MPFL Reconstruction Using Quadriceps Tendon Graft - Our Five Years Expirience

Authors

  • Jugoslav Marinkovic Military Medical Academy, Clinic for Orthopedic Surgery and Traumatology, Belgrade, Serbia
  • Aleksandar Radunovic Military Medical Academy, Clinic for Orthopedic Surgery and Traumatology, Belgrade, Serbia
  • Vladimir Vranic Military Medical Academy, Clinic for Orthopedic Surgery and Traumatology, Belgrade, Serbia
  • Munitlak Stasa Military Medical Academy, Clinic for Orthopedic Surgery and Traumatology, Belgrade, Serbia

DOI:

https://doi.org/10.12974/2313-0954.2020.07.4

Keywords:

Traumatic luxation, Patella, Reconstruction, Quadriceps tendon, Medial patelofemoral ligament.

Abstract

The primary traumatic luxation of the knee cup affects the general population with an incidence of 5.8 per 100,000 (3), while in the younger age group (10-17 years) it goes up to 29 per 100,000. Most patients will not have instability after non-operative treatment, while repeated luxation will occur in 15 to 44% of cases. The use of the quadriceps tendon for medial patelofemoral ligament (MPFL) reconstruction is a method described independently by Steensen et al. and Noyes and Albright. Today have more and more supporters because of their simplicity, minimal trauma and good postoperative results. Reconstruction of MPFL with quadriceps tendon (QT) for recurrent patellofemoral instability started in our Clinic in 2014. Indications for surgery were patients who have had clear clinical and radiological signs of instability, tibial tubercle-trochlear groove distance (TT-TG) < 20 mm, dysplastic trochlea grade A according to the Dejour classification. For clinical testing we used apprehension and Veselko's test. In our clinic 22 patients were operated in past fifth years. This study shows result of 17 patients. We noticed a significant improvement in patients in daily activities (instability, swelling, pain, kneeling, squatting, climbing stairs). All patients had full range of motion after approximately 3 months. The initial Lyscholm score value was 69.2 ± 6.4 while after two years 88.3 ± 3,2. Our observation shows that MPFL reconstruction with quadriceps graft in short time follow-up in selected cases may have very satisfactory results. The method itself is simple, inexpensive, with small complication rate and with great patients satisfaction.

References

Dye SF: An evolutionary perspective of the knee. J Bone Joint Surg Am 1987; 69(7): 976-983. https://doi.org/10.2106/00004623-198769070-00004

Kaufer H: Mechanical function of the patella. J Bone Joint Surg Am 1971; 53(8): 1551-1560. https://doi.org/10.2106/00004623-197153080-00007

Donald C Fithian, Elizabeth W Paxton, Mary Lou Stone, Patricia Silva, Daniel K Davis, David A Elias, Epidemiology and natural history of acute patellar dislocation. Am J Sports Med 2004; 32: 1114-21 https://doi.org/10.1177/0363546503260788

Kaplan EB. Factors responsible for the stability of the knee joint. Bull Hosp Joint Dis 1957; 18: 51-9.

Baldwin JL. The anatomy of the medial patellofemoral ligament. Am J Sports Med 2009; 37: 2355-61. https://doi.org/10.1177/0363546509339909

Philippot R, Choteau J, Wegrzyn J, Testa R, Fessy MH, Moyen B. Medial patellofemoral ligament anatomy: implications for its surgical reconstruction. Knee Surg Sports Traumatol Arthrosc 2009; 17: 475-9. https://doi.org/10.1007/s00167-009-0722-3

Nomura E, Inoue M, Osada N. Anatomical analysis of the medial patellofemoral ligament of the knee, especially the femoral attachment. Knee Surg Sports Traumatol Arthrosc 2005; 13: 510-5. https://doi.org/10.1007/s00167-004-0607-4

Desio SM, Burks RT, Bachus KN. Soft tissue restraints to lateral patellar translation in the human knee. Am J Sports Med 1998; 26: 59-65. https://doi.org/10.1177/03635465980260012701

Amis A, Firer P, Mountney J, Senavongse W, Thomas NP. Anatomy and biomechanics of the medial patellofemoral ligament. Knee 2003; 10: 215-20. https://doi.org/10.1016/S0968-0160(03)00006-1

Greiwe MR, Saifi C, Ahmad CS, Gardner TR. Anatomy and biomechanics of patellar instability. Oper Tech Sports Med 2010; 18: 62-7. https://doi.org/10.1053/j.otsm.2009.12.014

Balcarek P, Jan Ammon, Stephan Frosch, Tim A Walde, Jan P Schüttrumpf, Keno G Ferlemann, Helmut Lill, Magnetic resonance imaging characteristics of the medial patellofemoral ligament lesion in acute lateral patellar dislocations considering trochlear dysplasia, patella alta, and tibial tuberosity-trochlear groove distance. Arthroscopy. 2010; 26: 926-935. https://doi.org/10.1016/j.arthro.2009.11.004

Maenpaa H, Lehto MU. Patellar dislocation. The long-term results of nonoperative management in 100 patients. Am J Sports Med 1997; 25: 213-7. https://doi.org/10.1177/036354659702500213

Mehta VM, Inoue M, Nomura E, Fithian DC. An algorithm guiding the evaluation and treatment of acute primary patellar dislocations. Sports Med Arthrosc Rev 2007; 15: 78- 81. https://doi.org/10.1097/JSA.0b013e318042b695

Steensen R.N., Dopirak R.M., Maurus P.B. A simple technique for reconstruction of the medial patellofemoral ligament using a quadriceps tendon graft. Arthroscopy. 2005; 21: 365-370. https://doi.org/10.1016/j.arthro.2004.10.007

Noyes F.R., Albright J.C. Reconstruction of the medial patellofemoral ligament with autologous quadriceps tendon. Arthroscopy. 2006; 22: 904.1-7 https://doi.org/10.1016/j.arthro.2005.12.058

Dejour H, Walch G, Nove-Josserand L, Guier C. Factors of patellar instability: an anatomic radiographic study. Knee Surg SportsTraumatol Arthrosc 1994; 2: 19-26. https://doi.org/10.1007/BF01552649

Dejour D, Saggin PR, Meyer X, Tavernier T. Standard x-ray examination: patellofemoral disorders. Berlin: Springer- Verlag; 2010; p. 51-9. https://doi.org/10.1007/978-3-642-05424-2_6

Fairbank HA. Internal derangement of the knee in children and adolescents. Proc R Soc Med 1936; 30: 427-32. https://doi.org/10.1177/003591573703000450

Goslar T, Veselko M. Vloga medialnega patelofemoralnega ligamenta pri stabilizaciji pogačice v patelofemoralnem sklepu in načini rekonstrukcije patelofemoralnega ligamenta. Med Razgl 2007; 46: 321-28(slovenački)

Schneider D, Grawe B, Magnussen R, Ceasar A, Parikh S, Wall E, Colosimo A, Kaeding C, Myer G (2016) Outcomes after isolated medial patellofemoral ligament reconstruction for the treatment of recurrent lateral patellar dislocations: a systematic review and meta-analysis. Am J Sports Med. 2016 Nov; 44(11): 2993-3005 https://doi.org/10.1177/0363546515624673

Hsaio M, Owens B, Burks R, Sturdivant R, Cameron K. Incidence of acute traumatic patellar dislocation among active-duty United States military service members. Am J Sports Med 2010; 38(10): 1997-2004 https://doi.org/10.1177/0363546510371423

Arendt EA. MPFL reconstruction for PF instability. The soft (tissue) approach. Orthop Traumatol Surg Res 2009; 95(8 Suppl 1): S97-100. https://doi.org/10.1016/j.otsr.2009.09.002

Fithian D, Khan N. Medial patellofemoral ligament reconstruction. Oper Tech Sports Med 2010; 18: 93-7. https://doi.org/10.1053/j.otsm.2009.12.008

Tuxøe JI, Teir M, Winge S, and Nielsen PL. The medial patellofemoral ligament: a dissection study. Knee Surg Sports Traumatol Arthrosc. 2002; 10: 138-140 https://doi.org/10.1007/s00167-001-0261-z

Conlan T, Garth WP, and Lemons JE. Evaluation of the medial soft-tissue restraints of the extensor mechanism of the knee. J Bone Joint Surg Am. 1993; 75: 682-693 https://doi.org/10.2106/00004623-199305000-00007

Noyes FR, Butler DL, Grood ES, Zernicke RF, Hefzy MS. Biomechanical analysis of human ligament grafts used in knee-ligament repairs and reconstructions. J Bone Joint Surg Am 1984; 66: 344-52. https://doi.org/10.2106/00004623-198466030-00005

Herbort M. et al. Biomechanical properties of quadriceps tendon MPFL reconstruction in comparison to the Intact MPFL. A human cadaveric study. The Knee 2014; 21: 1169- 1174. https://doi.org/10.1016/j.knee.2014.07.026

Mackay ND, Smith NA, Parsons N, Spalding T, Thompson P, Sprowson AP. Medial patellofemoral ligament reconstruction for patellar dislocation: a systematic review. Orthop J Sport Med 2014; 8. https://doi.org/10.1177/2325967114544021

Fink C., Veselko M. Minimally Invasive Reconstruction of the Medial Patellofemoral Ligament Using Quadriceps Tendon. Arthroscopy Techniques 2014; 3(3): e325-e329 https://doi.org/10.1016/j.eats.2014.01.012

Bojanić I, MAHNIK A, Jelić M, Josipović M, Smoljanović T ,Ligament koji zaslužuje pozornost -medijalni patelofemoralni ligament Liječ Vjesn 2012;134: 224-232 (hrvatski)

Deepak G. The Superficial Quad Technique for Medial Patellofemoral Ligament Reconstruction Arthroscopy Techniques, 2015; 4(5): e569-e575 https://doi.org/10.1016/j.eats.2015.06.003

S. Rhatomy, Noha Roshadiansyah Soekarno, Riky Setyawan, Shinta Primasara, Imelda L Gaol, Nicolaas C Budipharama Minimal invasive MPFL reconstruction using quadriceps tendon graft with lateral release: 2 years follow up / International Journal of Surgery Open 2019; 17: 20-26 https://doi.org/10.1016/j.ijso.2019.01.004

Lee D, Park Y, Song S, Hwang S, Park J, Kang D. Which technique is better for treating patellar Dislocation? A systematic review and meta-analysis. Arthrosc J Arthrosc Relat Surg 2018; 34(11): 3082e93. https://doi.org/10.1016/j.arthro.2018.06.052

Downloads

Published

2020-06-06

How to Cite

Marinkovic, J., Radunovic, A., Vranic, V., & Stasa, M. (2020). MPFL Reconstruction Using Quadriceps Tendon Graft - Our Five Years Expirience. International Journal of Orthopedics and Rehabilitation, 7, 30–36. https://doi.org/10.12974/2313-0954.2020.07.4

Issue

Section

Articles