Original Articles
Results of medial patellofemoral ligament reconstruction in the treatment of patellar dislocation*

https://doi.org/10.1053/jars.2001.21490Get rights and content

Abstract

Purpose: The purpose of this study is to describe the technique of medial patellofemoral ligament reconstruction using autogenous hamstrings or autogenous fascia lata and report the results at a minimum 2-year follow-up. Type of Study: This study represents a case series. Patients with patellofemoral instability following patellar dislocation were restrospectively reviewed after being treated with medial patellofemoral ligament reconstruction. No concurrent control group was used. Methods: Nineteen consecutive patients underwent medial patellofemoral repair or reconstruction in the treatment of patellar instability after patellar dislocation. The reconstructions were performed using autogenous gracilis and/or semitendinosus tendons or a strip of autogenous fascia lata. Fifteen patients were available for interview, examination, and radiographic evaluation, with a mean follow-up of 31.5 months. Results: Subjectively, 10 knees had excellent results, 3 knees obtained good results, 1 knee had a fair result, and 1 knee had a poor result, for a total of 93% improvement overall. Using Fulkerson’s functional knee score, 93% had good or excellent results. The average postoperative result on Kujala’s score for anterior knee symptoms was 88 (range, 80-100). The Tegner activity level averaged 6.8 preinjury and 6.7 postoperatively. Radiographic evaluation showed significant improvements in the congruence angle by an average of 20° (P =.0006), and in the lateral patellofemoral angle by an average of 10° (P =.0003). Conclusions: Surgical reconstruction or repair of the medial patellofemoral ligament provides favorable results for the treatment of recurrent patellofemoral dislocations with regard to radiographic findings, patient satisfaction, and functional outcome.

Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 3 (March), 2001: pp 298–306

Section snippets

Patients

Between November 1994 and July 1996, the senior author (D.D.) performed reconstruction or repair of the medial patellofemoral ligament in the treatment of patellar dislocation in 19 knees in 19 patients. Fifteen of these patients were available for evaluation, which consisted of a questionnaire, 2 standard knee scores, physical examination, and radiographic imaging at a minimum of 2 years postoperatively. The remaining 4 patients could not be located. The patient population is summarized in

Results

Table 2 summarizes the questionnaire and knee score results.

. Questionnaire and Knee Score Results

PatientSubjective AssessmentRecurrent SubluxationPreinjury TegnerPostop TegnerFulkerson ScoreKujala Score
M.Br.Good 9 9 84 82
S.S.Excellent 4 4 85 90
A.G.Excellent 9 9100100
C.W.Poor 1 1 86 71
M.T.Excellent 7 7100 98
C.F.Excellent1 Episode 7  6100100
R.P.Good 5 3 76 57
A.S.Excellent 7 7 94 87
S.N.Excellent1010100100
M.Bu.Good 6 6 95 90
J.M.Excellent 7 7100 90
R.F.Fair 6 5 80 69
J.P.Excellent 10 10 95 95
M.D.Excellent 7 9100100
J.A.Excellent 7 7100

Discussion

Many authors have described the anatomy of the medial aspect of the knee joint.10, 16, 17, 18 Warren and Marshall16 described the location of the medial patellofemoral ligament in layer II of the medial side of the knee, with its origin at the adductor tubercle and its insertion at the superomedial border of the patella, the undersurface of the vastus medialis obliquus, and the aponeurosis of the vastus intermedius. Feller et al.18 have shown its anatomic consistency in 20 cadaveric

Acknowledgements

Acknowledgment: The authors thank Elizabeth Tarkington for her assistance in preparing the manuscript.

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    *

    Address correspondence and reprint requests to David Drez, Jr., M.D., 1717 Oak Park Blvd, 3rd Floor, Lake Charles Medical Plaza, Lake Charles, LA 70601, U.S.A.

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