title: Medial patellofemoral ligament reconstruction with a divergent patellar transverse 2-tunnel technique.
abstract: BACKGROUND
  The medial patellofemoral ligament (MPFL) is the primary passive restraint to lateral patellar dislocation and there is increasing awareness of its role in recurrent lateral patellar instability.
  
  
  OBJECTIVE
  This study was conducted to prospectively analyze the functional results of a modified MPFL reconstruction technique in recurrent patellar dislocation.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  Forty-eight patients (51 knees) with at least 3 episodes of lateral patellar dislocation who had been treated with a 6-month rehabilitation protocol were included in this study. All patients practiced sports regularly. Reconstruction was with a semitendinosus tendon using a divergent 2-tunnel technique. Outcome was evaluated with the Kujala, Larsen, modified Lysholm, and Fulkerson outcome scores. Patient satisfaction with range of motion, pain, and sporting activities was also assessed.
  
  
  RESULTS
  Three patients were lost at the final follow-up, giving a follow-up rate of 94%. The mean follow-up was 33 months. There was no patella dislocation postoperatively. The mean Kujala score improved significantly (P < .01) from 56.7 ± 17.7 (2 × standard deviation) preoperatively to 86.8 ± 14.4 postoperatively. The mean Larsen score improved significantly (P < .01) from 12.4 ± 3.2 to 17.1 ± 2.7. The mean Fulkerson score improved significantly (P < .01) from 59.2 ± 21.8 to 90.1 ± 14. The mean modified Lysholm score improved significantly (P < .01) from 57.6 ± 19.6 to 88.1 ± 16.2. Sixty-four percent of patients returned to the same type of sport at the same level, 16% reduced the level or type of sport for reasons unrelated to the surgery, while 20% reduced the level of sport or changed it for reasons related to surgery. Eighty-seven percent were either satisfied or very satisfied with the pain relief achieved. The patellar tilt decreased significantly from a preoperative mean of 11.1° to 8.9° at the last follow-up (P = .02). The mean preoperative Insall-Salvati ratio of 1.1 decreased to 1.06, although the change was not significant (P = .1).
  
  
  CONCLUSIONS
  The results of modified MPFL reconstructions are encouraging, with minimal risks of redislocation and an overall patient satisfaction rate of over 80%. These early and medium-term results are comparable with those of other MPFL reconstruction techniques reported in the literature.
authors.affiliation: Molise University, Science of Health, Orthopaedic Department, Campobasso, Italy.
authors.forename: Alfredo Schiavone
authors.initials: AS
authors.lastname: Panni
authors.forename: Mahbub
authors.initials: M
authors.lastname: Alam
authors.forename: Simone
authors.initials: S
authors.lastname: Cerciello
authors.forename: Michele
authors.initials: M
authors.lastname: Vasso
authors.forename: Nicola
authors.initials: N
authors.lastname: Maffulli
mesh_terms: D000293:Adolescent; D000328:Adult; D001178:Arthroplasty / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008023:Ligaments, Articular / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000637:transplantation*; D031222:Patellar Dislocation / Q000000981:diagnostic imaging / Q000601:surgery*; D017060:Patient Satisfaction; D011446:Prospective Studies; D011859:Radiography; D013177:Sports / Q000502:physiology; D014182:Transplantation, Autologous; D055815:Young Adult