Summary

Satisfactory long-term clinical outcomes and high survival rates in patients who underwent medial patella-tibial ligament (MPTL) reconstruction for patellofemoral instability.

Abstract

Background

Medial patella-tibial ligament (MPTL) is a ligamentous structure that, together with medial patello-femoral ligament (MPFL), forms the medial patellar retinaculum and acts as dynamic secondary patellar stabilizer.

Purpose

To evaluate long term clinical outcomes and survival rate after an original medial patella-tibial ligament reconstruction in patients with patellofemoral instability.
Study design: Retrospective study, Level IV.

Methods

26 knees (25 patients, 7 males and 18 females) treated for patellar instability (at least two objective dislocations) with medialization of the patellar tendon medial third combined with medial and lateral release were evaluated clinically at a mean follow-up of 15.6 ± 2.5 years (11.4-20.1). Associated trochleoplasty was performed in case of severe flat trochlea. WOMAC, Kujala, VAS for pain and Tegner activity scores were used. We considered as a failure : 1) redislocation and 2) knee replacement surgery.

Results

The mean age at first dislocation was 19.4 ± 10.5 years (8.4-44.1). The first episode of patellofemoral dislocations was traumatic in 5 (19.2%) and nontraumatic in 21 (81.8%) knees. Associated trochleoplasty was performed in 5 knees (19.2%). There was a significant improvement of all clinical scores and significant reduction in knee pain. 22 knees (84,6%) were normal or nearly normal by Kujala score at final follow-up. 4 knees (15,38%) were considered failures (2 further dislocations, 2 total knee arthroplasty). The overall survival rate at 10 years was 84%.

Conclusions

MPTL reconstruction produced great clinical results and high survival rate results at mean 15.6 ± 2.5 years follow- up, with 15,4% failures. The presented technique has good long term clinical results, is less technically demanding than MPFL reconstruction and has a low complication rate.