Skip to main content
SpringerLink
Log in

Clinical outcome after reconstruction of the medial patellofemoral ligament in patients with recurrent patella instability

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

We present the clinical results of a large consecutive, prospective, single-clinic series of patients treated with medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability.

Methods

The study included 224 patients undergoing MPFL reconstruction in a total of 240 knees between 2008 and 2011. Indication for surgery was two or more patellar dislocations and ADL limitations due to patella instability. Surgical procedure: A gracilis tendon autograft was fixed in drill holes in the medial edge of the patella and with screws at the femoral MPFL insertion point. Outcomes were evaluated with the Kujala Anterior Knee Pain Score and pain scores preoperatively and at follow-up (12–60 months). Furthermore, incidences of re-dislocations, subluxations and revision surgery were evaluated.

Results

The Kujala score improved from 62.5 (17) to 80.4 (18) (p < 0.001) at the 1-year follow-up. Pain during activity improved from 3.2 (2.6) to 1.3 (2.7) at 1 year (p < 0.001). The revision rate was 2.8 %. Some degree of pain at the medial femoral condyle was seen in 30 % of the patients. The reconstruction was supplemented with a tibial tuberosity osteotomy in 23 % of cases. The outcome for these patients did not differ from that of patients with isolated MPFL reconstruction. Female gender BMI >30, age >30 years and grade 3–4 cartilage injury predisposed a poor subjective outcome.

Conclusions

The present study is the largest MPFL reconstruction patient material reported to date. MPFL reconstruction with a gracilis tendon autograft consistently normalised the patella stability and improved knee function. Moderate medial pain was seen. Age above 30, obesity, cartilage injury and female gender are predictors of a poor subjective outcome.

Level of evidence

Level IV.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Amis AA, Firer P, Mountney J, Senavongse W, Thomas NP (2003) Anatomy and biomechanics of the medial patellofemoral ligament. Knee 10:215–220

    Article  PubMed  CAS  Google Scholar 

  2. Balcarek P, Jung K, Ammon J, Walde TA, Frosch S, Schuttrumpf JP, Sturmer KM, Frosch KH (2010) Anatomy of lateral patellar instability: trochlear dysplasia and tibial tubercle-trochlear groove distance is more pronounced in women who dislocate the patella. Am J Sports Med 38:2320–2327

    Article  PubMed  Google Scholar 

  3. Balcarek P, Jung K, Frosch KH, Sturmer KM (2011) Value of the tibial tuberosity-trochlear groove distance in patellar instability in the young athlete. Am J Sports Med 39:1756–1761

    Article  PubMed  Google Scholar 

  4. Blond L, Haugegaard M (2013) Combined arthroscopic deepening trochleoplasty and reconstruction of the medial patellofemoral ligament for patients with recurrent patella dislocation and trochlear dysplasia. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-013-2422-2

  5. Buckens CF, Saris DB (2010) Reconstruction of the medial patellofemoral ligament for treatment of patellofemoral instability: a systematic review. Am J Sports Med 38:181–188

    Article  PubMed  Google Scholar 

  6. Caton JH, Dejour D (2010) Tibial tubercle osteotomy in patello-femoral instability and in patellar height abnormality. Int Orthop 34:305–309

    Article  PubMed  PubMed Central  Google Scholar 

  7. Christiansen SE, Jacobsen BW, Lund B, Lind M (2008) Reconstruction of the medial patellofemoral ligament with gracilis tendon autograft in transverse patellar drill holes. Arthroscopy 24:82–87

    Article  PubMed  Google Scholar 

  8. Colvin AC, West RV (2008) Patellar instability. J Bone Joint Surg Am 90:2751–2762

    Article  PubMed  Google Scholar 

  9. Deie M, Ochi M, Sumen Y, Yasumoto M, Kobayashi K, Kimura H (2003) Reconstruction of the medial patellofemoral ligament for the treatment of habitual or recurrent dislocation of the patella in children. J Bone Joint Surg Br 85:887–890

    PubMed  CAS  Google Scholar 

  10. Dejour D, Le Coultre B (2007) Osteotomies in patello-femoral instabilities. Sports Med Arthrosc 15:39–46

    Article  PubMed  Google Scholar 

  11. Dejour D, Saggin P (2010) The sulcus deepening trochleoplasty-the Lyon’s procedure. Int Orthop 34:311–316

    Article  PubMed  PubMed Central  Google Scholar 

  12. Dejour H, Walch G, Nove-Josserand L, Guier C (1994) Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 2:19–26

    Article  PubMed  CAS  Google Scholar 

  13. Fernandez E, Sala D, Castejon M (2005) Reconstruction of the medial patellofemoral ligament for patellar instability using a semitendinosus autograft. Acta Orthop Belg 71:303–308

    PubMed  Google Scholar 

  14. Filardo G, Kon E, Andriolo L, Vannini F, Buda R, Ferruzzi A, Giannini S, Marcacci M (2013) Does patient sex influence cartilage surgery outcome? Analysis of results at 5-year follow-up in a large cohort of patients treated with Matrix-assisted autologous chondrocyte transplantation. Am J Sports Med 41:1827–1834

    Article  PubMed  Google Scholar 

  15. Fisher B, Nyland J, Brand E, Curtin B (2010) Medial patellofemoral ligament reconstruction for recurrent patellar dislocation: a systematic review including rehabilitation and return-to-sports efficacy. Arthroscopy 26:1384–1394

    Article  PubMed  Google Scholar 

  16. Fithian DC, Paxton EW, Stone ML, Silva P, Davis DK, Elias DA, White LM (2004) Epidemiology and natural history of acute patellar dislocation. Am J Sports Med 32:1114–1121

    Article  PubMed  Google Scholar 

  17. Fulkerson JP (1983) Anteromedialization of the tibial tuberosity for patellofemoral malalignment. Clin Orthop Relat Res 176-181

  18. Goutallier D, Bernageau J, Lecudonnec B (1978) The measurement of the tibial tuberosity. Patella groove distanced technique and results (author’s transl). Rev Chir Orthop Reparatrice Appar Mot 64:423–428

    PubMed  CAS  Google Scholar 

  19. Howells NR, Barnett AJ, Ahearn N, Ansari A, Eldridge JD (2012) Medial patellofemoral ligament reconstruction: a prospective outcome assessment of a large single centre series. J Bone Joint Surg Br 94:1202–1208

    Article  PubMed  CAS  Google Scholar 

  20. Insall J, Salvati E (1971) Patella position in the normal knee joint. Radiology 101:101–104

    Article  PubMed  CAS  Google Scholar 

  21. Kujala UM, Jaakkola LH, Koskinen SK, Taimela S, Hurme M, Nelimarkka O (1993) Scoring of patellofemoral disorders. Arthroscopy 9:159–163

    Article  PubMed  CAS  Google Scholar 

  22. Lind M, Jakobsen BW, Lund B, Christiansen SE (2008) Reconstruction of the medial patellofemoral ligament for treatment of patellar instability. Acta Orthop 79:354–360

    Article  PubMed  Google Scholar 

  23. Ma LF, Wang F, Chen BC, Wang CH, Zhou JW, Wang HY (2013) Medial retinaculum plasty versus medial patellofemoral ligament reconstruction for recurrent patellar instability in adults: a randomized controlled trial. Arthroscopy 29:891–897

    Article  PubMed  Google Scholar 

  24. Mulford JS, Wakeley CJ, Eldridge JD (2007) Assessment and management of chronic patellofemoral instability. J Bone Joint Surg Br 89:709–716

    Article  PubMed  CAS  Google Scholar 

  25. Nietosvaara Y, Aalto K, Kallio PE (1994) Acute patellar dislocation in children: incidence and associated osteochondral fractures. J Pediatr Orthop 14:513–515

    Article  PubMed  CAS  Google Scholar 

  26. Panni AS, Vasso M, Cerciello S (2013) Acute patellar dislocation. What to do? Knee Surg Sports Traumatol Arthrosc 21:275–278

    Article  PubMed  Google Scholar 

  27. Schepsis AA, Rogers AJ (2012) Medial patellofemoral ligament reconstruction: indications and technique. Sports Med Arthrosc 20:162–170

    Article  PubMed  Google Scholar 

  28. Schottle PB, Fucentese SF, Pfirrmann C, Bereiter H, Romero J (2005) Trochleaplasty for patellar instability due to trochlear dysplasia: a minimum 2-year clinical and radiological follow-up of 19 knees. Acta Orthop 76:693–698

    Article  PubMed  Google Scholar 

  29. Schottle PB, Hensler D, Imhoff AB (2010) Anatomical double-bundle MPFL reconstruction with an aperture fixation. Knee Surg Sports Traumatol Arthrosc 18:147–151

    Article  PubMed  Google Scholar 

  30. Sherman SL, Erickson BJ, Cvetanovich GL, Chalmers PN, Farr J, 2nd, Bach BR, Jr., Cole BJ (2013) Tibial Tuberosity Osteotomy: Indications, Techniques, and Outcomes. Am J Sports Med. doi:10.1177/0363546513507423

  31. Smith TO, Walker J, Russell N (2007) Outcomes of medial patellofemoral ligament reconstruction for patellar instability: a systematic review. Knee Surg Sports Traumatol Arthrosc 15:1301–1314

    Article  PubMed  Google Scholar 

  32. Steensen RN, Dopirak RM, McDonald WG 3rd (2004) The anatomy and isometry of the medial patellofemoral ligament: implications for reconstruction. Am J Sports Med 32:1509–1513

    Article  PubMed  Google Scholar 

  33. Tecklenburg K, Feller JA, Whitehead TS, Webster KE, Elzarka A (2010) Outcome of surgery for recurrent patellar dislocation based on the distance of the tibial tuberosity to the trochlear groove. J Bone Joint Surg Br 92:1376–1380

    Article  PubMed  CAS  Google Scholar 

  34. Thaunat M, Erasmus PJ (2007) The favourable ansiometry: an original concept for medial patellofemoral ligament reconstruction. Knee 14:424–428

    Article  PubMed  Google Scholar 

  35. Wagner D, Pfalzer F, Hingelbaum S, Huth J, Mauch F, Bauer G (2013) The influence of risk factors on clinical outcomes following anatomical medial patellofemoral ligament (MPFL) reconstruction using the gracilis tendon. Knee Surg Sports Traumatol Arthrosc 21:318–324

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Sports Trauma, Orthopaedic Department, Aarhus University Hospital, Tage Hansens Gade 2, 8000, Aarhus C, Denmark

    Ditte Enderlein, Torsten Nielsen, Svend Erik Christiansen, Peter Faunø & Martin Lind

Authors
  1. Ditte Enderlein
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Torsten Nielsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Svend Erik Christiansen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Peter Faunø
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Martin Lind
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Martin Lind.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Enderlein, D., Nielsen, T., Christiansen, S.E. et al. Clinical outcome after reconstruction of the medial patellofemoral ligament in patients with recurrent patella instability. Knee Surg Sports Traumatol Arthrosc 22, 2458–2464 (2014). https://doi.org/10.1007/s00167-014-3164-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-014-3164-5

Keywords

Search

Navigation