Medial patellotibial ligament (MPTL) reconstruction for patellar instability

Stefano Zaffagnini, Alberto Grassi, Giulio M aria Marcheggiani Muccioli, William F. Luetzow, Vittorio Vaccari, Andrea Benzi, Maurilio Marcacci

Research output: Contribution to journalArticle

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Abstract

PURPOSE: To evaluate mid-term clinical and radiographic outcomes after an original medial patellotibial ligament reconstruction in patients with patellar dislocation.

METHODS: Twenty-nine knees (27 patients, 8 males and 19 females) treated for patellar dislocation with medialization of the patellar tendon medial third combined with medial and lateral release were evaluated clinically and radiographically at a mean follow-up of 6.1±2.5 years. Trochleoplasty was performed in case of severe flat trochlea (6 knees, 21%). Aetiology of patellofemoral instability was traumatic in 6 (21%) and atraumatic in 23 (79%) knees. The mean age at first dislocation was 19.2±10.1 years. WOMAC, subjective and objective IKDC, Kujala, VAS for pain, Tegner activity and EQ-5D scores were used. Anteroposterior, lateral and 30° axial views were performed for radiographic monitoring.

RESULTS: There was a significant improvement of all clinical scores and significant reduction in knee pain. Twenty-four knees (83%) were normal or nearly normal by objective IKDC score at final follow-up. Radiographs showed a higher incidence of patella alta and flat trochlea in the atraumatic group. Severe signs of patellar osteoarthritis were found in 1 knee (3%). A higher body mass index (BMI) was correlated with worse pre-operative scores. Four knees (14%) were considered failures (2 further dislocations, 2 revision surgeries). The overall survival rate at 6 years was 0.811.

CONCLUSIONS: The presented techniques produced good clinical and radiographic results at mean 6.1 years follow-up, with 14 % failures. Signs of patellofemoral dysplasia were found in patients with atraumatic patellar dislocation. BMI was related to worse pre-operative clinical status.

LEVEL OF EVIDENCE: Retrospective study, Level IV.

Original languageEnglish
Pages (from-to)2491-2498
Number of pages8
JournalKnee Surgery, Sports Traumatology, Arthroscopy
Volume22
Issue number10
DOIs
Publication statusPublished - Oct 1 2014

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Patellar Ligament
Knee
Patellar Dislocation
Body Mass Index
Pain
Patella
Reoperation
Ligaments
Osteoarthritis
Survival Rate
Retrospective Studies
Incidence

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Zaffagnini, S., Grassi, A., Marcheggiani Muccioli, G. M. A., Luetzow, W. F., Vaccari, V., Benzi, A., & Marcacci, M. (2014). Medial patellotibial ligament (MPTL) reconstruction for patellar instability. Knee Surgery, Sports Traumatology, Arthroscopy, 22(10), 2491-2498. https://doi.org/10.1007/s00167-013-2751-1

Medial patellotibial ligament (MPTL) reconstruction for patellar instability. / Zaffagnini, Stefano; Grassi, Alberto; Marcheggiani Muccioli, Giulio M aria; Luetzow, William F.; Vaccari, Vittorio; Benzi, Andrea; Marcacci, Maurilio.

In: Knee Surgery, Sports Traumatology, Arthroscopy, Vol. 22, No. 10, 01.10.2014, p. 2491-2498.

Research output: Contribution to journalArticle

Zaffagnini, S, Grassi, A, Marcheggiani Muccioli, GMA, Luetzow, WF, Vaccari, V, Benzi, A & Marcacci, M 2014, 'Medial patellotibial ligament (MPTL) reconstruction for patellar instability', Knee Surgery, Sports Traumatology, Arthroscopy, vol. 22, no. 10, pp. 2491-2498. https://doi.org/10.1007/s00167-013-2751-1
Zaffagnini, Stefano ; Grassi, Alberto ; Marcheggiani Muccioli, Giulio M aria ; Luetzow, William F. ; Vaccari, Vittorio ; Benzi, Andrea ; Marcacci, Maurilio. / Medial patellotibial ligament (MPTL) reconstruction for patellar instability. In: Knee Surgery, Sports Traumatology, Arthroscopy. 2014 ; Vol. 22, No. 10. pp. 2491-2498.
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AU - Zaffagnini, Stefano

AU - Grassi, Alberto

AU - Marcheggiani Muccioli, Giulio M aria

AU - Luetzow, William F.

AU - Vaccari, Vittorio

AU - Benzi, Andrea

AU - Marcacci, Maurilio

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N2 - PURPOSE: To evaluate mid-term clinical and radiographic outcomes after an original medial patellotibial ligament reconstruction in patients with patellar dislocation.METHODS: Twenty-nine knees (27 patients, 8 males and 19 females) treated for patellar dislocation with medialization of the patellar tendon medial third combined with medial and lateral release were evaluated clinically and radiographically at a mean follow-up of 6.1±2.5 years. Trochleoplasty was performed in case of severe flat trochlea (6 knees, 21%). Aetiology of patellofemoral instability was traumatic in 6 (21%) and atraumatic in 23 (79%) knees. The mean age at first dislocation was 19.2±10.1 years. WOMAC, subjective and objective IKDC, Kujala, VAS for pain, Tegner activity and EQ-5D scores were used. Anteroposterior, lateral and 30° axial views were performed for radiographic monitoring.RESULTS: There was a significant improvement of all clinical scores and significant reduction in knee pain. Twenty-four knees (83%) were normal or nearly normal by objective IKDC score at final follow-up. Radiographs showed a higher incidence of patella alta and flat trochlea in the atraumatic group. Severe signs of patellar osteoarthritis were found in 1 knee (3%). A higher body mass index (BMI) was correlated with worse pre-operative scores. Four knees (14%) were considered failures (2 further dislocations, 2 revision surgeries). The overall survival rate at 6 years was 0.811.CONCLUSIONS: The presented techniques produced good clinical and radiographic results at mean 6.1 years follow-up, with 14 % failures. Signs of patellofemoral dysplasia were found in patients with atraumatic patellar dislocation. BMI was related to worse pre-operative clinical status.LEVEL OF EVIDENCE: Retrospective study, Level IV.

AB - PURPOSE: To evaluate mid-term clinical and radiographic outcomes after an original medial patellotibial ligament reconstruction in patients with patellar dislocation.METHODS: Twenty-nine knees (27 patients, 8 males and 19 females) treated for patellar dislocation with medialization of the patellar tendon medial third combined with medial and lateral release were evaluated clinically and radiographically at a mean follow-up of 6.1±2.5 years. Trochleoplasty was performed in case of severe flat trochlea (6 knees, 21%). Aetiology of patellofemoral instability was traumatic in 6 (21%) and atraumatic in 23 (79%) knees. The mean age at first dislocation was 19.2±10.1 years. WOMAC, subjective and objective IKDC, Kujala, VAS for pain, Tegner activity and EQ-5D scores were used. Anteroposterior, lateral and 30° axial views were performed for radiographic monitoring.RESULTS: There was a significant improvement of all clinical scores and significant reduction in knee pain. Twenty-four knees (83%) were normal or nearly normal by objective IKDC score at final follow-up. Radiographs showed a higher incidence of patella alta and flat trochlea in the atraumatic group. Severe signs of patellar osteoarthritis were found in 1 knee (3%). A higher body mass index (BMI) was correlated with worse pre-operative scores. Four knees (14%) were considered failures (2 further dislocations, 2 revision surgeries). The overall survival rate at 6 years was 0.811.CONCLUSIONS: The presented techniques produced good clinical and radiographic results at mean 6.1 years follow-up, with 14 % failures. Signs of patellofemoral dysplasia were found in patients with atraumatic patellar dislocation. BMI was related to worse pre-operative clinical status.LEVEL OF EVIDENCE: Retrospective study, Level IV.

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