The double-pulley technique for anatomical double-bundled medial patellofemoral ligament reconstruction.
BACKGROUND
Majority of the current medial patellofemoral ligament (MPFL) reconstruction techniques vary with respect to methods of fixation on the patella. In an effort to maximise the area of patellar footprint coverage and minimise the complication of patellar fracture, we developed a procedure that implemented the double-pulley suture anchors technique.


METHODS
Prospective case series.


METHODS
A primary medical centre in Kaohsiung, Taiwan.


METHODS
Eighteen consecutive patients (18 knees) who met the inclusion criteria underwent the aforementioned operation between January 2010 and March 2012. Patients were evaluated using functional scores (Kujala and Tegner-Lysholm scores), apprehension test, and radiographic examination (congruence angle and patellar tilting angle) preoperatively and at the follow-up.


RESULTS
The mean follow-up was 35 months. A firm endpoint to lateral patellar translation was noted in all patients at the last follow-up with a mean lateral translation quadrant of 1.5 (improved from 3.5 preoperatively, p<0.001). Both clinical and radiographic assessment improved significantly (p<0.001); the mean Kujala score improved from 55.3±6.8 preoperatively to 95.2±3.5 at the last follow-up; TegnerLysholm from 43.6±8.1 to 93.6±6.8; the mean congruence angle improved from 20.6°±2.1° preoperatively to -5.2°±2.4° at the last follow-up; and the patellar tilting angle from 23.8°±2.3° to 9.6°±1.3°.


CONCLUSIONS
The double-pulley patellar fixation technique, by having a result that is comparable with those of other studies that used aperture fixation techniques, can be a promising surgical option for anatomically reconstructing the medial petellofemoral ligament.
Department of Orthopedics, Kaohsiung Veterans General Hospital, 386 Dazong 1(st) Road, Kaohsiung City, Taiwan. Electronic address: johnkyl@yahoo.com.
Kuan-Yu
KY
Lin
Department of Orthopedics, Kaohsiung Veterans General Hospital, 386 Dazong 1(st) Road, Kaohsiung City, Taiwan.
Yih-Chau
YC
Lu
Department of Orthopedics, Kaohsiung Veterans General Hospital, 386 Dazong 1(st) Road, Kaohsiung City, Taiwan.
Jenn-Huei
JH
Renn
D000293:Adolescent; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000503:physiopathology / Q000534:rehabilitation / Q000601:surgery*; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D008023:Ligaments, Articular / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010329:Patella / Q000601:surgery*; D031222:Patellar Dislocation / Q000503:physiopathology / Q000534:rehabilitation / Q000601:surgery*; D057071:Patellofemoral Joint / Q000601:surgery; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods*; D053441:Suture Anchors; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome
Double-pulley technique; Medial patellofemoral ligament; Patellar instability; Reconstruction; Suture anchors