title: Results of anatomic gracilis MPFL reconstruction with precise tensioning.
abstract: BACKGROUND
  The medial patellofemoral ligament (MPFL) is the most commonly injured structure in patients with objective patellar instability. The objective of this study was to prospectively evaluate the clinical and radiographic results of MPFL reconstruction in 50 patients with chronic patellar instability.
  
  
  METHODS
  Fifty patients with chronic patellar instability, aged 15-39 years, were included. The MPFL was reconstructed using a free gracilis autograft tendon. Two anchors were used for patellar fixation, and femoral fixation was achieved with an interference screw placed into a tunnel between the adductor tubercle and medial epicondyle. The graft was tensioned to 10 N with the knee in 30° flexion. IKDC and Kujala scores were assessed pre- and post-operatively. Patellar tilt was measured from CT scans with the quadriceps relaxed and contracted, both pre- and post-operatively.
  
  
  RESULTS
  The follow-up period was 7 to 44 months (mean: 25 months, SD 10.3). The mean raw IKDC score increased from 51.5 preoperatively to 71.7 at last follow-up, the mean overall IKDC score increased from 38.5 to 61.7 and the Kujala score increased from 48.3 to 82.4. On CT scans, the mean patellar tilt went from 24° to 16.2° with the quadriceps relaxed and 27.7° to 18.1° in contraction. No recurrent dislocation was observed.
  
  
  CONCLUSIONS
  This technique of MPFL reconstruction provided significant improvements in IKDC and Kujala scores and significant reduction in patellar tilt. No recurrent dislocations were observed during the study period.
authors.affiliation: Laboratory of Exercise Physiology (LPE EA 4338), Lyon University, Saint-Etienne, France; Department of Orthopaedic Surgery, University Hospital Center of Saint-Etienne, France. Electronic address: olivier.carnesecchi@gmail.com.
authors.forename: Olivier
authors.initials: O
authors.lastname: Carnesecchi
authors.affiliation: Department of Orthopaedic Surgery, University Hospital Center of Saint-Etienne, France.
authors.forename: T
authors.initials: T
authors.lastname: Neri
authors.affiliation: Department of Orthopaedic Surgery, University Hospital Center of Saint-Etienne, France.
authors.forename: A
authors.initials: A
authors.lastname: Di Iorio
authors.affiliation: Department of Orthopaedic Surgery, University Hospital Center of Saint-Etienne, France.
authors.forename: F
authors.initials: F
authors.lastname: Farizon
authors.affiliation: Laboratory of Exercise Physiology (LPE EA 4338), Lyon University, Saint-Etienne, France; Department of Orthopaedic Surgery, University Hospital Center of Saint-Etienne, France.
authors.forename: R
authors.initials: R
authors.lastname: Philippot
mesh_terms: D000293:Adolescent; D000328:Adult; D064592:Autografts; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D017847:Patellar Ligament / Q000637:transplantation*; D057071:Patellofemoral Joint / Q000503:physiopathology / Q000601:surgery*; D011446:Prospective Studies; D052097:Quadriceps Muscle / Q000601:surgery*; D016059:Range of Motion, Articular / Q000502:physiology*; D019651:Plastic Surgery Procedures / Q000379:methods*; D014057:Tomography, X-Ray Computed; D055815:Young Adult
keywords: Graft tension; Isometry; MPFL; Patellar instability; Tilt