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Medium-term follow-up results in reconstruction of medial patello-femoral ligament (MPFL) using a bioactive synthetic ligament.
Author(s):
Ferrua P. (Italy)
,
Ferrua P. (Italy)
Affiliations:
Maione A.
,
Maione A.
Affiliations:
Tradati D.
,
Tradati D.
Affiliations:
Usellini Eva
,
Usellini Eva
Affiliations:
Uboldi F.
,
Uboldi F.
Affiliations:
Berruto M.
Berruto M.
Affiliations:
ESSKA Academy. Ferrua P. 05/09/18; 209551; P09-1043 Topic: Open Surgery
Dr. Paolo Ferrua
Dr. Paolo Ferrua
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Abstract
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Objectives: Medial patellofemoral ligament (MPFL) injury has been reported in more than 90% of the cases of patellar dislocations. It has been described as the main patellar passive stabilizer between 0° and 30° of flexion. Several different techniques have been proposed by different authors performable also in association with additional surgical procedures such as lateral-release, tibial tubercle osteotomy and trochleoplasty.
Different grafts can be used in MPFL reconstruction: autologous quadriceps or hamstring tendon, iliotibial band, allograft or synthetic ligaments.
The purpose of this study was to clinically evaluate the surgical outcome of MPFL reconstruction in objective patellofemoral instability, by using a bioactive synthetic ligament.

Methods: 26 patients (29 knees), 10 males and 16 females, underwent MPFL reconstruction as isolated surgery, or in association with other procedures, in order to provide a proper patellofemoral kinematic. The mean age of patients was 29.7±8.5 and the mean follow up was 4.43±1.9. Patients with previously ipsilateral knee surgeries for patellar insability, meniscal or ligamentous lesions were not included in the study. All patients reported a clinical history of patellofemoral dislocation or instability, confirmed by the local examination. Patellar height and trochlear dysplasia were evaluated by mean of plain X-rays (antero-posterior, sagittal and Merchant view) and TT-TG, evaluated either by CT or MRI, was determined in order to plan additional surgical procedures.
The clinical outcomes were evaluated before surgery, 1 year post-operatively and yearly until reaching final follow-up using Kujala, subjective IKDC and KOOS scores. Pain quantified with VAS scale and satisfaction according to Insall and Crosby were assessed prior to surgery, 1 year post-operatively and yearly until reaching final follow-up.

Results: All the clinical scores improved significantly: Kujala score improved from 57.79 ± 10.7 to 83.69 ± 13.3 points (p<.01) at the final follow-up, the subjective IKDC changed significantly from 44.81 ± 12.02 to 76.64 ± 16.45 and KOOS from 57.88 ± 11.44 to 81.43 ± 14.32 (p<.01). Tegner Activity Score improved as well from 2.38 ± 0.90 to 4.66 ± 1.6. Finally, pain improved from 6.52 ± 1.29 to 1.76 ± 1.82 and the satisfaction rate was very high. No patient reported recurrency of patellar dislocation during the analyzed period.

Conclusions: The present study shows that reconstruction of MPFL using synthetic ligament is a valid surgical option for the treatment of patellofemoral instability and the results are encouraging in the first post-operative period and are stable at 5 years of follow-up. The results are comparable to those collected with other grafts confirming its reliability as an alternative to auto- and allografts for MPFL reconstruction

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