Abstract
Introduction
Current problem – Multiple surgical interventions for patellar instability and no defined criteria for use of medial patellofemoral ligament (MPFL) reconstruction.
Aims
Investigate the functional outcomes of MPFL reconstructions that had been performed following selection for treatment based on a defined patellar instability algorithm.
Methods
Study design – prospective case series
Treatment number – 19 knees in 17 patients
Intervention – medial patellofemoral ligament reconstruction using free gracillis tendon graft.
Inclusion critieria – Recurrent patellar dislocation with a trochlear groove - tibial tubercle (TG-TT) offset of 20mm or less, and trochlear dysplasia and patellar alta classed as normal, mild or moderate.
Primary outcome measure – Kujala patellofemoral questionnaire, assessed preoperatively and postoperatively at 6 weeks and 3, 6, 9, 12, 18, 24 months and at final follow up.
Secondary outcome measures – Fulkerson patellofemoral scores, return to work, return to preoperative sport and complications.
Results
Median follow up time was 24 months (range 12 – 36 months).
Kujala scores improved from 58 to 96 (p < 0.05) and Fulkerson scores improved from 56 to 95 (p < 0.05) pre- and postoperatively respectively.
The median return to work was 8 weeks and return to preoperative sport was 12 weeks.
There was one complication of post-operative stiffness, which settled with intensive physiotherapy.
There were no instances of repeat dislocation or patellar fracture.
There were no cases needing further surgery.
Conclusions
MPFL reconstruction, when performed following selection using our defined treatment algorithm is safe and effective for the treatment of patellar instability.
Longer follow up is required to see long term outcomes.
