Medial patellofemoral ligament reconstruction in patients with lateral patellar instability and trochlear dysplasia.
BACKGROUND
Reconstruction of the medial patellofemoral ligament has been proven to restore stability in patients with lateral patellar instability. No study to date has examined the results in a patient population with the predisposing factor of femoral trochlear dysplasia.


OBJECTIVE
Reconstruction of the medial patellofemoral ligament restores stability and provides pain relief in patients who have lateral patellar instability in association with trochlear dysplasia.


METHODS
Case series; Level of evidence, 4.


METHODS
Thirty-four patients with chronic patellar instability and trochlear dysplasia were treated with medial patellofemoral ligament reconstruction using an adductor tendon autograft, bone-quadriceps tendon autograft, or bone-patellar tendon allograft. All patients were evaluated preoperatively and postoperatively with Kujala, Lysholm, and Tegner scores at a minimum of 24 months.


RESULTS
Thirty-four patients were followed for a mean of 66.5 months (range, 24-130 months) after surgery. Kujala scores improved from 53.3 to 90.7, Lysholm scores improved from 52.4 to 92.1, and Tegner activity scores improved from 3.1 to 5.1. All improvements were highly statistically significant (P < .001). No statistical difference was found between the postoperative Lysholm, Kujala, and Tegner scores and the degree of dysplasia, graft type, or degree of symptoms. There were 85.3% and 91.1% good and excellent results based on Kujala and Lysholm scores, respectively. No recurrent dislocations have occurred.


CONCLUSIONS
Medial patellofemoral ligament reconstruction provides excellent long-term pain relief and functional return in patients with patellar instability and femoral trochlear dysplasia. In addition, reconstruction prevents recurrent dislocation, despite the diminished bony constraint of a dysplastic trochlea.
Wayne State University, Department of Orthopedic Surgery, UHC-7C, 4201 St Antoine, Detroit, MI 48201, USA. timmsteiner@hotmail.com
Timothy M
TM
Steiner
Roger
R
Torga-Spak
Robert A
RA
Teitge
D000328:Adult; D001848:Bone Diseases, Developmental / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D050376:Bone-Patellar Tendon-Bone Grafting / Q000379:methods; D005260:Female; D005269:Femur / Q000503:physiopathology / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D017888:Medial Collateral Ligament, Knee / Q000503:physiopathology / Q000601:surgery*; D010146:Pain / Q000209:etiology; D031222:Patellar Dislocation / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D011182:Postoperative Care; D011183:Postoperative Complications / Q000601:surgery; D011300:Preoperative Care; D016059:Range of Motion, Articular; D012086:Reoperation; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D016896:Treatment Outcome