No Difference in Outcome Between Femoral Soft-Tissue and Screw Graft Fixation for Reconstruction of the Medial Patellofemoral Ligament: A Randomized Controlled Trial

Autor: Bjarne Mygind-Klavsen, Torsten Toftegaard Nielsen, Ole Gade Sørensen, Peter Faunø, Martin Lind, Lene Lindberg Miller
Rok vydání: 2019
Předmět:
Joint Instability
Adult
Male
musculoskeletal diseases
medicine.medical_specialty
Adolescent
Patellar Dislocation
Bone Screws
Osteoarthritis
Patellofemoral Joint/surgery
Medial patellofemoral ligament
Tendons/transplantation
Single Center
Palpation
law.invention
Tendons
Patellofemoral Joint
Ligaments
Articular/surgery
Young Adult
03 medical and health sciences
0302 clinical medicine
Randomized controlled trial
law
Humans
Medicine
Orthopedics and Sports Medicine
Prospective Studies
Autografts
Prospective cohort study
Fixation (histology)
Patellar Dislocation/surgery
030222 orthopedics
Sutures
medicine.diagnostic_test
business.industry
Soft tissue
030229 sport sciences
Middle Aged
musculoskeletal system
medicine.disease
Surgery
medicine.anatomical_structure
Ligaments
Articular
Female
Joint Instability/surgery
business
Zdroj: Lind, M, Nielsen, T, Miller, L, Sørensen, O G, Mygind-Klavsen, B & Faunø, P 2019, ' No Difference in Outcome Between Femoral Soft-Tissue and Screw Graft Fixation for Reconstruction of the Medial Patellofemoral Ligament : A Randomized Controlled Trial ', Arthroscopy: The Journal of Arthroscopy and Related Surgery, vol. 35, no. 4, pp. 1130-1137 . https://doi.org/10.1016/j.arthro.2018.11.051
Lind, M, Nielsen, T G, Miller, L, Sørensen, O G, Mygind-Klavsen, B & Faunø, P 2019, ' No Difference in Outcome Between Femoral Soft-Tissue and Screw Graft Fixation for Reconstruction of the Medial Patellofemoral Ligament : A Randomized Controlled Trial ', Arthroscopy-Journal of Arthroscopic and Related Surgery, vol. 35, no. 4, pp. 1130-1137 . https://doi.org/10.1016/j.arthro.2018.11.051
ISSN: 0749-8063
DOI: 10.1016/j.arthro.2018.11.051
Popis: PURPOSE: The aim of the present randomized controlled trial was to compare 2 different medial patellofemoral ligament reconstruction (MPFL-R) techniques that utilize different femoral fixation principles, which could affect subjective clinical outcomes and surgical morbidity.METHODS: Sixty patients were randomly assigned to 2 MPFL-R techniques: bone or soft-tissue fixation of the graft at the femoral condyle. Patients had operations performed between 2010 and 2015 at a single center. Indication for surgery was 2 or more patellar dislocations. When the bone fixation technique was used, the gracilis tendon was fixed with the use of an interference screw. When the soft-tissue fixation technique was used, the gracilis tendon was looped around the adductor magnus tendon. Both techniques used patella-graft fixation with drill holes in the medial patellar edge. Clinical outcomes were evaluated by means of Kujala, knee injury and osteoarthritis outcome, and pain scores before the operation and at 1- and 2-year follow-up examinations. Surgical morbidity was evaluated by pain on palpation along the reconstruction site.RESULTS: Kujala scores were 88 and 89 for bone and soft-tissue fixation groups, respectively, with no difference between groups (P = .73). No significant differences in knee injury osteoarthritis outcome or pain scores were found. Analysis of surgical morbidity, defined as femoral-based tenderness overlying the fixation site, demonstrated that 13% and 12% of patients had significant tenderness at the reconstruction site after bone and soft-tissue MPFL-R, respectively. No patellar re-dislocations were observed in either group.CONCLUSIONS: MPFL-R with soft-tissue graft fixation at the femoral condyles resulted in findings for subjective clinical outcome, patellar stability, and pain level similar to those associated with MPFL-R with bone fixation. Surgical morbidity was also similar between patients who had soft-tissue and those who had bone fixation MPFL-R. Soft-tissue femoral graft fixation does not result in inferior clinical outcomes compared with screw fixation, and it can be used safely for MPFL-R.
Databáze: OpenAIRE
Externí odkaz: