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Medial Patellofemoral Ligament Reconstruction: A Longitudinal Study Comparison of 2 Techniques with 2 and 5-Years Follow-Up.

Astur DC, Gouveia GB, Borges JH, Astur N, Arliani GG, Kaleka CC, Cohen M - Open Orthop J (2015)

Bottom Line: There were statistical significant differences favorable to patients in Group 1 with a shorter follow-up length (2-5 years) compared to those with a longer period of 5-10 years for both Kujala and Fulkerson scores and no difference for group 2.Gender was not significant for surgical results.Moreover, group 1 patients had higher number of complications.

View Article: PubMed Central - PubMed

Affiliation: Centro de Traumatologia do Esporte do Departamento de Ortopedia e Traumatologia da Escola Paulista de Medicina/ Universidade Federal de São Paulo, São Paulo, Brazil.

ABSTRACT

Background: The purpose of this study was to compare the results of two popular surgical techniques for medial patellofemoral ligament MPFL reconstruction with a minimum of two-year follow-up.

Methods: Fifty-eight patients with traumatic tear of the medial patellofemoral ligament were included in one of the two surgical groups. Group 1 MPFLs were reconstructed through graft endobutton fixation and Group 2 through graft anchor fixation into the patella. After two to five-year follow-up, patients were asked to answer knee function questionnaires (Fulkerson and Kujala) as well as the SF-36 life quality score.

Results: There were no statistical difference among postoperative Kujala, Fulkerson, and SF-36 questionnaires scores between Groups 1 and 2. There were statistical significant differences favorable to patients in Group 1 with a shorter follow-up length (2-5 years) compared to those with a longer period of 5-10 years for both Kujala and Fulkerson scores and no difference for group 2.

Conclusion: Both medial patellofemoral ligament reconstruction techniques had similar results in a two to ten-year follow-up according to functions and life quality questionnaires. Furthermore, endobutton fixation for the patellar edge of the graft had better results in patients with 2 years of follow-up than those with 5 years. Gender was not significant for surgical results. Moreover, group 1 patients had higher number of complications.

No MeSH data available.


Related in: MedlinePlus

Endobutton patellar fixation ilustration. A medialparapatellar approach is performed identifying the intersection ofthe superior and medial thirds of the medial border of the patella,where the anatomic insertion point is located. A transverse tunnel isthen made in the patella and the tendon graft is then passed throughthe tunnel guided by the wire and fixed with an endobutton. Thefemoral edge of the graft is also passed through the tunnel and fixedwith an interference screw with the knee in 30-45 degrees of flexion
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Figure 1: Endobutton patellar fixation ilustration. A medialparapatellar approach is performed identifying the intersection ofthe superior and medial thirds of the medial border of the patella,where the anatomic insertion point is located. A transverse tunnel isthen made in the patella and the tendon graft is then passed throughthe tunnel guided by the wire and fixed with an endobutton. Thefemoral edge of the graft is also passed through the tunnel and fixedwith an interference screw with the knee in 30-45 degrees of flexion

Mentions: Group 1 patients underwent ligament reconstruction through endobutton patellar fixation. Arthroscopic investigation was always performed before open surgical repair to detect associated injuries in the joint. Once this is completed, an anteromedial approach to the proximal third of the tibia is then carried out for gracilis muscle tendon graft harvesting. At this point, a medial parapatellar approach is performed layer-by-layer identifying the intersection of the superior and medial thirds of the medial border of the patella, where the anatomic insertion point is located. A transverse tunnel in the upper 1/3 is then made in the patella under fluoroscopic guidance, initially with a guide wire followed by a number 6 patellar drill. The tendon graft is then passed through the tunnel guided by the wire and fixed with an endobutton. Next, the appropriate femoral fixation point is marked and confirmed by fluoroscopy. This location is typically 0.5-1 cm distal and anterior to the medial femoral epicondyle, between the epicondyle and the adductor tubercle. A guide wire is then passed followed by a number 6 drill. The femoral edge of the graft is also passed through the tunnel with guide wire assistance and tensioned and fixed with a number 7 x 28 mm interference screw with the knee in 30-45 degrees of flexion (Fig. 1). We conducted an isometric test to define the correct tension of the graft. For this, we engage the graft in the already fixed guide wire in the femur. We performed a flexion and extension of the knee and observe if there is a graft excursion. If this tour is less than 3 mm we considered that it is the proper tension for the fixation.


Medial Patellofemoral Ligament Reconstruction: A Longitudinal Study Comparison of 2 Techniques with 2 and 5-Years Follow-Up.

Astur DC, Gouveia GB, Borges JH, Astur N, Arliani GG, Kaleka CC, Cohen M - Open Orthop J (2015)

Endobutton patellar fixation ilustration. A medialparapatellar approach is performed identifying the intersection ofthe superior and medial thirds of the medial border of the patella,where the anatomic insertion point is located. A transverse tunnel isthen made in the patella and the tendon graft is then passed throughthe tunnel guided by the wire and fixed with an endobutton. Thefemoral edge of the graft is also passed through the tunnel and fixedwith an interference screw with the knee in 30-45 degrees of flexion
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4493629&req=5

Figure 1: Endobutton patellar fixation ilustration. A medialparapatellar approach is performed identifying the intersection ofthe superior and medial thirds of the medial border of the patella,where the anatomic insertion point is located. A transverse tunnel isthen made in the patella and the tendon graft is then passed throughthe tunnel guided by the wire and fixed with an endobutton. Thefemoral edge of the graft is also passed through the tunnel and fixedwith an interference screw with the knee in 30-45 degrees of flexion
Mentions: Group 1 patients underwent ligament reconstruction through endobutton patellar fixation. Arthroscopic investigation was always performed before open surgical repair to detect associated injuries in the joint. Once this is completed, an anteromedial approach to the proximal third of the tibia is then carried out for gracilis muscle tendon graft harvesting. At this point, a medial parapatellar approach is performed layer-by-layer identifying the intersection of the superior and medial thirds of the medial border of the patella, where the anatomic insertion point is located. A transverse tunnel in the upper 1/3 is then made in the patella under fluoroscopic guidance, initially with a guide wire followed by a number 6 patellar drill. The tendon graft is then passed through the tunnel guided by the wire and fixed with an endobutton. Next, the appropriate femoral fixation point is marked and confirmed by fluoroscopy. This location is typically 0.5-1 cm distal and anterior to the medial femoral epicondyle, between the epicondyle and the adductor tubercle. A guide wire is then passed followed by a number 6 drill. The femoral edge of the graft is also passed through the tunnel with guide wire assistance and tensioned and fixed with a number 7 x 28 mm interference screw with the knee in 30-45 degrees of flexion (Fig. 1). We conducted an isometric test to define the correct tension of the graft. For this, we engage the graft in the already fixed guide wire in the femur. We performed a flexion and extension of the knee and observe if there is a graft excursion. If this tour is less than 3 mm we considered that it is the proper tension for the fixation.

Bottom Line: There were statistical significant differences favorable to patients in Group 1 with a shorter follow-up length (2-5 years) compared to those with a longer period of 5-10 years for both Kujala and Fulkerson scores and no difference for group 2.Gender was not significant for surgical results.Moreover, group 1 patients had higher number of complications.

View Article: PubMed Central - PubMed

Affiliation: Centro de Traumatologia do Esporte do Departamento de Ortopedia e Traumatologia da Escola Paulista de Medicina/ Universidade Federal de São Paulo, São Paulo, Brazil.

ABSTRACT

Background: The purpose of this study was to compare the results of two popular surgical techniques for medial patellofemoral ligament MPFL reconstruction with a minimum of two-year follow-up.

Methods: Fifty-eight patients with traumatic tear of the medial patellofemoral ligament were included in one of the two surgical groups. Group 1 MPFLs were reconstructed through graft endobutton fixation and Group 2 through graft anchor fixation into the patella. After two to five-year follow-up, patients were asked to answer knee function questionnaires (Fulkerson and Kujala) as well as the SF-36 life quality score.

Results: There were no statistical difference among postoperative Kujala, Fulkerson, and SF-36 questionnaires scores between Groups 1 and 2. There were statistical significant differences favorable to patients in Group 1 with a shorter follow-up length (2-5 years) compared to those with a longer period of 5-10 years for both Kujala and Fulkerson scores and no difference for group 2.

Conclusion: Both medial patellofemoral ligament reconstruction techniques had similar results in a two to ten-year follow-up according to functions and life quality questionnaires. Furthermore, endobutton fixation for the patellar edge of the graft had better results in patients with 2 years of follow-up than those with 5 years. Gender was not significant for surgical results. Moreover, group 1 patients had higher number of complications.

No MeSH data available.


Related in: MedlinePlus