preliminary clinical results after medial patellofemoral ligament reconstruction author: ruzsa paul...
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Preliminary clinical results after Medial Patellofemoral Ligament Reconstruction
Author: Ruzsa Paul - Gabriel
Co-author: Gal Mihaela - Alexandra Jerdea Bogdan - Daniel Pop Sorin - Ioan
Scientific coordinator: Lecturer Russu Octav, MD, PhD
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The patellofemoral articulation
• Role in locomotion and activities that involve knee flexion and extention
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The patellofemoral articulation
• 94 % of patients suffer tear to the medial patellofemoral ligament following
patellar dislocation
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•Is a band of tissue that
extends from the upper
aspect of the patella to the
femoral medial epicondyle
Medial Patellofemoral Ligament (MPFL)
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Medial Patellofemoral Ligament (MPFL)
• The most important soft
tissue stabilizer of the
patella (first 30⁰ of flexion)
• Helps in preventing lateral
patellar subluxation or
dislocation
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MPFL reconstruction
• Is a surgical procedure indicated to patients with severe lateral patellar instability
• Was first described in 1992 by Dr. Ellera Gomes• There have been various approaches to this
technique
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MPFL reconstruction: Double bundle technique
• Replicates the nativeshape of the MPFL using a gracilis autograft which is harvested and prepared at the beginning of the surgery
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1.Preparation of the patella
2.4 mm drill tip Guide Pin 4.5 mm cannulated rimmer
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2.Graft fixation to the patella
bioabsorbable screw
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3.Preparation of the femoral insertion
MPFL Template
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4.Preparation of the Medial Patellofemoral Layer
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5. Femoral Graft Passage and Fixation
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Postoperative considerations
1 Day1 Day 6 weeks6 weeks 12 weeks12 weeks
Active quadriceps exercises between 0⁰ – 90⁰ of flexion
Post operative knee brace locked at 0⁰ - 90⁰
of flexion and crutch until wound healing
Full range of motion with light jogging or cycling
The patient can resume full activity
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Objective
To evaluate the short-term clinical results of patients after
MPFL reconstruction
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Material and methods
• There have been 10 cases of MPFL reconstruction (May 2012 – April 2014) at the Orthopaedic and Traumatology II Clinic in Târgu Mureş
• There were 6 female and 4 male patients between 16-38 years old, all of them were diagnosed with recurrent lateral patellar dislocation
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• This score is meant to asses the activity and functionality of the knee joint
• Grading <65 Poor65-83 Fair84-90 Good>90 Excellent
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Results
• There were no postoperative patellar complication or redislocations and the patients regained full mobility after 6 weeks
• The mean value of Tegner – Lysholm score improved to 90.8 (range 82 - 95) from a preoperative mean value of 63.5 (range 55 - 72)
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Conclusion
• Regarding the different methods of treating lateral patellofemoral instability MPFL reconstruction is one of the most promising procedures performed nowadays thanks to its simplicity, lack of complication and patient evolution
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Conclusion
• Our results show improved knee function and physical activity in patients treated with this procedure
• In order to clearly state the long-term benefits of this reconstruction technique a large scale case study is required
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Preliminary clinical results after Medial Patellofemoral Ligament Reconstruction
Do you haveany questions????
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Thank you!
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1.Shital N. Parikh, Senthil T. Nathan,Eric J. Wall and Emily A. Eismann:Complications of Medial Patellofemoral Ligament Reconstruction in Young PatientsAm J Sports Med May 2013 41 1030-1038; published online before print March 28, 2013, doi:10.1177/03635465134820852. Tegner Y, Lysholm J. :Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res. 1985 Sep;(198):43-93. Schottle PB, Hensler D, Imhoff AB:Anatomical Double-Bundle MPFL Reconstruction with an Aperture Fixation Knee Surg Sports Traumatol Arthroscopy (epub ahead of print), 2009. 4.Schottle PB, Schmeling A, Rosenstiel N, Weiler A : Radiographic Landmarks For Femoral Tunnel Placement In Medial Patellofemoral Ligament Reconstruction Am J Sports Med 35: 801-804, 2007. 5.Steensen RN, Dopirak RM, McDonald WG, III : The Anatomy and Isometry of the Medial Patellofemoral Ligament: Implications for Reconstruction Am J Sports Med 32: 1509-1513, 2004.
Bibliography