A postoperative physiotherapist-directed rehabilitation protocol will be implemented, as is routine. The primary outcome is the Kujala functional score and its change over the study period. Data on further secondary outcomes using validated outcomes scores will also be collected, specifically the Tegner and Lysholm, Banff Patellar Instability Index, and ACL Quality of Life Score. Secondary outcomes are complications and revision for any reason. The patient follow-up time is 2 years. The first patient will be recruited in January 2018. The expected trial deadline for recruitment is December 2018, with records and results being held for 5 years. Discussion This RCT study is the first to directly compare the efficacy of autograft versus synthetic allograft in MPFL reconstruction and the graft effects on patient-reported clinical outcomes. Trial registration ISRCTN, 16657952. Registered on 3 March 2017. The study protocol has been approved by the Office for Research Ethics Committees of Northern Ireland (ORECNI 17/NI/0129). Electronic supplementary material The online version of this article (10.1186/s13063-018-2622-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Adam Tucker
- Altnagelvin Area Hospital, Glenshane Road, Londonderry, BT47 6SB, Northern Ireland.
| | - Sam McMahon
- Altnagelvin Area Hospital, Glenshane Road, Londonderry, BT47 6SB, Northern Ireland
| | - Bronwyn McArdle
- Altnagelvin Area Hospital, Glenshane Road, Londonderry, BT47 6SB, Northern Ireland
| | - Bridgeen Rutherford
- R+D Office, Clinical Translational Research and Innovation Centre (C TRIC), Altnagelvin Area Hospital, Glenshane Road, Londonderry, BT47 6SB, Northern Ireland
| | - Danny Acton
- Altnagelvin Area Hospital, Glenshane Road, Londonderry, BT47 6SB, Northern Ireland
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16
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McNeilan RJ, Everhart JS, Mescher PK, Abouljoud M, Magnussen RA, Flanigan DC. Graft Choice in Isolated Medial Patellofemoral Ligament Reconstruction: A Systematic Review With Meta-analysis of Rates of Recurrent Instability and Patient-Reported Outcomes for Autograft, Allograft, and Synthetic Options. Arthroscopy 2018; 34:1340-1354. [PMID: 29366741 DOI: 10.1016/j.arthro.2017.11.027] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 11/17/2017] [Accepted: 11/20/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine whether graft selection or patient age affects the following after isolated medial patellofemoral ligament (MPFL) reconstruction: (1) rates of recurrent instability, (2) rates of postoperative complications (other than instability), and (3) subjective symptom improvement. METHODS A systematic search identified studies reporting outcomes for isolated MPFL reconstruction. Rates of recurrent instability, subjective Kujala knee function scores, and complications were tabulated. Symptom improvement was defined as change in Kujala score (preoperative evaluation to final follow-up). RESULTS Forty-five studies were included with 27 documented cases of recurrent instability among 1,504 patients (1.8%); instability rates ranged from 0% to 20.0% overall; among autograft in adults, 0% to 11.1% (1.4%, 18/1,260); among autograft in adolescents, 0% to 20% (10.0%, 8/80); among allograft, 0% (0/65 cases); and among synthetic, 0% to 3.3% (1.3%, 1/76). Among autograft choices in adults, rates of recurrent instability were low; recurrence with gracilis ranged from 0% to 11.1% (0.9%, 1/116); with semitendinosus, 0% to 6.3% (0.6%, 4/676); with quad or patellar tendon, 0% (0/65); and with adductor tendon, 5.6% to 8.3% (6.7%, 2/30). Complication rates ranged from 0% to 34.4%. All included studies reported significant improvement in Kujala scores after surgery (P < .01). There was significant heterogeneity in effect size and evidence of reporting bias among small studies, precluding reliable pooled analysis of treatment effect. CONCLUSIONS Autograft is not superior to allograft or synthetic grafts for isolated reconstruction of the MPFL, and rates of recurrent instability are generally low. Isolated MPFL reconstruction can provide significant symptom relief regardless of graft selection, although there is a bias toward reporting better than expected results among smaller studies. Pediatric patients and patients treated with adductor tendon autograft have higher recurrent instability rates. While caution should be used in making definitive recommendations secondary to the small number of allograft and synthetic studies, selection of graft type based on surgeon preference, comfort, and prior experience remains appropriate. LEVEL OF EVIDENCE Level IV, systematic review of Level I to IV studies.
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Affiliation(s)
- Ryan J McNeilan
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Joshua S Everhart
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Patrick K Mescher
- College of Medicine, The Ohio State University, Columbus, Ohio, U.S.A
| | - Moneer Abouljoud
- College of Medicine, The Ohio State University, Columbus, Ohio, U.S.A
| | - Robert A Magnussen
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - David C Flanigan
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A.; Cartilage Restoration Program, The Ohio State University, Columbus, Ohio, U.S.A..
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17
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Li X, Fu Z, Lü C. [Arthroscopic treatment for patellar dislocation with lateral retinacular release combined with medial patellofemoral ligament reconstruction]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:169-173. [PMID: 29806406 DOI: 10.7507/1002-1892.201711050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the effectiveness of the arthroscopic lateral retinacular release combined with medial patellofemoral ligament (MPFL) reconstruction for patellar dislocation. Methods Between January 2016 and March 2017, 28 cases (32 knees) with patellar dislocation were treated by arthroscopic lateral retinacular release and MPFL reconstruction. There were 6 males (6 knees) and 22 females (26 knees) with an average age of 21 years (range, 17-29 years). The disease duration ranged from 2 days to 2 years (mean, 8 months). Apprehension test of all patients were positive. The preoperative Lysholm score was 68.34±12.26. Anteroposterior X-ray film showed the patellar subluxation or dislocation. The Q angle was (17.67±4.21)° and the distance of tibia tuberosity-trochlear groove was less than 20 mm. The femoral attachment of retinacular were fixed by the interference screws (16 knee) or the anchors (16 knee), respectively. Results All incisions healed by first intention. All patients were followed up 6 months. The function of knee joint was significantly improved at 6 months after operation. The Lysholm score was 92.88±6.42 and the Q angle was (12.15±3.68)° at 6 months. There were significant differences in the Lysholm score and the Q angle between pre- and post-operation ( t=-3.408, P=0.006; t=-2.317, P=0.004). Apprehension test of all patients were negative. No knee pain, knee weakness, and patellar dislocation occurred during follow-up. There was no significant difference in the Lysholm score and the Q Angle between the anchor group and interference screw group ( t=-3.254, P=0.820; t=-3.576, P=0.940). Conclusion Lateral retinacular release combined with MPFL reconstruction under arthroscopy can effectively improve the function of the knee joint for patients with Q angle less than 20° and TT-TG less than 20 mm, and the early effectiveness is good. There is no significant difference in knee function between the anchor and interference screw internal fixation.
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Affiliation(s)
- Xiaojian Li
- Department of Orthopedics, No.3 Hospital of Xi'an,
| | - Zhanli Fu
- Department of Orthopedics, No.3 Hospital of Xi'an, P.R.China
| | - Changwei Lü
- Department of Orthopedics, No.3 Hospital of Xi'an, P.R.China
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Smeets K, Slane J, Scheys L, Claes S, Bellemans J. Mechanical Analysis of Extra-Articular Knee Ligaments. Part One: Native knee ligaments. Knee 2017; 24:949-956. [PMID: 28784565 DOI: 10.1016/j.knee.2017.07.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 06/15/2017] [Accepted: 07/20/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND The aim of this study was to provide a characterization of the tensile properties of the medial collateral ligament (MCL), lateral collateral ligament (LCL), anterolateral ligament (ALL) and medial patellofemoral ligament (MPFL). Our hypothesis was that extra-articular knee ligaments are heterogeneous in nature and possess distinct material properties. METHODS MCL (n=12), LCL (n=11), MPFL (n=12) and ALL (n=19) samples from fresh frozen human cadaveric knees were subjected to uniaxial tensile testing to failure and analyzed for their material properties. The elastic modulus (slope of the linear portion of the stress/strain curve), ultimate stress (stress at failure), ultimate strain (strain at failure) and strain energy density (area under the stress/strain curve) were calculated. RESULTS The MCL had the highest elastic modulus (441.8±117.2MPa) and was significantly greater than the MPFL (294.6±190.4MPa) and LCL (289.0±159.7MPa) (P<0.05) as well as the ALL (173.7±91.8MPa) (P<0.001). The ultimate stress was significantly higher (P<0.05) for the LCL (83.6±38.1MPa) and MCL (72.4±20.7MPa), relative to the MPFL (49.1±31.0MPa) and ALL (46.4±20.1MPa). The ultimate strain of the LCL (41.0±9.9%) and ALL (37.8±7.9%) were significantly higher (P<0.05) compared to the MCL (22.9±2.5%) and MPFL (22.2±5.6%). The strain energy density of the LCL (15.2±6.4MPa) was significantly greater (P<0.05) than all other ligaments (ALL 7.8±3.1MPa, MCL 7.5±2.9MPa and MPFL 5.0±2.9MPa). CONCLUSIONS Extra-articular knee ligaments are a heterogeneous group with respect to material characteristics. Each ligament has tensile properties that are significantly different from others and treatment strategies should take these findings into account.
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Affiliation(s)
- Kristof Smeets
- Doctoral School for Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium; Department of Orthopedic Surgery, Ziekenhuis Oost-Limburg, Genk, Belgium.
| | - Joshua Slane
- Institute for Orthopaedic Research and Training, Division of Orthopaedics, University Hospitals Leuven/Department of Development and Regenartion, Faculty of Medicine, KULeuven, Leuven, Belgium
| | - Lennart Scheys
- Institute for Orthopaedic Research and Training, Division of Orthopaedics, University Hospitals Leuven/Department of Development and Regenartion, Faculty of Medicine, KULeuven, Leuven, Belgium
| | - Steven Claes
- Department of Orthopedic Surgery, AZ Herentals Hospital, Herentals, Belgium; Department of Orthopedic Surgery, University Hospitals Leuven, Pellenberg, Belgium
| | - Johan Bellemans
- Department of Orthopedic Surgery, Ziekenhuis Oost-Limburg, Genk, Belgium; Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
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