Medial patellofemoral ligament reconstruction using nonresorbable sutures yields comparable outcomes to reconstruction with a pedicled quadriceps tendon autograft when performed in addition to bony risk factor correction

• Published in: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA Vol. 31; no. 1; pp. 264 - 271
• Main Authors: Milinkovic, Danko Dan, Zimmermann, Felix, Balcarek, Peter
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.01.2023; Springer Nature B.V
• Subjects: Adult; Age; Allografts; Autografts; Female; Females; Humans; Joint Instability - etiology; Joint Instability - surgery; Joints (anatomy); Knee; Knee Joint; Lateral stability; Ligaments; Ligaments, Articular - surgery; Male; Males; Medicine; Medicine & Public Health; Orthopedics; Pain; Patellar Dislocation - surgery; Patellofemoral Joint - surgery; Quadriceps muscle; Quality assessment; Quality of Life; Reconstructive surgery; Risk analysis; Risk Factors; Sports Medicine; Sutures; Tendons; Tendons - transplantation; Young Adult; Synthetic graft; Autograft; MPFL reconstruction; Risk factors; Bony correction; BPII 2.0
• ISSN: 0942-2056; 1433-7347
• DOI: 10.1007/s00167-022-07104-1

Purpose To evaluate the results for reconstruction of the medial patellofemoral ligament using synthetic nonresorbable sutures (S-MPFL-R) in comparison to MPFL-R using quadriceps tendon autograft (QT-MPFL-R) in patients undergoing simultaneous correction of anatomic risk factors for lateral patellar instability (LPI) at a minimum of 2 years of follow-up. Methods Between November 2018 and June 2019, 19 patients (male/female 8/11; mean age 26 ± 7 years) underwent S-MPFL-R (FiberTape ® ) in combination with the correction of predisposing risk factors for LPI. The control group of 38 patients (male/female 16/22, mean age 26 ± 6 years) who underwent QT-MPFL-R was matched 1:2 by sex, age, anatomic risk factors, and concomitant surgical correction of bony risk factors. The Banff Patella Instability Instrument 2.0 (BPII 2.0) and a numerical analog scale (NAS 0–10) for patellofemoral pain and subjective knee joint function were used to assess patients’ reported quality of life before and after surgery. Results The BPII 2.0 score increased from 35.0 ± 21.7 points to 79.7 ± 13.3 points ( p  < 0.0001) in the S-MPRL-R group and from 44.3 ± 19.6 points to 80.9 ± 15 points ( p  < 0.0001) in the QT-MPFL-R group from preoperatively to postoperatively, respectively, without any significant difference between the groups. In the S-MPFL-R group and QT-MPFL-R group, 95% (18/19) and 92% (35/38) of patients, respectively, crossed the minimally clinically important difference reported for the BPII 2.0. NAS values for pain and subjective knee joint function improved significantly in both groups ( p  < 0.0001, p  < 0.0001) without any significant difference between the groups at the final follow-up. Conclusions This study demonstrates that nonresorbable sutures can serve as a viable option for MPFL-R, yielding comparable outcomes compared to quadriceps tendon autograft reconstruction when performed concomitantly with the correction of anatomic risk factors for LPI. This option reduces the need for autologous tendon harvesting or the use of allografts for MPFL-R. Level of evidence Level III.