Summary

The implant-free, double-bundle technique for MPFL reconstruction with hamstrings autograft is a safe and reliable option for treating patella dislocation providing satisfactory patient reported outcomes.

Abstract

OBJECTIVES
Patella dislocation is one of the most usual pathologies of the knee in the young population. The basic anatomical structure getting injured in these cases is the medial patellofemoral ligament (MPFL). With the present study we aim to evaluate the medium-term clinical and radiographic results of our implant-free, double-bundle technique for isolated MPFL reconstruction with hamstrings autograft.

Methods

A retrospective analysis of 31 patients (33 patellae) with patella instability treated with isolated MPFL reconstruction surgery by the same orthopaedic surgeon between 2010 and 2022 was conducted. Patients were assessed using the following PROMs: IKDC, Lysholm, Kujala, Modified Cincinatti both pre and postoperatively. Radiographic evaluation of both knees was performed, in order to assess the development of patellofemoral arthritis based on the IWANO classification. Patients with severe trochlear dysplasia ( Dejour II, III, IV) were excluded from the study. The statistical analysis of study data was executed using SPSS software version 26 for Windows.

Significance

threshold of 0.05 or lower was applied to assess the statistical significance of each conducted test.

Results

The mean patients’ age at the time of the first dislocation was 16.1 years (range from 10 to 21 years) and the mean age at the time of surgery was 20.3 years (from 20 to 34). All of the patellae were dislocated more than once before the surgery. 56,2% of the patients were females and 43.8% were males, while most of the cases referred to the right knee (56% vs 44%). 50% of the injuries took place during any form of exercise and 6.2% after a direct hit. The mean follow up was 7.3 years (from 2 to 13). All of the scores at the follow up had a significant improvement (p<0.05) when compared to the preoperative baseline. The IKDC increased from 49.2 to 84.5, Lysholm from 53 to 88.2, Kujala from 61 to 88.5 and modified Cincinatti from 49.2 to 83.6. None of the patients reported any immediate postoperative complications and none of them had any incidence of re-dislocation or reoperation. 9.6% of the patients had a positive patella apprehension test but only one of them (3%) declared that was dissatisfied from the surgery with worsening of her quality of life postoperatively. After the radiological evaluation, 2nd grade of patellofemoral arthritis was present in 15% of the patients and 3rd grade in 9% according to the IWANO classification.

Conclusions

The implant-free, double-bundle technique for MPFL reconstruction with hamstrings autograft is a safe and reliable option for treating patella dislocation providing satisfactory patient reported outcomes. No severe complications were recorded and only mild cartilage lesions could be developed after the procedure and at the latest follow up.