A 2-year follow-up of isolated Medial Patellofemoral Ligament Reconstruction by using soft suture anchor and adjustable cortical fixation system

Minimally Invasive Medial Patellofemoral Ligament Reconstruction With Patellar-Sided Tensioning Using All-Suture Anchors

Medial patellofemoral ligament (MPFL) reconstruction is a commonly performed procedure to reestablish the checkrein to the lateral patellar translation in patients with recurrent patellofemoral instability. Graft tensioning is one of the most critical aspects of the procedure. Most surgical methods for MPFL reconstruction involve tensioning and securing the graft on the femoral side. In this article, we describe a technique for patellar-sided tensioning of the graft using all-suture anchors, which provides the surgeon with the ability to finely control graft tension with two independent graft limbs, while preserving patellar bone stock.

Is the patella apprehension test a valid diagnostic test for patellar instability? A systematic review

Introduction

Patellar instability can arise from a traumatic event with anatomical predisposing factors increasing the risk of dislocation. Accurate diagnosis is required to initiate appropriate treatment. We aimed to evaluate the patella apprehension test (PAT) as a method to diagnose patellar instability.

Methods

The PRISMA diagnostic test accuracy checklist was followed. The review protocol was registered on PROSPERO with registration number CRD42022357898. Electronic databases, currently registered studies, conference proceedings and the reference lists of included studies were searched. A narrative synthesis evaluated the validity of the PAT as a method of diagnosing patellar instability.

Results

A total of 4867 records were screened in the initial search. Of these, 34 articles satisfied the inclusion criteria, assessing 1139 knees of 1046 patients. The PAT was found to have a high sensitivity and specificity. Its intra and inter-rater reliability was highly variable among studies. Studies reporting patellar instability correction following surgery also found a decrease in the number of patients exhibiting a positive PAT.

Conclusion

Current evidence suggests that the PAT has a high sensitivity and specificity. The intra- and inter-rater validities of the PAT are widely variable due to its subjective nature. Thus, though the PAT can be used to provide a provisional clinical diagnosis of patellar instability, formal functional assessment and imaging should be performed to confirm the diagnosis. Further research should explore the association between a positive PAT and anatomical parameters. In addition, studies comparing the accuracy of the PAT and radiological investigations should be performed.

Medial Patellofemoral Ligament Reconstruction and Lateral Retinacular Lengthening from a Lateral Approach

The medial patellofemoral ligament (MPFL) is frequently torn and attenuated in patients with acute or chronic patellar instability. The mainstay for surgical treatment has become MPFL reconstruction to reestablish the checkrein to lateral patellar translation. The authors describe a technique for MPFL reconstruction with concomitant lateral retinacular lengthening with a gracilis allograft and adjustable loop cortical femoral fixation performed chiefly from a lateral parapatellar approach. This technique allows for reliable retensioning of the medial and lateral patellar soft tissues while avoiding complications associated with techniques that use interference screw fixation. Successful execution of this procedure provides a strong MPFL construct that allows patients to undergo early aggressive rehabilitation and return to activities.