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Dasril DF, Randy, Hadi IAN, Guntara A. Minimal invasive medial patellofemoral ligament reconstruction using quadriceps tendon with de novo technique and arthroscopic guided: A case report. Int J Surg Case Rep 2024; 122:110144. [PMID: 39128217 DOI: 10.1016/j.ijscr.2024.110144] [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: 05/23/2024] [Revised: 08/03/2024] [Accepted: 08/08/2024] [Indexed: 08/13/2024] Open
Abstract
INTRODUCTION Medial Patellofemoral ligament (MPFL) reconstruction, the primary procedure for restoring patellar stability and preventing further dislocation, has seen numerous methods and grafts. However, a consensus on the technique and graft remains elusive. This study introduces a novel approach to MPFL reconstruction, utilizing a unique combination of minimal invasiveness, de novo method, and arthroscopic guidance to harvest a quadriceps tendon (QT) graft without the need for a harvesting tool. CASE ILLUSTRATION A 37-year-old female presented to the emergency room with the chief complaints of left knee pain and swelling following the third spontaneous dislocation of the patella. The patient had a few episodes of locking sensation and instability of the left knee while walking, especially while climbing stairs. A knee MRI revealed MPFL tear in the left knee. A modified minimal invasive MPFL reconstruction technique was performed. The IKDC, Lysholm, and Modified Cincinnati scores improved significantly from preoperatively 48.3 %, 49 %, and 51 % to 89.7 %, 90 %, and 95 % consecutively. No recurrent patellar dislocations or swelling were reported during follow-up. DISCUSSION While quadriceps graft harvesting for MPFL reconstruction is typically highly invasive, using quadriceps tendons has consistently shown excellent outcomes. This study, however, takes it a step further by demonstrating that a minimally invasive procedure for harvesting quadriceps tendons, even without specialized instrumentation, can also yield excellent results. CONCLUSION MPFL reconstruction using superficial quadriceps tendon autograft can be achieved using a minimally invasive technique without the use of specialized instrumentation and has shown excellent knee functional improvement.
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Affiliation(s)
- Demy Faheem Dasril
- Sport and Arthroscopy Division, Department of Orthopaedic and Traumatology, Mayapada Hospital Kuningan, Jakarta, Indonesia
| | - Randy
- General Practitioner, Orthopaedic Intern, Department of Orthopaedic and Traumatology, Mayapada Hospital Kuningan, Jakarta, Indonesia.
| | - Ivana Ariella Nita Hadi
- General Practitioner, Orthopaedic Intern, Department of Orthopaedic and Traumatology, Mayapada Hospital Kuningan, Jakarta, Indonesia
| | - Aswin Guntara
- General Practitioner, Orthopaedic Intern, Department of Orthopaedic and Traumatology, Mayapada Hospital Kuningan, Jakarta, Indonesia
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Runer A, Klotz S, Schneider F, Egelseer T, Csapo R, Hoser C, Abermann E, Mayr R, Raas C, Attal R, Arora R, Fink C, Liebensteiner M. Medial Patellofemoral Ligament Reconstruction Using Pedicled Quadriceps Tendon Autograft Yields Similar Clinical and Patient-Reported Outcomes but Less Donor-Site Morbidity Compared With Gracilis Tendon Autograft. Arthroscopy 2024; 40:438-445. [PMID: 37479150 DOI: 10.1016/j.arthro.2023.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 06/23/2023] [Accepted: 07/01/2023] [Indexed: 07/23/2023]
Abstract
PURPOSE To compare clinical and patient-reported outcome measures (PROMs) in patients with recurrent patellar dislocation after medial patellofemoral ligament (MPFL) reconstruction using either a gracilis tendon (GT) or quadriceps tendon autograft (QT). METHODS All MPFL reconstruction performed between 2017 and 2019 were reviewed retrospectively. Only patients with isolated MPFL reconstruction, without any major patellofemoral risk factors and a minimum follow-up of 24 months, were included in the study. Patients were matched with respect to sex, age, and body mass index. All patients were evaluated clinically and using PROMs. RESULTS A total of 64 patients with an average follow up of 28.7 ± 7.5 months were included in this study. The mean Kujala score (GT: 84.8 ± 12.9, QT: 88.9 ± 10.1), Lysholm score (GT: 89.4 ± 10.2, QT: 88.4 ± 5.0), and visual analog scale score for pain (GT: 1.9 ± 1.8, QT: 1.1 ± 1.3) did not significantly differ between both groups. Tegner activity level was significantly greater (P = .027) in the QT group (5.5 ± 1.9) compared with the GT group (4.6 ± 1.8), but within the minimal clinically important differences. Occasional patellar instability events, but no recurrent dislocation, were reported in 12.5% in the GT group and 6.3% in the QT group (P = .39). Of all patients, 90.6% in the QT and 68.8% in the HT group exceeded the PASS for the Kujala score (P = .06). Significantly more patients (59.4%) treated with GT reported donor-site morbidity in the form of sensitivity deficit at the lower leg compared with those treated with QT (3.1%, P = .001). CONCLUSIONS GT and QT MPFL reconstruction have comparable PROMs and patellar redislocation rates 2 years' postoperatively. Significantly more patients treated with GT reported lower-leg sensitivity deficit compared with those treated with QT. LEVEL OF EVIDENCE Level III, retrospective case-control study.
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Affiliation(s)
- Armin Runer
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria; Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
| | - Stefan Klotz
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Friedemann Schneider
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Tim Egelseer
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Robert Csapo
- Gelenkpunkt - Sports and Joint Surgery, Innsbruck, Austria; Centre for Sport Science and University Sports, University of Vienna, Vienna, Austria
| | - Christin Hoser
- Gelenkpunkt - Sports and Joint Surgery, Innsbruck, Austria; Private University for Health Sciences, Medical Informatics and Technology (UMIT), ISAG, Research Unit for Orthopaedic Sports Medicine and Injury Prevention, Hall in Tirol, Austria
| | | | - Raul Mayr
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Christoph Raas
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Rene Attal
- Department of Trauma Surgery and Sports Traumatology, Academic Hospital Feldkirch, LKH Feldkirch, Austria
| | - Rohit Arora
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Christian Fink
- Gelenkpunkt - Sports and Joint Surgery, Innsbruck, Austria; Private University for Health Sciences, Medical Informatics and Technology (UMIT), ISAG, Research Unit for Orthopaedic Sports Medicine and Injury Prevention, Hall in Tirol, Austria
| | - Michael Liebensteiner
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria; Orthopädie Knie & Fuß im Zentrum, Innsbruck, Austria
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Lubis AMT, Menkher MAR, Setyawan R. Medial patellofemoral ligament reconstruction using superficial layer of quadriceps tendon autograft: A case series of three patients. INTERNATIONAL JOURNAL OF SURGERY OPEN 2022. [DOI: 10.1016/j.ijso.2022.100482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Olotu O, Siddiqui A, Peterson D, de Sa D. The Superficial "Swing-Down" Quadriceps Tendon Autograft Is a Viable Option for Medial Patellofemoral Ligament Reconstruction: A Systematic Review. Arthroscopy 2021; 37:3187-3197. [PMID: 33961979 DOI: 10.1016/j.arthro.2021.04.048] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 04/06/2021] [Accepted: 04/12/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this systematic review is to ascertain the reported clinical outcomes and complication profiles of medial patellofemoral ligament (MPFL) reconstruction performed using a superficial "swing-down" quadriceps tendon autograft. METHODS Three databases (PubMed, EMBASE, and MEDLINE) were searched from January 1, 2000, to April 06, 2020. Keywords used in the search included: "medial patellofemoral ligament" and "reconstruction". After screening based on inclusion and exclusion criteria, patient demographics, graft type, outcomes, and complications were extracted. Methodological Index for Non-Randomized Studies criteria were used to assess the quality of each included study. RESULTS Eleven studies were included, comprising data from 226 patients with mean follow up ranging from 12 to 38 months. All reconstructions used a superficial "swing-down" quadriceps tendon autograft fixed at 20-30 degrees of knee flexion where reported. Eight of eleven studies reported significant improvement in patient reported outcomes such as Kujala score, Lysholm score, and Tegner score. The mean preoperative Kujala score ranged from 35.8 to 82.1 (167 patients), while the mean postoperative Kujala score ranged from 88.4 to 94.8 (197 patients). The mean of the preoperative Lysholm score ranged from 43.3 to 79.3 (77 patients), while the mean of the postoperative Lysholm score ranged from 81.9 to 90.9 (99 patients). The I2 statistic for Lysholm and Kujala scores was 94% and 97%, respectively. Across data reported on 194 patients, there was no incidence of patellar redislocation, patellar fracture, or graft site morbidity. CONCLUSION The quadriceps tendon produced improved clinical outcomes with low rates of recurrent postoperative patellar dislocation. These data suggest that the quadriceps tendon remains a suitable alternative for MPFL reconstruction and should remain part of the arsenal of knee ligament surgeons. LEVEL OF EVIDENCE Systematic review of Level III and IV studies.
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Affiliation(s)
- Olumide Olotu
- MACSports Research Program, McMaster University, Hamilton, Ontario, Canada; School of Medicine, St. George's University, True Blue, Grenada, West Indies
| | - Ali Siddiqui
- MACSports Research Program, McMaster University, Hamilton, Ontario, Canada
| | - Devin Peterson
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Darren de Sa
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada.
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Migliorini F, Trivellas A, Eschweiler J, Betsch M, Tingart M, Maffulli N. Pedicled Strip of Quadriceps Tendon Graft for Primary Medial Patellofemoral Ligament Reconstruction in Recurrent Patellofemoral Instability: A Systematic Review. Arthroscopy 2021; 37:1992-1999. [PMID: 33539974 DOI: 10.1016/j.arthro.2021.01.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 01/10/2021] [Accepted: 01/15/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE A systematic review of the literature was conducted to ascertain advantages and limitations, update current evidences, and investigate the role of a pedicled quadriceps tendon autograft for primary medio-patellofemoral ligament (MPFL) reconstruction in patients with recurrent patellofemoral instability. METHODS The present systematic review was performed according to the PRISMA guidelines. The literature search was conducted in September 2020. All the clinical studies investigating the role of a pedicled strip of quadriceps tendon autograft for primary MPFL reconstruction in patients with recurrent patellofemoral instability were considered for inclusion. Studies investigating the role of MPFL reconstruction combined with additional surgical procedures except for lateral retinacular release were excluded. The methodological quality assessment was performed through the modified Coleman Methodology score. RESULTS Data from 9 articles (191 procedures) were retrieved. The mean follow-up was 12 to 38 months. The mean age of the patients was 11.5 to 25.2 years. One hundred twenty of 191 patients were female. All clinical scores showed significant improvement following the procedures. The Kujala score improved of 32.52% points (P < 0.0001), the Lysholm score of 23.74% (P = 0.006), the Tegner scale improved of 8.6% (P = 0.02). Concerning complications, after surgery the apprehension test was positive in 5 of 166 patients, and persistent joint instability was found in 5 of 149 patients. No patient experienced any re-dislocations or underwent reoperations. CONCLUSIONS The use of pedicled strip of quadriceps tendon as graft for MPFL reconstruction is a suitable choice in patients with recurrent patellar instability. Although frequently associated with a lateral release, it is unclear whether the latter is necessary for the success of the technique. Appropriately powered randomized controlled trials comparing this graft source to the others commonly used are necessary to at least ascertain the noninferiority of this graft to the others. LEVEL OF EVIDENCE IV, Systematic review of Level III-IV studies.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedics, RWTH Aachen University Clinic, Aachen, Germany
| | - Andromahi Trivellas
- Department of Orthopaedics, David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A
| | - Jörg Eschweiler
- Department of Orthopaedics, RWTH Aachen University Clinic, Aachen, Germany
| | - Marcel Betsch
- University of Toronto Orthopaedic Sports Medicine Program (UTOSM), Womenás College Hospital, Toronto, Canada
| | - Markus Tingart
- Department of Orthopaedics, RWTH Aachen University Clinic, Aachen, Germany
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy; School of Pharmacy and Bioengineering, Keele University School of Medicine, Stoke on Trent, England; Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, London, England.
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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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