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JOURNAL ARTICLE
Austin Wetzler, Sean McMillan, Erik Brewer, Aakash Patel, Samuel Handy, Merrick Wetzler
PURPOSE: To compare the pullout strength of a bio-inductive implant (BI) used to augment a medial patellofemoral ligament (MPFL) repair with the pullout strength of semitendinosus graft in a biomechanical cadaveric model. METHODS: Six matched pairs of cadavers (12 knees) were used in the biomechanical testing comparing semitendinosus tendon (Semi-T) versus a BI. The Semi-T was harvested from 1 of the matched pairs. A standard double-bundle technique using 2 sockets in the upper two-thirds of the patella 15 mm apart was performed...
February 2024: Arthroscopy, sports medicine, and rehabilitation
#22
JOURNAL ARTICLE
Andreas Panagopoulos, Vasileios Giannatos, Panagiotis Antzoulas, John Lakoumentas, Vasileios Raoulis, Michael Hantes
BACKGROUND: The medial patellofemoral ligament (MPFL) has been investigated widely in the past 30 years, resulting in many research achievements in this field. PURPOSE: To perform a comprehensive bibliometric analysis to evaluate the 100 top-cited articles on the MPFL. STUDY DESIGN: Cross-sectional study. METHODS: We searched the Scopus database in December 2022 using the terms "medial patellofemoral ligament" OR "MPFL...
January 2024: Orthopaedic Journal of Sports Medicine
#23
JOURNAL ARTICLE
Nicolas Pascual-Leone, Danielle E Chipman, Ryann Davie, Joshua T Bram, Douglas N Mintz, Peter D Fabricant, Daniel W Green
PURPOSE: There are various anatomic risk factors for patellofemoral instability (PFI) that help guide surgical treatment, including the tibial tubercle to trochlear groove (TT-TG) distance. However, no study has analysed the temporal changes in TT-TG prior to surgical intervention. This study sought to understand the variations in TT-TG over time for pediatric patients suffering from PFI prior to surgical intervention. The authors hypothesised that the TT-TG would substantially change between time points...
January 31, 2024: Knee Surgery, Sports Traumatology, Arthroscopy
#24
JOURNAL ARTICLE
Zachary I Li, Sharif Garra, Jordan Eskenazi, Samuel R Montgomery, Jairo Triana, Andrew J Hughes, Michael J Alaia, Eric J Strauss, Laith M Jazrawi, Kirk A Campbell
PURPOSE: To investigate the rate of return to sports and sport psychological readiness between patients who underwent isolated MPFLR (iMPFLR) compared to a matched cohort of patients who underwent MPFLR with anteromedializing tibial tubercle osteotomy (MPFLR/TTO). METHODS: Patients who underwent primary MPFLR with or without TTO for recurrent patellar instability were retrospectively reviewed from 2012 to 2020 at a single institution. Preinjury sport and work information, Kujala, Tegner, Visual Analogue Score for pain, satisfaction and MPFL-Return to Sport after Injury (MPFL-RSI) score were collected...
February 2024: Knee Surgery, Sports Traumatology, Arthroscopy
#25
JOURNAL ARTICLE
Kyoung Ho Yoon, Bi O Jeong, Sung Hyun Hwang, Jin Hyung Kim, Yoon Seok Kim, Hee Sung Lee
BACKGROUND: This study aimed to compare the clinical and radiological outcomes of medial patellofemoral ligament (MPFL) reconstruction (MPFLR) between anatomic femoral tunnel positions: proximal (near adductor tubercle [AT]) and distal (near medial epicondyle [ME]). HYPOTHESIS: MPFLR with the proximal femoral tunnel position has worse clinical and radiological outcomes than those with the distal femoral tunnel position. PATIENTS AND METHODS: Fifty-five patients who underwent isolated MPFLR with proximal or distal femoral tunnels with at least 2 years of follow-up were retrospectively analyzed...
January 19, 2024: Orthopaedics & Traumatology, Surgery & Research: OTSR
#26
JOURNAL ARTICLE
Pia M Baumann-Jungmann, Paula Giesler, Julia Schneider, Matthias Jung, Dimitrios C Karampinos, Dominik Weidlich, Alexandra S Gersing, Frederic A Baumann, Andreas B Imhoff, Klaus Woertler, Fabian Bamberg, Christian Holwein
OBJECTIVE: To qualitatively and quantitatively evaluate the 2.5-year MRI outcome after Matrix-associated autologous chondrocyte implantation (MACI) at the patella, reconstruction of the medial patellofemoral ligament (MPFL), and combined procedures. METHODS: In 66 consecutive patients (age 22.8 ± 6.4years) with MACI at the patella (n = 16), MPFL reconstruction (MPFL; n = 31), or combined procedures (n = 19) 3T MRI was performed 2...
January 19, 2024: Skeletal Radiology
#27
REVIEW
Daofeng Wang, Tong Zheng, Yanwei Cao, Zhijun Zhang, Menglinqian Di, Qizhen Fu, Jianzhong Sun, Hui Zhang
PURPOSE: The purpose of this study is to systematically review and quantitatively analyse the clinical outcomes of combined derotational distal femoral osteotomy (D-DFO) and medial patellofemoral ligament reconstruction (MPFL-R) in the treatment of recurrent patellar dislocation (RPD) with increased femoral anteversion angle (FAA). METHODS: This study was performed in line with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and AMSTAR (Assessing the Methodological Quality Of Systematic Reviews) Guidelines...
January 2024: Knee Surgery, Sports Traumatology, Arthroscopy
#28
EDITORIAL
Seth Lawrence Sherman, Anna Bartsch
When planning an adolescent's primary surgery for recurrent patella instability, the surgeon must weigh the failure risk of performing medial patellofemoral reconstruction (MPFLR) versus the potential morbidity of adding a concomitant bony procedure, such as tibial tubercle osteotomy (TTO). In this age group, isolated MPFLR is an excellent operation with high clinical success, low failure rates, and favorable complication profile. Patients with high grade J-sign and severe trochlea dysplasia, apprehension into deep flexion, and extremes of bony malalignment, including elevated tibial tubercle-trochlear groove distance may benefit from "doing more" than MPFLR alone...
November 19, 2023: Arthroscopy
#29
EDITORIAL
Elizabeth Matzkin
Our understanding of patellar instability and the medial patellofemoral complex (MPFC) has evolved over the past 15 years. Despite advancements and appreciation of the anatomy and biomechanics of the MPFC, the best surgical treatment for recurrent patellar instability has yet to be determined. The goals of medial patellofemoral ligament (MPFL), medial quadriceps tendon femoral ligament (MQTFL), or MPFC reconstructions (with grafts from both the patella and quad to the femur) are to return patients back to activity and avoid complications such as recurrent instability, overconstraint, secondary arthrosis, and potential patellar fracture from surgical drill holes...
November 18, 2023: Arthroscopy
#30
JOURNAL ARTICLE
Bradley M Kruckeberg, Ryan R Wilbur, Bryant M Song, Abhinav Lamba, Christopher L Camp, Daniel B F Saris, Aaron J Krych, Michael J Stuart
BACKGROUND: The medial patellofemoral ligament (MPFL) is the primary soft tissue restraint to lateral patellar translation and is often disrupted by lateral patellar dislocation. Surgical management for recurrent patellar instability focuses on restoring the MPFL function with repair or reconstruction techniques. Recent studies have favored reconstruction over repair; however, long-term comparative studies are limited. PURPOSE: To compare long-term clinical outcomes, complications, and recurrence rates of isolated MPFL reconstruction and MPFL repair for recurrent lateral patellar instability...
January 2024: Orthopaedic Journal of Sports Medicine
#31
JOURNAL ARTICLE
Sabrina P Iddir, Kelly C Phelan, Christopher S Lee
Recurrent patellar instability is a rare complication after patellofemoral arthroplasty (PFA) and usually involves a traumatic injury. Medial patellofemoral ligament (MPFL) reconstruction after arthroplasty is a complicated and technically challenging surgical procedure because the lack of patellar bone stock due to resurfacing significantly increases the risk of patellar fracture. We present our surgical technique for revision MPFL reconstruction for recurrent instability after PFA. This technical note describes the use of 1...
December 2023: Arthroscopy Techniques
#32
REVIEW
Erdem Sahin, Reha Tandogan, Michael Liebensteiner, Guillaume Demey, Asim Kayaalp
Surgical intervention is the treatment of choice for recurrent lateral patellar instability. Surgery should be considered for first time lateral patella dislocations with osteochondral fractures or underlying anatomical risk factors. Primary repair and nonanatomical imbrications/reconstructions have fallen out of favor due to abnormal biomechanics and high rates of recurrence. Anatomical reconstruction of the MPFL using a variety of auto and allograft tissues have yielded good outcomes and low redislocation rates...
January 9, 2024: EFORT Open Reviews
#33
JOURNAL ARTICLE
George C Balazs, Kathleen N Meyers, Elizabeth R Dennis, Suzanne A Maher, Beth E Shubin Stein
PURPOSE: To characterize the ability of the intact medial patellofemoral ligament (MPFL) and the adductor transfer and adductor sling MPFL reconstruction techniques to resist subluxation and dislocation in a cadaveric model. METHODS: Nine fresh-frozen cadaveric knees were placed on a custom testing fixture with the femur fixed parallel to the floor, the tibia placed in 20° of flexion, and the patella attached to a load cell. The patella was displaced laterally, and subluxation load (in newtons), dislocation load (in newtons), maximum failure load (in newtons), patellar displacement at failure, and mode of failure were recorded...
February 2024: Arthroscopy, sports medicine, and rehabilitation
#34
REVIEW
Panayiotis Tanos, Chryssa Neo, Edwin Tong, Andrea Volpin
(1) Background: Acute patella dislocation (APD) is a prevalent knee injury, with rates between 5.8-77.8 per 100,000. APD often results in repeat lateral patella dislocations due to the instability of the medial patellofemoral ligament (MPFL). Non-operative treatments have a 50% recurrence rate. While autologous grafting for MPFL has been favored, surgeons are now exploring synthetic grafts. We aimed to assess the effectiveness of synthetic grafts in MPFL reconstruction surgeries for repeated patellar dislocations; (2) Methods: Our research was based on a thorough search from the National Institute of Health and Clinical Excellence Healthcare Databases, using the Modified Coleman Methodology Score for quality assessment; (3) Results: Six studies met the inclusion criteria...
November 28, 2023: Medical Sciences: Open Access Journal
#35
JOURNAL ARTICLE
Andrew L Schaver, Meaghan A Tranovich, Olivia C O'Reilly, Matthew J Bollier, Kyle R Duchman, Brian R Wolf, Robert W Westermann
It is unclear if bracing is necessary after isolated medial patellofemoral ligament reconstruction (MPFLr) for recurrent patellar instability. We hypothesize that patients who did not use a brace will have similar outcomes to those who were braced postoperatively. A retrospective review of patients who underwent isolated MPFLr from January 2015 to September 2020 at a single institution was performed. Those with less than 6 weeks of follow-up were excluded. The braced group was provided a hinged-knee brace postoperatively until the return of quadriceps function, which was determined by the treating physical therapist (brace, "B"; no brace, "NB")...
February 7, 2024: Journal of Knee Surgery
#36
REVIEW
Borna Guevel, Abdoulie Njai, Aly Raboff, Andrew Hillman, Michael Barton, Mininder S Kocher
BACKGROUND: There has been recent debate regarding the optimal surgical management strategy for recurrent patellofemoral instability in the presence of an increased tibial tuberosity-trochlear groove (TT-TG) distance. In particular, performing a combined tibial tuberosity osteotomy (TTO) and medial patellofemoral ligament reconstruction (MPFLR) for patients with a TT-TG >20 mm has been questioned, with the hypothesis that an isolated MPFLR (iMPFLR) would be just as effective. PURPOSE: To pool and compare outcomes after MPFLR+TTO versus iMPFLR in patients with a TT-TG >20 mm...
December 2023: Orthopaedic Journal of Sports Medicine
#37
REVIEW
Tyler J Stavinoha, Kevin G Shea
PURPOSE OF REVIEW: To update and concepts for pediatric physeal-sparing patellofemoral stabilization surgery. RECENT FINDINGS: Recent studies have demonstrated positive results in patellofemoral stabilization in pediatric populations with physeal-sparing techniques that limit the potential for physeal damage. Comprehensive analysis remains limited by population and technique heterogeneity. Physeal-sparing patellofemoral stabilization, most significantly through physeal-sparing reconstruction of the medial patellofemoral ligament complex remains a viable option for pediatric patients with recurrent patellofemoral instability...
December 11, 2023: Current Reviews in Musculoskeletal Medicine
#38
JOURNAL ARTICLE
Kyoung Ho Yoon, Cheol Hee Park, Sung Hyun Hwang, Hyunjae Baek, Hee Sung Lee
BACKGROUND: This study aimed to compare the clinical and radiological outcomes of medial patellofemoral ligament reconstruction (MPFLR) between anatomic femoral tunnel positions at anterior and posterior footprints. METHODS: Fifty-seven patients who underwent MPFLR for patellofemoral instability with anterior or posterior femoral tunnels between 2014 and 2021 with at least 2 years of follow-up were retrospectively analyzed. Based on postoperative images, the femoral tunnel positions anterior to the line connecting the adductor tubercle and medial epicondyle were assigned to the anterior group, group A, and those posterior to the line to the posterior group, group P...
December 6, 2023: BMC Musculoskeletal Disorders
#39
JOURNAL ARTICLE
Joana Almeida, Ana Rita Senra, Maria João Leite, Paulo Oliveira, António Sousa, João Torres
PURPOSE: There is no consensus for management of patellar instability, even in the case of malalignment. The purpose of the review is to evaluate outcomes in the literature of MPFL reconstruction with and without tibial tubercle osteotomy. METHODS: Two databases PubMed and Scopus were searched for studies comparing MPFL reconstruction with and without concomitant tibial tuberosity osteotomy. PRISMA guidelines were followed. Data on functional outcomes via Kujala score, redislocation rates and return to sport rates were reported...
October 2023: Journal of Clinical Orthopaedics and Trauma
#40
JOURNAL ARTICLE
Eoghan T Hurley, Seth L Sherman, Jorge Chahla, Safa Gursoy, Michael J Alaia, Miho J Tanaka, J L Pace, Laith M Jazrawi, Andrew J Hughes, Elizabeth A Arendt, Olufemi R Ayeni, Ashley J Bassett, Kevin F Bonner, Christopher L Camp, Kirk A Campbell, Cordelia W Carter, Michael G Ciccotti, Andrew J Cosgarea, David Dejour, Cory M Edgar, Brandon J Erickson, João Espregueira-Mendes, Jack Farr, Lutul D Farrow, Rachel M Frank, Kevin B Freedman, John P Fulkerson, Alan Getgood, Andreas H Gomoll, John A Grant, F W Gwathmey, Fares S Haddad, Laurie A Hiemstra, Betina B Hinckel, Ian Savage-Elliott, Jason L Koh, Aaron J Krych, Robert F LaPrade, Zachary I Li, Catherine A Logan, Guillem Gonzalez-Lomas, Brian J Mannino, Martin Lind, Bogdan A Matache, Elizabeth Matzkin, Bert Mandelbaum, Thomas F McCarthy, Mary Mulcahey, Volker Musahl, Philippe Neyret, Clayton W Nuelle, Sam Oussedik, Peter Verdonk, Scott A Rodeo, Fiachra E Rowan, Matthew J Salzler, Patrick C Schottel, Fintan J Shannon, Andrew J Sheean, Sabrina M Strickland, Brian R Waterman, Jocelyn R Wittstein, Michael Zacchilli, Stefano Zaffagnini
AIMS: The aim of this study was to establish consensus statements on medial patellofemoral ligament (MPFL) reconstruction, anteromedialization tibial tubercle osteotomy, trochleoplasty, and rehabilitation and return to sporting activity in patients with patellar instability, using the modified Delphi process. METHODS: This was the second part of a study dealing with these aspects of management in these patients. As in part I, a total of 60 surgeons from 11 countries contributed to the development of consensus statements based on their expertise in this area...
December 1, 2023: Bone & Joint Journal
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