title: Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Instability Using a Gracilis Autograft without Bone Tunnel.
abstract: BACKGROUND
  Several tendon graft and fixation methods have been introduced in medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar dislocation. The purpose of this study was to evaluate the results of MPFL reconstruction using a gracilis autograft fixation without bone tunnel in patients with recurrent patellar instability.
  
  
  METHODS
  Nine patients (four males and five females) diagnosed with recurrent patellar instability from July 2009 to January 2013 and had MPFL reconstruction using a gracilis autograft were included. The average age of the patients was 24.6 years (range, 13 to 48 years), and the average follow-up period was 19.3 months (range, 12 to 30 months). For every patient, femoral attachment was fixed using suture anchors securing the patella by suturing the periosteum and surrounding soft tissue. Clinical evaluation included the Kujala, Lysholm, and Tegner scores; in addition, patients were examined for any complication including recurrent dislocation. The congruence angle and patella alta were assessed radiologically before and after surgery.
  
  
  RESULTS
  The Kujala score improved from an average of 42.7 ± 8.4 before surgery to 79.6 ± 13.6 (p = 0.008) at final follow-up; the Lysholm score improved from 45.8 ± 5.7 to 82.0 ± 10.5 (p = 0.008); and the Tegner score improved from 2.8 ± 0.8 to 5.6 ± 1.5 (p = 0.007). The Insall-Salvati ratio changed from 1.16 ± 0.1 (range, 0.94 to 1.35) before surgery to 1.14 ± 0.1 (range, 0.96 to 1.29; p = 0.233) at the final follow-up without significance. The congruence angle significantly improved from 26.5° ± 10.6° (range, 12° to 43°) before surgery to -4.0° ± 4.3° (range, -12° to 5°; p = 0.008) at final follow-up. Subluxation was observed in one patient and hemarthrosis occurred in another patient 2 years after surgery, but these patients were asymptomatic.
  
  
  CONCLUSIONS
  We achieved good results with a patellar fixation technique in MPFL reconstruction using a gracilis autograft employing soft tissue suturing in patients with recurrent patellar dislocation.
authors.affiliation: Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, Korea.
authors.forename: Tae-Seong
authors.initials: TS
authors.lastname: Kim
authors.affiliation: Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, Korea.
authors.forename: Hee-June
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, Korea.
authors.forename: In-Hoo
authors.initials: IH
authors.lastname: Ra
authors.affiliation: Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, Korea.
authors.forename: Hee-Soo
authors.initials: HS
authors.lastname: Kyung
mesh_terms: D000293:Adolescent; D000328:Adult; D064592:Autografts; D005260:Female; D006801:Humans; D007718:Knee Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D008023:Ligaments, Articular / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000601:surgery / Q000637:transplantation; D010329:Patella / Q000000981:diagnostic imaging / Q000601:surgery*; D057071:Patellofemoral Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D012189:Retrospective Studies; D013848:Thigh / Q000601:surgery; D055815:Young Adult
keywords: Gracilis; Medial patellofemoral ligament; Patellar instability