Table 1 Clinical results of MPTL and MPFL reconstructions
References | N | Follow-up (mean) | Indications | Graft/technique | Associated risk factors | Results |
|---|---|---|---|---|---|---|
Ebied and El-Kholy [12] | 25 | 34 months | - At least 1 dislocation or subluxation - Persistent symptoms of instability despite 2 weeks of rehabilitation | ST and GT with distal insertion maintained One tunnel in the patella Lateral retinaculum release in 68% TTO in 32% | Trochlear dysplasia with: - Mean sulcus angle 141° Patella alta: not mentioned Lateral quadriceps vector: mean TTTG 15 mm | Results: 76% excellent, 20% good, and 4% fair IKDC scores: 54–81 Effusion of the knee: 8% |
Brown and Ahmad [13] | 2 | 14 months | Dislocation with normal osseous anatomy and mechanical alignment | ST and GT Distal insertion maintained Docking tunnel in the patella | No risk factors | Redislocation: none Kujala scores: 43–88 in 1 patient; 50–98 in 2 patients Lysholm scores: 38–97 in 1 patient 1; 55–95 in 2 patients |
Sobhy et al. [20] | 29 | 32.2 months | Recurrent dislocation with normal patellofemoral bone morphology and limb alignment with no other ligamentous deficiencies | ST and GT with distal insertion maintained Two tunnels in the patella | No risk factors | Redislocation: none Returned to previous level of activity:96.4% Kujala scores: 36.6–90.6 Lysholm scores: 51.9–89.5 VAS mean 6.3–1.8 Cincinnati scores: 50–88 Congruence angle: 11.93°–6.48° Patellar tilt: 10.9°–2.45° Subjective instability: 6.9% |
Hinckel et al. [22] | 7 | 5.5 months | Recurrent patellar dislocation with: - Subluxation in extension - Instability in flexion - Hyperextension of the knee with ligament laxity - Open growth plate with predisposing factors (increased lateral quadriceps vector, patella alta and trochlear dysplasia) | Medial quadriceps for the MPFL and medial patellar tendon for the MPTL Lateral retinaculum release in 42.9%. Shortening of the patellar tendon in 14.3% | Trochlear dysplasia with: - Modified Dejour classification: A (57.1%), B (14.3%), C (14.3%) and D (14.3%) Patella alta: CD > 1.2 (71.4%) Lateral quadriceps vector: TTTG > 20 mm (42.9%) | Lengthening of the quadriceps tendon: 14.3% Redislocation: none Satisfaction 9/10: 71.4% Wound dehiscence: 14.3% |
Drez et al. [27] | 15 | 31.5 months | - Recurrent instability after failed non-operative measures - Patients with patellar instability and a loose osteochondral fragment following patellar dislocation | ST (6 knees), ST + GT (5 knees), and Iliotibial band (3 knees). All as free grafts, one repair | - Trochlear dysplasia: not mentioned - Patella alta: normal - Lateral quadriceps vector: Q angle < 15° | Redislocation: none Results: 93% excellent and good. Fulkerson score mean: 93. Kujala score mean: 88.6. Congruence angle: 25.3°–5.5°. Arthrofibrosis: 6.7%. Quadriceps atrophy: 60%. |
Yang and Zhang [28] | 58 | 24 months | - At least two lateral patellar dislocations - Failure of a nonoperative treatment programme - 18 years at the time of surgery | ST with distal insertion maintained and fixed to tibial periosteum Proximal end fixed at the origin of the naïve MPFL in the medial aspect of the femur | - TT–TG distance > 20 mm - Grade of trochlear dysplasia - Patella alta: by Insall–Salvati ratio criteria | Results: 87.9% excellent, 6.9% good, 3.4% fair, 1.7% poor. Kujala score: 89.5 ± 10.2 IKDC score: 85 ± 13.9 VAS: 11 ± 4 Patellar tilt: 113 ± 5.2 Insall–Salvati ratio: 1.37 ± 0.19 Modified Insall–Salvati ratio: 1.95 ± 0.25 TT–TG distance: 19.9 ± 1.7 Caton–Deschamps Index: 1.31 ± 0.17 |
Sadigursky et al. [29] | 7 | 12 months | - More than two episodes of patellar dislocation - MRI demonstrating extensive rupture of the medial retinaculum were included | ST with distal insertion maintained fixed with a metallic anchor inserted into the tibia The graft is percutaneously transferred to medial edge of the patella and fixated by a metal anchor And passed to the femur it is fixed by the fourth anchor in the Schöttle point | - Patellar height: Caton-Deschamps - Trochlear dysplasia - TT–TG distance | Kujala score: 88.57 ± 5.09 Lysholm score: 87.71 ± 5.70 |
Hetsroni et al. [30] | 20 | 43 months | - History of recurrent lateral patellar instability - Physis closure - Patella which could be dislocable under anaesthesia | GT or ST with distal insertion maintained. Docking tunnel in the patella. it is fixed by the anchor in a mid-point between medial epicondyle and adductor tubercle | - BMI - Beighton score - TT–TG distance in the range (10–18 mm) - no cases of significant trochlea dysplasia or patella alta | Kujala score: 86.4 ± 12.5 Tegner score: 4.8 ± 2.4 |
Maffulli et al. [37] | 34 | 3.1 years | - Two documented episodes of unilateral patellar dislocation necessitating reduction confirmed radiographically. - All patients undertaken intensive rehabilitation for 3 to 6 months after each documented episode of dislocation | Combined reconstruction of MPFL and MPTL using an ipsilateral autologous GT, passed into two patella tunnels, looped and sutured on the adductors magnus tendon | No risk factors | Cincinnati Score increase to 90 ± 19 (p < 0.001) Kajala score increase to 82 ± 17 (p < 0.02) Insall-Salvati index remain within normal range No difference between males and females No difference with or without osteochondral lesions |