Summary

Different techniques provide the use of fixing systems have been designed for the reconstruction of MPFL in the recurrent dislocations of patella. In young patients with development metaphysis the use of bone tunnels or fixation device can lead to different inconveniences. The study shows the clinical results of a completely implant free MPFL reconstruction technique in a population of young ath

Abstract

Introduction

AND PURPOSE:
Patellar instability with patellofemoral ligament (MPFL) injury is a common problem especially in young active population.
Treatment for first-time patella dislocations is typically nonoperative and includes bracing, early range of motion, and physical therapy. For those patients who progress to recurrent instability, further investigation into the predisposing factors is required. The MPFL has been shown biomechanically to be the primary restraint among the medial patellar stabilizers.
Different techniques are described in literatures for the reconstruction of MPFL but often they involve the use of bone tunnels or fixation systems which can bring stiffness and compromising the clinical results especially in patients with immature skeletons.
A peculiar MPFL reconstruction technique was tested to achieve optimal graft fixation with minimal suture knots: Basket-Weave technique for medial patellofemoral ligament reconstruction.
The aim of this study is to evaluate the effectiveness of the Basket-Weave technique which does not involve the use of bone tunnels and is completely implant free.
MATERIAL & METHODS
24 patients (16 men and 8 women) with a mean age of 15±3,5 years (range, 12 to 19 years) who suffered of recurrent lateral patellar dislocation (at least 3 times) not responding to conservative treatment were treated using Basket-Weave technique from February 2018 to May 2021.
All patients underwent to arthroscopy to perform any needed accessory gestures such as loose body removal, chondroplasty, etc.
Pre-op planning was performed with MRI and CT-scan. All patients were, also, classified using The Dejour Classification of Trochlear Dysplasia. Type C and D according to Dejour Classification were excluded because they would have required accessory gestures on bone such as transposition of the anterior tibial tuberosity.
MRI evaluations were achieved at 12 months follow-up.
At 12-, 24- and 36-months clinical evaluation were analyzed with IKDC score, Tegner and Kujala score.

Results

The preoperative clinical evaluation was as follows: Kujala P-F Scale 64.2±5.3, IKDC 54.0±4.2, Tegner 2.2±1.6 points. The Kujala P-F Scale score and IKDC score at 24 months were 89.2±1.6 and 79.6±8.7 points, respectively. At the final check-up, the clinical evaluation obtained the following results: Kujala P-F Scale 89.5±2.9, IKDC score 92.1±5.4 and Tegner score 5.9±1.2.

Conclusions

Basket-Weave reconstruction technique guaranteed safety and excellent results, avoiding complications related to the creation of bone tunnels and the use of implants, in particular in growing subjects with open-physes. According to our results it represents an effective and reproducible technique