Summary

MPFL reconstruction using a pedicled quadriceps tendon graft in failed lateral release and medial plication procedure can provide improved clinical results without complications of patellar fracture or stiffness of the knee, infection, and re-dislocation.

Abstract

Introduction

Medial Patellofemoral Ligament (MPFL) reconstruction is a popular procedure to repair recurrent patellar dislocation. Numerous surgical procedures for MPFL reconstruction have been described in the literature. Few of these techniques have the advantage of avoidance on bony patellar complications.

Purpose

This study aims to compare the functional outcome of MPFL reconstruction using a pedicled quadriceps tendon graft after the unsuccessful prior surgeries such as, lateral release and medial plication and to identify possible risks.

Methods

Six patients were included in this retrospective study with a history of recurrent dislocation trauma from 2017 to 2019 who underwent MPFL reconstruction using quadriceps tendon graft after a failed previous surgery using lateral release and medial plication techniques. The outcomes were evaluated comparatively pre-operative and 2 years post-operatively using IKDC score, Lysholm knee score, Kujala score, thigh circumference size, and kneel down ability. Patellar fracture, re-dislocation, and other complications were also assessed 2 years post-operative.

Results

The average age at the time of operation was 15,5 years old (14-17), The average follow-up after operation was 15 moths (12-24) and showed significant improvement in clinical outcomes. Five patients were very satisfied (83,4%), and one patient was partially satisfied with the surgical procedure (16,6%). The Lysholm score increased from 64.28 ± 6.33 to 90.49 ± 3.24 (p = 0.012), IKDC score increased from 61.83 ± 6.46 to 89.26 ± 2.83 (p < 0.001). Kujala score increased from 62.10 ± 6,59 to 88.53 ± 4.32 (p < 0.001) with decreased in thigh circumference (1–2 cm). Four patients have full ROM, able to kneeling, while 2 patients were able to kneeling with adjustments. There were no postoperative infection, patellar fractures nor re-dislocations.

Conclusions

MPFL reconstruction using a pedicled quadriceps tendon graft in failed lateral release and medial plication procedure can provide improved clinical results without complications of patellar fracture or stiffness of the knee, infection, and re-dislocation. It might therefore be a valuable alternative to more extensive procedures.