title: Medial retinaculum plasty versus medial patellofemoral ligament reconstruction for recurrent patellar instability in adults: a randomized controlled trial.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the clinical results of medial retinaculum plasty (MRP) and medial patellofemoral ligament reconstruction (MPFLR) with concomitant lateral retinacular release with respect to imaging and functional results.
  
  
  METHODS
  Seventy patients with recurrent patellar instability were randomly divided into 2 groups based on their birth years (even/odd), receiving either MRP or MPFLR. Lateral retinacular release was also performed in all patients. Preoperatively, all patients received magnetic resonance imaging to evaluate the injury to the medial patellofemoral ligament. Computed tomography was performed before surgery and at follow-up. The subjective symptoms and functional outcome were evaluated preoperatively and postoperatively with the Kujala score, the Tegner activity score, and a subjective questionnaire. The physical apprehension test was examined, and redislocation was recorded.
  
  
  RESULTS
  Patients were followed up for a mean period of 40 months (range, 24 to 55 months). The measurement results for the congruence angle, patellar tilt angle, and patellar lateral shift decreased significantly from the pretreatment measurements to the normal range at the latest follow-up, without a statistically significant difference between the 2 groups (P > .05). The median Kujala score had significantly improved after surgery. However, no statistically significant difference was found between the 2 groups at the latest follow-up (P > .05). In 6 cases in the MRP group (19%) and 3 in the MPFLR group (9%), we found patellar lateral shift that exceeded 1.5 cm but was less than 2.0 cm with a firm endpoint for the apprehension test, without a significant difference between the 2 groups.
  
  
  CONCLUSIONS
  This prospective randomized study showed that MPFLR for recurrent patellar instability could achieve good clinical results, with a good congruous patellofemoral joint and good knee function. MRP could yield similar results to MPFLR for recurrent patellar instability in adults with medial patellofemoral ligament injuries from the patella or midsubstance portions.
  
  
  METHODS
  Level II, prospective comparative study.
authors.affiliation: Department of Joint Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China.
authors.forename: Long-Fei
authors.initials: LF
authors.lastname: Ma
authors.forename: Fei
authors.initials: F
authors.lastname: Wang
authors.forename: Bai-Cheng
authors.initials: BC
authors.lastname: Chen
authors.forename: Cheng-Hai
authors.initials: CH
authors.lastname: Wang
authors.forename: Jian-Wei
authors.initials: JW
authors.lastname: Zhou
authors.forename: Hao-Yu
authors.initials: HY
authors.lastname: Wang
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000534:rehabilitation / Q000601:surgery*; D008023:Ligaments, Articular / Q000601:surgery*; D008297:Male; D031222:Patellar Dislocation / Q000534:rehabilitation / Q000601:surgery*; D011446:Prospective Studies; D012008:Recurrence; D055815:Young Adult