A 'sandwich' method of reconstruction of the medial patellofemoral ligament using a titanium interference screw for patellar instability in skeletally immature patients

Autor: Taku Tadenuma, Masaru Kadowaki, Suguru Kuwata, Yuji Uchio, Nobuyuki Kumahashi
Rok vydání: 2012
Předmět:
Zdroj: Archives of Orthopaedic and Trauma Surgery. 132:1077-1083
ISSN: 1434-3916
0936-8051
DOI: 10.1007/s00402-012-1516-5
Popis: No standard surgical procedure for medial patellofemoral ligament (MPFL) reconstruction exists in skeletally immature patients with patellar instability. This study aimed to evaluate the clinical effectiveness of a novel reconstruction technique for the MPFL in patients with patellar instability because of non-closure of the epiphyseal line. The “sandwich” method was fixation of the patella between a double-stranded semitendinosus tendon through the posterior third of the femoral insertion of the medial collateral ligament (MCL) as a pulley with a titanium interference screw in a single patellar tunnel. Five knees in five patients were studied: four with recurrent and one with habitual patellar dislocations. Subjects underwent MPFL reconstruction with or without lateral release. Patients were evaluated using pre-operative and post-operative physical and radiographic examinations, including apprehension testing, assessment of tilting and congruence angles, medial and lateral shift ratios under stress measured using X-ray imaging, and Kujala and Lysholm scores. No patient experienced recurrent post-operative episodes of dislocation or subluxation. By the final follow-up, patellar apprehension had disappeared in all patients. In addition, all patients showed significant improvement in the following: tilting angle, congruence angle, lateral shift ratio, Kujala score, and Lysholm score. The MPFL reconstruction methods, using a double-stranded semitendinosus autograft and sparing the femoral physeal line in non-closure of the epiphyseal line, provide acceptable short-term results for the treatment of patellar instability.
Databáze: OpenAIRE
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