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"Basket weave technique" for medial patellofemoral ligament reconstruction: Clinical outcome of a prospective study.

Kodkani PS - Indian J Orthop (2016 Jan-Feb)

Bottom Line: Arthroscopy was performed for associated injuries and loose bodies.This new method of MPFL reconstruction gives excellent results.It is a safe, effective, reliable and reproducible technique.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics, K.B. Bhabha Hospital, Mumbai, Maharashtra, India; Department of Orthopaedics - Joint preservation, Arthroscopy and Sports Injury: Chief Consultant - Bombay Hospital, Shushrusha Hospital, Hinduja Healthcare, Mumbai, Maharashtra, India.

ABSTRACT

Background: Bone tunneling and implants with rigid fixations for medial patellofemoral ligament (MPFL) reconstruction are known to compromise results and are avoidable, especially in skeletally immature subjects. This study was to assess if these deficiencies were overcome with the technique devised by the author which avoids implants and bone tunnels. Results were assessed for complication rate and outcome.

Materials and methods: Fifty six knees of recurrent lateral patellar dislocation were treated in the past 49 months by MPFL reconstruction. Thirty nine were female and 17 male knees. The mean age was 20.6 years (range 9-48 years). Mean followup was 26 months. Five knees had previously failed stabilization procedures. Thirty one cases had Dejours Type A or B and 12 had Type C trochlear dysplasia. Arthroscopy was performed for associated injuries and loose bodies. Seven knees required loose body removal. Five knees underwent lateral retinacular release. Four knees had tibial tuberosity transfer. One knee had an associated anterior cruciate ligament reconstruction. An anatomical MPFL reconstruction was performed using hamstring autograft without the need for intraoperative fluoroscopy. Only soft tissue fixation was necessary with this newly devised technique and suturing. A rapid rehabilitation protocol was implemented with monthly followup until normalcy and 6 monthly thereafter.

Results: All achieved full range of motion and normal mediolateral stability. There was no recurrence of dislocation. No major surgery related complications. One patella fracture at 8 months was due to a fall developed terminal restriction of flexion. Those in sports could return to their sporting activities (Tegner 1-9). Cases with osteochondral fractures had occasional pain that subsided in 1 year. Mean Kujala score improved from 64.3 to 99.69 with KOOS score near normal in all.

Conclusion: This new method of MPFL reconstruction gives excellent results. It avoids complications related to bone tunneling and implants. It is a safe, effective, reliable and reproducible technique.

No MeSH data available.


Related in: MedlinePlus

(a) “Pretzel stitch” (diagrammatic) in cross section. Peroperative photographs (1-4) showing steps of technique
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Figure 5: (a) “Pretzel stitch” (diagrammatic) in cross section. Peroperative photographs (1-4) showing steps of technique

Mentions: Simple suturing of the graft to the sleeves might not be adequate, as it might cut through or might result in too many knots on the anterior surface. To avoid this issue, a special “pretzel stitch” [Figure 5a–d] was designed for fixing the graft to each of the sleeves. This stitch cinched the sleeve around the graft and simultaneously transfixes the graft to the sleeve thus giving a firm fixation to the sleeves. These “pretzel stitches” are taken at each sleeve level where the graft passes above or below them. Each level of suturing beyond the first suture provides a backup fixation for the previous thus reinforcing the fixation. A total of three or four fixation sutures were ensured for each limb of the graft [Figure 6].


"Basket weave technique" for medial patellofemoral ligament reconstruction: Clinical outcome of a prospective study.

Kodkani PS - Indian J Orthop (2016 Jan-Feb)

(a) “Pretzel stitch” (diagrammatic) in cross section. Peroperative photographs (1-4) showing steps of technique
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4759872&req=5

Figure 5: (a) “Pretzel stitch” (diagrammatic) in cross section. Peroperative photographs (1-4) showing steps of technique
Mentions: Simple suturing of the graft to the sleeves might not be adequate, as it might cut through or might result in too many knots on the anterior surface. To avoid this issue, a special “pretzel stitch” [Figure 5a–d] was designed for fixing the graft to each of the sleeves. This stitch cinched the sleeve around the graft and simultaneously transfixes the graft to the sleeve thus giving a firm fixation to the sleeves. These “pretzel stitches” are taken at each sleeve level where the graft passes above or below them. Each level of suturing beyond the first suture provides a backup fixation for the previous thus reinforcing the fixation. A total of three or four fixation sutures were ensured for each limb of the graft [Figure 6].

Bottom Line: Arthroscopy was performed for associated injuries and loose bodies.This new method of MPFL reconstruction gives excellent results.It is a safe, effective, reliable and reproducible technique.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics, K.B. Bhabha Hospital, Mumbai, Maharashtra, India; Department of Orthopaedics - Joint preservation, Arthroscopy and Sports Injury: Chief Consultant - Bombay Hospital, Shushrusha Hospital, Hinduja Healthcare, Mumbai, Maharashtra, India.

ABSTRACT

Background: Bone tunneling and implants with rigid fixations for medial patellofemoral ligament (MPFL) reconstruction are known to compromise results and are avoidable, especially in skeletally immature subjects. This study was to assess if these deficiencies were overcome with the technique devised by the author which avoids implants and bone tunnels. Results were assessed for complication rate and outcome.

Materials and methods: Fifty six knees of recurrent lateral patellar dislocation were treated in the past 49 months by MPFL reconstruction. Thirty nine were female and 17 male knees. The mean age was 20.6 years (range 9-48 years). Mean followup was 26 months. Five knees had previously failed stabilization procedures. Thirty one cases had Dejours Type A or B and 12 had Type C trochlear dysplasia. Arthroscopy was performed for associated injuries and loose bodies. Seven knees required loose body removal. Five knees underwent lateral retinacular release. Four knees had tibial tuberosity transfer. One knee had an associated anterior cruciate ligament reconstruction. An anatomical MPFL reconstruction was performed using hamstring autograft without the need for intraoperative fluoroscopy. Only soft tissue fixation was necessary with this newly devised technique and suturing. A rapid rehabilitation protocol was implemented with monthly followup until normalcy and 6 monthly thereafter.

Results: All achieved full range of motion and normal mediolateral stability. There was no recurrence of dislocation. No major surgery related complications. One patella fracture at 8 months was due to a fall developed terminal restriction of flexion. Those in sports could return to their sporting activities (Tegner 1-9). Cases with osteochondral fractures had occasional pain that subsided in 1 year. Mean Kujala score improved from 64.3 to 99.69 with KOOS score near normal in all.

Conclusion: This new method of MPFL reconstruction gives excellent results. It avoids complications related to bone tunneling and implants. It is a safe, effective, reliable and reproducible technique.

No MeSH data available.


Related in: MedlinePlus