The effect of tight medial patellofemoral ligament fixation
ESSKA Academy. Nakamura K. 11/08/19; 284438; epESMA-31 Topic: I1 - Medial patellofemoral ligament (MPFL) reconstruction
Kaori Nakamura
Kaori Nakamura
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The effect of tight medial patellofemoral ligament fixation

ePoster - epESMA-31

Topic: General Sports Medicine

Nakamura K., Hayashi M., Ogiuchi T., Yoshimura H., Takahashi T., Matsumura E., Uomizu M., Hasegawa S., Seki R., Hoshino A.
Kawaguchi Kogyo General Hospital, Saitama, Japan

Introduction: There are various treatment options for medial patellofemoral ligament reconstruction (MPFL-R). MPFL-R techniques differ in the graft used, fixation angle, force, and position. But there remains a lack of evidence regarding the optimal knee angle position and tension during MPFL fixation. It is important to know how to fix the graft to avoid the complications of stiffness in knee flexion anterior knee pain and patellar chondromalacia due to increased contact pressures.
Aims; This study is to compare the fixation angle and force in MPFL-R. We hypotheses that thigh fixation resulted in good outcome 1 year after the operation.
Methods: The clinical and radiographic results of MPFL-R at our institution between 2009 and 2019 were evaluated retrospectively. Two-fold Hamstrings tendon was used and two anchors for patellar fixation and one suspensory button was used at femur side. From December 2009 to March 2014, we fixed the graft with soft tension with the knee in 60° (L group). From April 2014 to August 2018, we fixed the graft with tight tension with the knee in 30°indicated using arthroscopy (T group). We evaluated Tilting angle (TA) (°), Insall-Salvati ratio (ISR) (%), and congruence angle (CA) (°) before and after surgery. Crosby & Insall evaluation and Range of motion (ROM) (°) war evaluated 1 year after the operation.
Results: 75 patients agreed to be included for this study (L group=25, T group=50).
TA in T group just after surgery was significantly smaller than that of L group (p=.0038).
Insall-Salvati ratio in the T group after reconstruction was significantly smaller than that of the L group (p=.0038). Even if there was no significant difference of TA before operation between two groups (p=0.26), but T group was significantly smaller than the L group after the operation (p=.0038). Also, there was no significant difference in ISR before operation (p=.30), but ISR was significantly smaller in the group after the operation (p=.00002). There was no significant difference in CA before and after operation between the two groups (p=.67). There was no difference between the two groups in Crosby & Insall evaluation and ROM1 year after the operation. No recurrent dislocations were observed in T group.
Conclusions: MPFL is the medial stabilizer of the patella during the first 30°of knee flexion. Tight fixation with lower fixation angle provided a significant reduction in patellar tilt and height and appear to be a safer and better fixation.
The effect of tight medial patellofemoral ligament fixation

ePoster - epESMA-31

Topic: General Sports Medicine

Nakamura K., Hayashi M., Ogiuchi T., Yoshimura H., Takahashi T., Matsumura E., Uomizu M., Hasegawa S., Seki R., Hoshino A.
Kawaguchi Kogyo General Hospital, Saitama, Japan

Introduction: There are various treatment options for medial patellofemoral ligament reconstruction (MPFL-R). MPFL-R techniques differ in the graft used, fixation angle, force, and position. But there remains a lack of evidence regarding the optimal knee angle position and tension during MPFL fixation. It is important to know how to fix the graft to avoid the complications of stiffness in knee flexion anterior knee pain and patellar chondromalacia due to increased contact pressures.
Aims; This study is to compare the fixation angle and force in MPFL-R. We hypotheses that thigh fixation resulted in good outcome 1 year after the operation.
Methods: The clinical and radiographic results of MPFL-R at our institution between 2009 and 2019 were evaluated retrospectively. Two-fold Hamstrings tendon was used and two anchors for patellar fixation and one suspensory button was used at femur side. From December 2009 to March 2014, we fixed the graft with soft tension with the knee in 60° (L group). From April 2014 to August 2018, we fixed the graft with tight tension with the knee in 30°indicated using arthroscopy (T group). We evaluated Tilting angle (TA) (°), Insall-Salvati ratio (ISR) (%), and congruence angle (CA) (°) before and after surgery. Crosby & Insall evaluation and Range of motion (ROM) (°) war evaluated 1 year after the operation.
Results: 75 patients agreed to be included for this study (L group=25, T group=50).
TA in T group just after surgery was significantly smaller than that of L group (p=.0038).
Insall-Salvati ratio in the T group after reconstruction was significantly smaller than that of the L group (p=.0038). Even if there was no significant difference of TA before operation between two groups (p=0.26), but T group was significantly smaller than the L group after the operation (p=.0038). Also, there was no significant difference in ISR before operation (p=.30), but ISR was significantly smaller in the group after the operation (p=.00002). There was no significant difference in CA before and after operation between the two groups (p=.67). There was no difference between the two groups in Crosby & Insall evaluation and ROM1 year after the operation. No recurrent dislocations were observed in T group.
Conclusions: MPFL is the medial stabilizer of the patella during the first 30°of knee flexion. Tight fixation with lower fixation angle provided a significant reduction in patellar tilt and height and appear to be a safer and better fixation.
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