A “sandwich” method of reconstruction of the medial patellofemoral ligament using a titanium interference screw for patellar instability in skeletally immature patients

• Published in: Archives of orthopaedic and trauma surgery Vol. 132; no. 8; pp. 1077 - 1083
• Main Authors: Kumahashi, Nobuyuki, Kuwata, Suguru, Tadenuma, Taku, Kadowaki, Masaru, Uchio, Yuji
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.08.2012; Springer Nature B.V
• Subjects: Adolescent; Bone Screws; Child; Female; Humans; Joint Instability - surgery; Knee; Knee Joint; Ligaments; Ligaments, Articular - surgery; Male; Medicine; Medicine & Public Health; Orthopaedic Surgery; Orthopedic Procedures - methods; Orthopedics; Patella; Retrospective Studies; Titanium; Reconstruction; Patellar instability; Medial patellofemoral ligament; Interference fit anchoring system; Epiphyseal line
• ISSN: 0936-8051; 1434-3916
• DOI: 10.1007/s00402-012-1516-5

Background No standard surgical procedure for medial patellofemoral ligament (MPFL) reconstruction exists in skeletally immature patients with patellar instability. This study aimed to evaluate the clinical effectiveness of a novel reconstruction technique for the MPFL in patients with patellar instability because of non-closure of the epiphyseal line. Methods The “sandwich” method was fixation of the patella between a double-stranded semitendinosus tendon through the posterior third of the femoral insertion of the medial collateral ligament (MCL) as a pulley with a titanium interference screw in a single patellar tunnel. Five knees in five patients were studied: four with recurrent and one with habitual patellar dislocations. Subjects underwent MPFL reconstruction with or without lateral release. Patients were evaluated using pre-operative and post-operative physical and radiographic examinations, including apprehension testing, assessment of tilting and congruence angles, medial and lateral shift ratios under stress measured using X-ray imaging, and Kujala and Lysholm scores. Results No patient experienced recurrent post-operative episodes of dislocation or subluxation. By the final follow-up, patellar apprehension had disappeared in all patients. In addition, all patients showed significant improvement in the following: tilting angle, congruence angle, lateral shift ratio, Kujala score, and Lysholm score. Conclusions The MPFL reconstruction methods, using a double-stranded semitendinosus autograft and sparing the femoral physeal line in non-closure of the epiphyseal line, provide acceptable short-term results for the treatment of patellar instability.