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The presence of a preoperative high-grade J-sign and femoral tunnel malposition are associated with residual graft laxity after MPFL reconstruction

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study was to analyse the risk factors associated with residual graft laxity after medial patellofemoral ligament reconstruction (MPFL-R) in patients with recurrent patellar dislocation (RPD).

Methods

A total of 312 consecutive patients (354 knees) with clinically diagnosed RPD who underwent MPFL-R from 2011 to 2015 were retrospectively analysed. Postoperative MPFL graft stability was assessed with patellofemoral stress radiography, and if the patellar central ridge surpassed the apex of the lateral femoral trochlea, the reconstructed MPFL was defined as having residual graft laxity. Finally, 15 patients who exhibited MPFL residual graft laxity (study group) were matched in a 1:2 fashion to 30 control participants (control group), who showed a normal postoperative patellar stability on stress radiography. Preoperative three-dimensional computed tomography (3D-CT) was used to identify patients with a high-grade J-sign. Femoral tunnel position was assessed using 3D-CT to identify cases with femoral tunnel malposition. Potential predictors of MPFL residual graft laxity, including age, sex, a preoperative high-grade J-sign, femoral tunnel malposition, and several radiological parameters, were assessed by logistic regression analysis.

Results

A preoperative high-grade J-sign was identified in 66.7% of the study group, which was significantly higher than that the 13.3% in the control group (P = 0.001). In addition, the presence of a preoperative high-grade J-sign (odds ratio, 11.9 [95% CI, 1.7–82.8]; P = 0.012) and femoral tunnel malposition (odds ratio, 8.2 [95% CI, 1.2–58.0]; P = 0.036) were determined to be independent risk factors associated with residual graft laxity after MPFL-R.

Conclusion

The presence of a preoperative high-grade J-sign and femoral tunnel malposition are associated with residual graft laxity after MPFL-R in patients with RPD. These results may provide additional information for counselling patients on residual graft laxity after MPFL-R.

Level of evidence

Level III.

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Funding

This study was funded by Beijing Natural Science Foundation (L192051), Beijing Municipal Science and Technology Commission (Z181100001718106), and Capital’s Funds for Health Improvement and Research (2020-1-2071).

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Authors and Affiliations

  1. Sports Medicine Service, Beijing Jishuitan Hospital, No. 31, Xin Jie Kou East Street, Xi Cheng District, Beijing, China

    ZhiJun Zhang, GuanYang Song, Tong Zheng, QianKun Ni, Hua Feng & Hui Zhang

Authors
  1. ZhiJun Zhang
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  2. GuanYang Song
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  3. Tong Zheng
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  4. QianKun Ni
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  5. Hua Feng
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  6. Hui Zhang
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Contributions

ZZ participated in study design and data collection, and drafted the manuscript. GS carried out the radiological measurements. TZ participated in the data collection and statistical analysis. QN carried out the radiological measurements. HF participated in the study design and data collection. HZ conceived of the study, and participated in its design and helped to draft the manuscript. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Hua Feng or Hui Zhang.

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Conflicts of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this retrospective study were in accordance with the ethical standards of the Beijing Jishuitan hospital, and this study was performed after obtaining approval from our institutional review board (IRB, No. 20190601).

Consent to participate

All patients provided informed consent before participating in this study.

Consent for publication

All patients provided informed consent for publication.

Availability of data and material

The datasets used or analysed during the current study are available from the corresponding author on reasonable request.

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Yes.

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Electronic supplementary material

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Supplementary file1 Video 1 Typical high-grade J-sign during physical examination (MP4 1830 kb)

Supplementary file2 (PDF 49 kb)

Supplementary file3 (DOC 99 kb)

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Zhang, Z., Song, G., Zheng, T. et al. The presence of a preoperative high-grade J-sign and femoral tunnel malposition are associated with residual graft laxity after MPFL reconstruction. Knee Surg Sports Traumatol Arthrosc 29, 1183–1190 (2021). https://doi.org/10.1007/s00167-020-06140-z

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  • DOI: https://doi.org/10.1007/s00167-020-06140-z

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