Clinical and radiological outcomes of medial patellofemoral ligament (MPFL) reconstruction with a transpatellar tunnel technique. NINA MAGNITSKAYA 1,2 , ANDREY KOROLEV 1,2, MIKHAIL RYAZANTSEV 1,2, MIKHAIL SINITSKIY 3 and PAVEL KADANTSEV 4 1 People's Friendship University of Russia, Moscow, Russia 2 European Clinic of Sports Traumatology and Orthopaedics (ECSTO), Moscow, Russia 3 European Medical Centre, Moscow, Russia 4 I.M. Sechenov First Moscow State Medical University, Moscow, Russia
RESULTS
INTRODUCTION • The MPFL reconstruction is a widespread procedure in treatment of recurrent patellar dislocation • Numerous techniques have been described • The double bundle reconstruction shows promising clinical outcomes
24 MPFL reconstructions in 23 patients Time from surgery to follow up - 45 months (IQR 27-70). Age at the time of surgery - 22 years (IQR 18-32),
• We describe a new double-bundle transpatellar tunnel technique with semitendinosus tendon autograft looped through the vertical patellar tunnel and fixed in the femoral bone with a bioabsorbable screw
BMI - 23,9 (IQR 20,8-25,4).
Radiological analysis
AIM
PREOP MRI
The aim of the present study was to evaluate clinical and radiological outcomes of medial patella-femoral ligament (MPFL) reconstruction using double bundle semitendinosus tendon autograft passed through the vertical tunnel in patella.
InsallSalvati index Median
METHOD
IQR
Retrospective study Isolated MPFL reconstruction with transpatellar tunnel technique Minimum 12 months follow up Preoperative MRI - Insall-Salvati index, TT-TG distance, dysplasia of the trochlea grading [1], [2], [3]. Postoperative MRI - distance from medial patellar margin to patellar tunnel, patellar tunnel diameter (d_PAT), femoral tunnel diameter (d_FEM) Postoperative X-ray - femoral tunnel angle (FTA) Pre- and postsurgical sport activity Kujala score, IKDC and Lysholm subjective questionnaires Medians and interquartile ranges (IQR) were reported
▪ ▪ ▪ ▪ ▪
▪ ▪ ▪ ▪
A
B
A
A B
B
C
C
3. Graft passage A) Ethibond sutures passed through patellar tunnel B) The graft passed through patellar tunnel 1. Patellar tunnel A) K-wire positioning coronal view; B) K-wire positioning sagittal view; C) Macro
2. Femoral tunnel A) K-wire positioning coronal view; B) K-wire positioning sagittal view; C) Macro
4. Repositioning of the patella
TT-TG (mm)
POSTOP MRI
d_PAT (mm)
POSTOP X-Ray
Medial patellar margin distance (mm)
d_FEM (mm)
FTA °
1,1
14,2
5,6
7,1
7,9
19
1,0-1,3
12,2-21,5
5,1-6,2
6,5-8,9
7,6-8,2
12-22
At the time of follow up the median subjective score accounted: Kujala score - 96 (IQR 90-98), IKDC score - 87,4 (IQR 73,6 -91,4), Lysholm score - 91 (IQR 84-98).
After surgery 47,4 % returned to preoperative level of activity
52,6% returned at lower levels
No recurrent dislocations were registered.
Patellar tunnel diameter (d_PAT)
Medial patellar margin distance
Femoral tunnel diameter (d_FEM)
Femoral tunnel angle (FTA)
CONCLUSIONS
REFERENCES
➢ Reconstruction of the MPFL using transpatellar tunnel technique and bioabsorbable screw femoral fixation is an effective reproducible treatment of patellar instability without severe trochlear dysplasia
1. Schoettle P, Zanetti M, Seifert B, Pfirrmann C, Fucentese S, Romero J. The tibial tuberosity– trochlear groove distance; a comparative study between CT and MRI scanning. The Knee. 2006;13(1):26-31. 2. Tecklenburg K, Dejour D, Hoser C, Fink C. Bony and cartilaginous anatomy of the patellofemoral joint. Knee Surgery, Sports Traumatology, Arthroscopy. 2005;14(3):235240. 3. Lippacher S, Dejour D, Elsharkawi M, Dornacher D, Ring C, Dreyhaupt J et al. Observer Agreement on the Dejour Trochlear Dysplasia Classification. The American Journal of Sports Medicine. 2012;40(4):837-843.
➢ The current technique shows good subjective outcomes, low complication rate and high return to sports levels ➢ The transpatellar tunnel technique can also be cost effective due to decreased number of implants used
ACKNOWLEDGEMENTS The study was conducted on the basis of European Clinic of Sports Traumatology and Orthopaedics (ECSTO), Moscow, Russian Federation.
CONTACT INFORMATION European Clinic of Sports Traumatology and Orthopaedics, Moscow, Orlovskiy lane, 7
[email protected], +79269615743
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