Korean J Sports Med.  2023 Mar;41(1):11-18. 10.5763/kjsm.2023.41.1.11.

Medial Patellofemoral Ligament Reconstruction Using Adjustable Tensioning under Arthroscopic Visualization Provides Satisfactory Radiographic and Clinical Outcomes

• Sohn S
• Choi JY

• KMID: 2539685
• DOI: http://doi.org/10.5763/kjsm.2023.41.1.11

Abstract

Purpose
Recurrent patellar dislocation required a surgical reconstruction of medial patellofemoral ligament (MPFL) in many cases. During MPFL reconstruction, over-tension of medial construct altered the patellofemoral kinematics which may result in pain, patellofemoral joint degeneration, or graft failure. Thus, it is important to confirm appropriate tension intraoperatively. The purpose of this study was to evaluate the clinical and radiographic outcomes of MPFL reconstruction with use of an adjustable tensioning under arthroscopic direct visualization of patellofemoral joint.
Methods
This retrospective study included 11 MPFL reconstructions (nine patients) from 2013 to 2020. All the patients received the same surgical procedures by a single surgeon. Final graft tension was determined after confirming patellar position to the trochlear groove at 60° knee flexion under arthroscopic exam. Patient demographics, pre- and postoperative radiographic results including congruence angle and Insall-Salvati ratio, and clinical outcomes were compared.
Results
The congruence angle was significantly changed from 32.8°±21.1° preoperatively to 8.4°±11.5° postoperatively (p=0.003), and the Insall-Salvati ratio was 1.16°±0.15° and 1.10°±0.13° respectively (p=0.02). Clinical scores were significantly improved between pre- and postoperatively; Kujala score (33.2±18.3 to 88.8±4.7, p=0.04), Lysholm score (30.2±15 to 79.0±5.2, p=0.005), and Tegner level (2.2±1.1 to 4.4±1.7, p=0.04). There was no recurrence of patellar dislocation.
Conclusion
MPFL reconstruction using adjustable tensioning under arthroscopic direct visualization could obtain satisfactory outcomes after surgery.

Keyword

Medial patellofemoral ligament; Reconstruction; Arthroscopy; Video-assisted surgery; Treatment outcome

Figure

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  Fig. 1 Intraoperative fluoroscopic image of distal femur that determined the isometric femoral attachment site of medial patellofemoral ligament. Dotted line: vertical line from posterior femoral cortex, dashed line: the most posterior aspect of the Blumensaat line.

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  Fig. 2 Arthroscopic images during the 2nd step of tension adjustment. (A) Knee flexion of 30° at which angle lots of conventional studies recommended for final fixation of graft, showing insufficient patellar engagement. (B) Knee flexion of 60° showing sufficient patellar engagement.

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  Fig. 3 An illustration depicting surgical procedures and tension adjustment method.

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  Fig. 4 The Merchant view of (A) pre- and (B) postoperative radiographs. Angle c indicates congruence angle and angle t indicates patellar tilt.

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