title: Clinical and radiological outcome of medial patellofemoral ligament reconstruction with a semitendinosus autograft for patella instability.
abstract: BACKGROUND
  Recurrent patellar instability is a common problem after dislocation. The medial patellofemoral ligament (MPFL) contributes 40-80% of the total medial restraining forces. This study assessed the clinical and radiological outcome after a follow-up of 4 years after linear MPFL reconstruction using an ipsilateral Semitendinosus tendon autograft.
  
  
  METHODS
  15 knees in 12 patients were examined with a mean of 47 months after linear reconstruction of the MPFL at a mean age of 30 years. 3 knees underwent previous surgery. 3 patients had mild trochlear dysplasia grade I or II, according to the classification of Dejour. If preoperative tibial tuberosity-trochlear groove distance (TTTG) was more than 15 mm, patients underwent additional medialisation of the tibial tuberosity (n=8) creating a similar postoperative situation for all patients. All patients were available for a postoperative evaluation, which consisted of a subjective questionnaire, the Kujala score, and the recording of potential patellar redislocation and apprehension. Patellar height and tilt was measured on plain radiographs. Postoperative CT scans were performed in patients with an additional tibial tuberosity-transfer.
  
  
  RESULTS
  Postoperatively, one patient reported on recurrent bilateral redislocation. Physical examination however revealed no findings. Three knees presented with persistent patellar apprehension. Thirteen knees had improved subjectively after surgery. The mean Kujala score improved significantly from 55.0 to 85.7 points. The patellar tilt decreased significantly from 11.3 degrees to 9.2 degrees. Four knees had patella alta preoperatively, but only two at the latest follow-up visit. Previous surgery or additional trochlear dysplasia had no influence on the clinical outcome.
  
  
  CONCLUSIONS
  MPFL reconstruction improves clinical symptoms, reduces the patellar tilt substantially, and may correct patella alta. Additional mild trochlear dysplasia did not compromise the outcome; however, this fact needs further attention in a larger study group.
authors.affiliation: Orthopedic Department, University Hospital Balgrist Zurich, Switzerland.
authors.forename: P B
authors.initials: PB
authors.lastname: Schöttle
authors.forename: S F
authors.initials: SF
authors.lastname: Fucentese
authors.forename: J
authors.initials: J
authors.lastname: Romero
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000601:surgery*; D007718:Knee Injuries / Q000601:surgery; D007719:Knee Joint / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D017888:Medial Collateral Ligament, Knee / Q000000981:diagnostic imaging / Q000601:surgery*; D010329:Patella / Q000033:anatomy & histology / Q000601:surgery*; D031222:Patellar Dislocation / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography; D012189:Retrospective Studies; D013710:Tendons / Q000637:transplantation; D014182:Transplantation, Autologous; D016896:Treatment Outcome