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Clinical and Functional Outcomes following Primary Repair versus Reconstruction of the Medial Patellofemoral Ligament for Recurrent Patellar Instability.

Tompkins M, Kuenze CM, Diduch DR, Miller MD, Milewski MD, Hart JP - J Sports Med (Hindawi Publ Corp) (2014)

Bottom Line: Results.In addition, there was no side to side difference in torque generation or surface EMG activation of VL or VMO.Conclusions.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200, Minneapolis, MN 55454, USA.

ABSTRACT
Background. The purpose of this study was to compare outcomes of medial patellofemoral ligament (MPFL) repair or reconstruction. Methods. Fourteen knees that underwent MPFL repair and nine (F5, M4) knees that underwent reconstruction at our institution were evaluated for objective and subjective outcomes. The mean age at operation was 20.1 years for repair and 19.8 years for reconstruction. All patients had a minimum of 2 years of follow-up (range: 24-75 months). Patient subjective outcomes were obtained using the International Knee Documentation Committee (IKDC) and Kujala patellofemoral subjective evaluations, as well as Visual Analog (VAS) and Tegner Activity Scales. Bilateral isometric quadriceps strength and vastus medialis obliquus (VMO) and vastus lateralis (VL) surface EMG were measured during maximal isometric quadriceps contractions at 30° and 60° of flexion. Results. There were no redislocations in either group. There was no difference in IKDC (P = 0.16), Kujala (P = 0.43), Tegner (P = 0.12), or VAS (P = 0.05) scores at follow-up. There were no differences between repair and reconstruction in torque generation of the involved side at 30° (P = 0.96) and 60° (P = 0.99). In addition, there was no side to side difference in torque generation or surface EMG activation of VL or VMO. Conclusions. There were minimal differences found between patients undergoing MPFL repair and MPFL reconstruction for the objective and subjective evaluations in this study.

No MeSH data available.


Related in: MedlinePlus

(a) The Allis clamp is being used to evaluate competency of the MPFL after it has been avulsed off the femur. (b) Suture anchors are placed at the MPFL insertion on the femur. (c) The MPFL is sutured back to the femoral insertion using suture anchors.
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fig3: (a) The Allis clamp is being used to evaluate competency of the MPFL after it has been avulsed off the femur. (b) Suture anchors are placed at the MPFL insertion on the femur. (c) The MPFL is sutured back to the femoral insertion using suture anchors.

Mentions: The repair technique was based on the location of injury along the MPFL. The ligament was identified during dissection; however, often the ligament is difficult to definitively identify so tension was applied to the tissue for confirmation of correct identification. Using suture anchors, the ligament was then secured back to the area of injury and the tissue was tightened (Figure 3). Generally speaking, the location of injury was tearing the ligament off the femur but did sometimes involve the patella. Also included in the repair group were four patients undergoing imbrications in which anchors were not used. Rather, sutures were placed in the midsubstance of the ligament in a “pants-over-vest” fashion in order to tighten the ligament. Imbrication procedures were performed in patients where there was no discrete tear but chronic stretching of the MPFL was obvious on exam; these imbrications were performed prior to reconstructions becoming a routine part of our practice.


Clinical and Functional Outcomes following Primary Repair versus Reconstruction of the Medial Patellofemoral Ligament for Recurrent Patellar Instability.

Tompkins M, Kuenze CM, Diduch DR, Miller MD, Milewski MD, Hart JP - J Sports Med (Hindawi Publ Corp) (2014)

(a) The Allis clamp is being used to evaluate competency of the MPFL after it has been avulsed off the femur. (b) Suture anchors are placed at the MPFL insertion on the femur. (c) The MPFL is sutured back to the femoral insertion using suture anchors.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4590910&req=5

fig3: (a) The Allis clamp is being used to evaluate competency of the MPFL after it has been avulsed off the femur. (b) Suture anchors are placed at the MPFL insertion on the femur. (c) The MPFL is sutured back to the femoral insertion using suture anchors.
Mentions: The repair technique was based on the location of injury along the MPFL. The ligament was identified during dissection; however, often the ligament is difficult to definitively identify so tension was applied to the tissue for confirmation of correct identification. Using suture anchors, the ligament was then secured back to the area of injury and the tissue was tightened (Figure 3). Generally speaking, the location of injury was tearing the ligament off the femur but did sometimes involve the patella. Also included in the repair group were four patients undergoing imbrications in which anchors were not used. Rather, sutures were placed in the midsubstance of the ligament in a “pants-over-vest” fashion in order to tighten the ligament. Imbrication procedures were performed in patients where there was no discrete tear but chronic stretching of the MPFL was obvious on exam; these imbrications were performed prior to reconstructions becoming a routine part of our practice.

Bottom Line: Results.In addition, there was no side to side difference in torque generation or surface EMG activation of VL or VMO.Conclusions.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200, Minneapolis, MN 55454, USA.

ABSTRACT
Background. The purpose of this study was to compare outcomes of medial patellofemoral ligament (MPFL) repair or reconstruction. Methods. Fourteen knees that underwent MPFL repair and nine (F5, M4) knees that underwent reconstruction at our institution were evaluated for objective and subjective outcomes. The mean age at operation was 20.1 years for repair and 19.8 years for reconstruction. All patients had a minimum of 2 years of follow-up (range: 24-75 months). Patient subjective outcomes were obtained using the International Knee Documentation Committee (IKDC) and Kujala patellofemoral subjective evaluations, as well as Visual Analog (VAS) and Tegner Activity Scales. Bilateral isometric quadriceps strength and vastus medialis obliquus (VMO) and vastus lateralis (VL) surface EMG were measured during maximal isometric quadriceps contractions at 30° and 60° of flexion. Results. There were no redislocations in either group. There was no difference in IKDC (P = 0.16), Kujala (P = 0.43), Tegner (P = 0.12), or VAS (P = 0.05) scores at follow-up. There were no differences between repair and reconstruction in torque generation of the involved side at 30° (P = 0.96) and 60° (P = 0.99). In addition, there was no side to side difference in torque generation or surface EMG activation of VL or VMO. Conclusions. There were minimal differences found between patients undergoing MPFL repair and MPFL reconstruction for the objective and subjective evaluations in this study.

No MeSH data available.


Related in: MedlinePlus