Isolated and combined medial patellofemoral ligament reconstruction in revision surgery for patellofemoral instability: a prospective study.
BACKGROUND
Persistent pain and redislocations after surgical treatment of patellofemoral instability are described in up to 40% of patients. However, prospective outcome data about revision surgery are missing.


OBJECTIVE
To evaluate the clinical outcome after revision medial patellofemoral ligament (MPFL) reconstruction using isolated and combined procedures, with a follow-up of 24 months.


METHODS
Case series; Level of evidence, 4.


METHODS
Study participants were 42 patients (median age, 22 years; range, 13-46 years) who underwent revision surgery between January 2007 and December 2009 because of persistent patellofemoral instability after a mean of 1.8 previous failed surgical interventions (lateral release, medial imbrication/vastus medialis obliquus distalization, medialization of the tuberosity). An isolated MPFL reconstruction was performed in 15 cases, while a combination procedure was performed in 27 cases. The clinical results were evaluated preoperatively and 24 months postoperatively using the International Knee Documentation Committee (IKDC), Kujala, and Tegner scores as well as a subjective questionnaire. Patellar shift, tilt, and height, as well as level of degeneration, were defined preoperatively and at the latest follow-up on plain radiographs and magnetic resonance imaging.


RESULTS
At 24-month follow-up, 87% of the patients were satisfied or very satisfied with the treatment. No apprehension or redislocation was reported at follow-up, and there was a significant decrease in pain during daily activities. There were significant improvements (P < .001) in IKDC (from 50 to 80), Kujala (from 51 to 85), and Tegner scores (from 2.4 to 4.9). Patellar shift, tilt, and height decreased significantly (P < .05) to anatomic values, and there was no aggravation to the level of pre-existing degeneration. No significant difference was noticed between the isolated and combined procedures.


CONCLUSIONS
As patellofemoral instability is a multifactorial problem, revision surgery should be indicated only after a comprehensive examination. The results of this study show that MPFL reconstruction, alone or in combination, seems to be an effective treatment for recurrent patellar dislocations after a failed previous surgery, leading to significant increases in stability and functionality as well as a reduction in pain.
Department for Trauma Surgery and Orthopaedic Surgery, Krankenhaus Landshut-Achdorf, Landshut, Germany.
Ludwig M
LM
Kohn
Gebhart
G
Meidinger
Knut
K
Beitzel
Ingo J
IJ
Banke
Daniel
D
Hensler
Andreas B
AB
Imhoff
Philip B
PB
Schöttle
D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000601:surgery*; D008023:Ligaments, Articular / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D057071:Patellofemoral Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D017060:Patient Satisfaction; D011446:Prospective Studies; D011859:Radiography; D012086:Reoperation; D016896:Treatment Outcome; D055815:Young Adult
MPFL reconstruction; dislocation; knee ligaments, general; knee, patella; medial patellofemoral ligament; patellar instability; revision surgery