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Joint Diseases and
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Original Article · Open access

Anatomical medial patellofemoral ligament reconstruction improves sport participation and activity levels in adolescents with recurrent patellar dislocation

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Çağrı Örs

Department of Knee and Sport Surgery, Acıbadem Adana Ortopedia Hospital, Adana, Türkiye

ORCID: 0000-0001-7998-1662

Remzi Çaylak

Department of Knee and Sport Surgery, Acıbadem Adana Ortopedia Hospital, Adana, Türkiye

ORCID: 0000-0002-2926-4590

Özlem Karataş

Department of Physical Medicine and Rehabilitation, Antalya Training and Research Hospital, Antalya, Türkiye

ORCID: 0000-0002-6617-8448

Yaman Sarpel

Department of Knee and Sport Surgery, Acıbadem Adana Ortopedia Hospital, Adana, Türkiye

ORCID: 0000-0002-7008-7805

Abstract

Objectives: This study aims to evaluate the clinical outcomes of an anatomical medial patellofemoral ligament (MPFL) reconstruction and the effects of concomitant patellofemoral joint injuries and radiological findings on outcomes in adolescents with recurrent patellar dislocation (RPD).

Patients and methods: Between January 2011 and January 2020, a total of 34 patients (19 males, 15 females; median age: 15.6 years; range, 13 to 17 years) with RPD who underwent anatomic MPFL reconstruction were retrospectively analyzed. Lateral release was performed as indicated. Clinical outcomes were evaluated preoperatively and at the final follow-up using the Visual Analog Scale (VAS), Lysholm, Kujala, and Tegner activity rating scales. Magnetic resonance imaging was performed to detect concomitant injuries such as bone, cartilage, and soft tissue injuries.

Results: The mean follow-up was 5±2 years. All postoperative knee functions and activity levels were statistically significantly improved without re-dislocation (p<0.001). There was no statistically significant relationship between the presence and location of cartilage lesions and clinical outcomes (p>0.05). Patients with cartilage lesions had a significantly higher CatonDeschamps index and a higher incidence of bone edema in both the patella and femur than patients without.

Conclusion: Anatomic MPFL reconstruction with meticulous physical therapy has successful clinical outcomes, prevents re-dislocation, and increases participation in sports and activity levels in adolescent patients with RPD. Although cartilage injuries are common after RPD, it has no adverse effect on clinical outcomes in the mid-term.

Declarations

Ethics Committee Approval

The study protocol was approved by the Çukurova University Faculty of Medicine Non-Interventional Clinical Research Ethics Committee (date: 04.0.3.2022, no: 120/40/07.04.2022). The study was conducted in accordance with the principles of the Declaration of Helsinki.

Informed Consent

A written informed consent was obtained from the parents and/or legal guardians of the patients.

Author Contributions

Idea/concept, design, control/ supervision, analysis and/or interpretation, materials: C.O.; Data collection and/or processing: C.O., Y.S.; Literature review, writing the article: C.O., O.K., R.C.; Critical review: Y.S.; References and fundings: C.O., O.K.; Other: R.C., O.K.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

The authors received no financial support for the research and/or authorship of this article.

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

References

  1. Fithian DC, Paxton EW, Stone ML, Silva P, Davis DK, Elias DA, et al Epidemiology and natural history of acute patellar dislocation. Am J Sports Med 2004;32:1114-21. DOI: 10.1177/0363546503260788.
  2. Guerrero P, Li X, Patel K, Brown M, Busconi B. Medial patellofemoral ligament injury patterns and associated pathology in lateral patella dislocation: An MRI study. Sports Med Arthrosc Rehabil Ther Technol 2009;1:17. DOI: 10.1186/1758-2555-1-17.
  3. Saggin PR, Saggin JI, Dejour D. Imaging in patellofemoral instability: An abnormality-based approach. Sports Med Arthrosc Rev 2012;20:145-51. DOI: 10.1097/JSA.0b013e3182553cfe.
  4. Tompkins MA, Rohr SR, Agel J, Arendt EA. Anatomic patellar instability risk factors in primary lateral patellar dislocations do not predict injury patterns: An MRI-based study. Knee Surg Sports Traumatol Arthrosc 2018;26:677-84. DOI: 10.1007/s00167-017-4464-3.
  5. Siebold R, Karidakis G, Fernandez F. Clinical outcome after medial patellofemoral ligament reconstruction and autologous chondrocyte implantation following recurrent patella dislocation. Knee Surg Sports Traumatol Arthrosc 2014;22:2477-83. DOI: 10.1007/s00167-014-3196-x.
  6. Conchie H, Clark D, Metcalfe A, Eldridge J, Whitehouse M. Adolescent knee pain and patellar dislocations are associated with patellofemoral osteoarthritis in adulthood: A case control study. Knee 2016;23:708-11. DOI: 10.1016/j.knee.2016.04.009.
  7. Hing CB, Smith TO, Donell S, Song F. Surgical versus nonsurgical interventions for treating patellar dislocation. Cochrane Database Syst Rev 2011;11:CD008106. DOI: 10.1002/14651858.CD008106.pub2.
  8. Deie M, Ochi M, Sumen Y, Yasumoto M, Kobayashi K, Kimura H. Reconstruction of the medial patellofemoral ligament for the treatment of habitual or recurrent dislocation of the patella in children. J Bone Joint Surg [Br] 2003;85:887-90.
  9. Kim HK, Shiraj S, Kang CH, Anton C, Kim DH, Horn PS. Patellofemoral instability in children: Correlation between risk factors, injury patterns, and severity of cartilage damage. AJR Am J Roentgenol 2016;206:1321-8. DOI: 10.2214/AJR.15.15217.
  10. Nelitz M, Dreyhaupt J, Reichel H, Woelfle J, Lippacher S. Anatomic reconstruction of the medial patellofemoral ligament in children and adolescents with open growth plates: Surgical technique and clinical outcome. Am J Sports Med 2013;41:58-63. DOI: 10.1177/0363546512463683.
  11. Steiner TM, Torga-Spak R, Teitge RA. Medial patellofemoral ligament reconstruction in patients with lateral patellar instability and trochlear dysplasia. Am J Sports Med 2006;34:1254-61. DOI: 10.1177/0363546505285584.
  12. Kujala UM, Jaakkola LH, Koskinen SK, Taimela S, Hurme M, Nelimarkka O. Scoring of patellofemoral disorders. Arthroscopy 1993;9:159-63. DOI: 10.1016/s0749-8063(05)80366-4.
  13. Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 1985;198:43-9.
  14. Arendt EA, England K, Agel J, Tompkins MA. An analysis of knee anatomic imaging factors associated with primary lateral patellar dislocations. Knee Surg Sports Traumatol Arthrosc 2017;25:3099-107. DOI: 10.1007/s00167-016-4117-y.
  15. Dejour H, Walch G, Nove-Josserand L, Guier C. Factors of patellar instability: An anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 1994;2:19-26. DOI: 10.1007/BF01552649.
  16. Dejour D, Le Coultre B. Osteotomies in patello-femoral instabilities. Sports Med Arthrosc Rev 2007;15:39-46. DOI: 10.1097/JSA.0b013e31803035ae.
  17. Schottle PB, Romero J, Schmeling A, Weiler A. Technical note: Anatomical reconstruction of the medial patellofemoral ligament using a free gracilis autograft. Arch Orthop Trauma Surg 2008;128:479-84. DOI: 10.1007/s00402-007-0300-4.
  18. Lind M, Enderlein D, Nielsen T, Christiansen SE, Faunø P. Clinical outcome after reconstruction of the medial patellofemoral ligament in paediatric patients with recurrent patella instability. Knee Surg Sports Traumatol Arthrosc 2016;24:666-71. DOI: 10.1007/s00167-014-3439-x.
  19. Nomura E, Inoue M, Kurimura M. Chondral and osteochondral injuries associated with acute patellar dislocation. Arthroscopy 2003;19:717-21. DOI: 10.1016/s0749-8063(03)00401-8.
  20. Nomura E, Inoue M. Cartilage lesions of the patella in recurrent patellar dislocation. Am J Sports Med 2004;32:498- 502. DOI: 10.1177/0095399703258677.
  21. Nomura E, Inoue M. Second-look arthroscopy of cartilage changes of the patellofemoral joint, especially the patella, following acute and recurrent patellar dislocation. Osteoarthritis Cartilage 2005;13:1029-36. DOI: 10.1016/j.joca.2005.07.004.
  22. Vollnberg B, Koehlitz T, Jung T, Scheffler S, Hoburg A, Khandker D, et al. Prevalence of cartilage lesions and early osteoarthritis in patients with patellar dislocation. Eur Radiol 2012;22:2347-56. DOI: 10.1007/s00330-012-2493-3.
  23. Seeley MA, Knesek M, Vanderhave KL. Osteochondral injury after acute patellar dislocation in children and adolescents. J Pediatr Orthop 2013;33:511-8. DOI: 10.1097/BPO.0b013e318288b7a0.
  24. Meynard P, Malatray M, Sappey-Marinier E, Magnussen RA, Bodiou V, Lustig S, et al. Medial patellofemoral ligament reconstruction for recurrent patellar dislocation allows a good rate to return to sport. Knee Surg Sports Traumatol Arthrosc 2022;30:1865-1870. DOI: 10.1007/s00167-021-06815-1.
  25. Monllau JC, Masferrer-Pino À, Ginovart G, Pérez-Prieto D, Gelber PE, Sanchis-Alfonso V. Clinical and radiological outcomes after a quasi-anatomical reconstruction of medial patellofemoral ligament with gracilis tendon autograft. Knee Surg Sports Traumatol Arthrosc 2017;25:2453-9. DOI: 10.1007/s00167-015-3934-8.
  26. Zhang H, Ye M, Liang Q. Clinical outcomes after medial patellofemoral ligament reconstruction with suture fixation of the gracilis tendon via transosseous tunnels. Orthop J Sports Med 2020;8:2325967119900373. DOI: 10.1177/2325967119900373.
  27. Atik OŞ. Writing for Joint Diseases and Related Surgery (JDRS): There is something new and interesting in this article! Jt Dis Relat Surg 2023;34:533. DOI: 10.52312/jdrs.2023.57916.
  28. Migliorini F, Maffulli N, Bell A, Betsch M. Outcomes, return to sport, and failures of MPFL reconstruction using autografts in children and adolescents with recurrent patellofemoral instability: A systematic review. Children (Basel) 2022;9:1892. DOI: 10.3390/children9121892.
  29. Husen M, Milbrandt TA, Shah V, Krych AJ, Stuart MJ, Saris DBF. Medial patellofemoral ligament reconstruction using allografts in skeletally immature patients. Am J Sports Med 2023;51:1513-24. DOI: 10.1177/03635465231164400.
  30. Thompson P, Metcalfe AJ. Current concepts in the surgical management of patellar instability. Knee 2019;26:1171-81. DOI: 10.1016/j.knee.2019.11.007.
  31. Palmu S, Kallio PE, Donell ST, Helenius I, Nietosvaara Y. Acute patellar dislocation in children and adolescents: A randomized clinical trial. J Bone Joint Surg Am 2008;90:463- 70. DOI: 10.2106/JBJS.G.00072.
  32. Migliorini F, Rath B, Tingart M, Meisen N, Eschweiler J. Surgical management for recurrent patellar dislocations in skeletally immature patients. Eur J Orthop Surg Traumatol 2019;29:1815-22. DOI: 10.1007/s00590-019-02483-7.
  33. Parikh SN, Nathan ST, Wall EJ, Eismann EA. Complications of medial patellofemoral ligament reconstruction in young patients. Am J Sports Med 2013;41:1030-8. DOI: 10.1177/0363546513482085.