Patellar instability – Arthroscopy assisted double bundled MPFL reconstruction using looped semitendinosus autograft. Is there an advantage? A prospective study of 25 cases
|IJOCP | Volume – 2015| Issue – 2015| Article ID – 2015:96
Conference: Indian Orthopaedic Association Annual Conference IOACON-2013, India [Click for Full details]
Authors: Sundararajan S R, Rajasekaran S
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Purpose: Patellar instability is a painful disabling condition of the knee characterized by repeated lateral subluxation or dislocation of patello-femoral joint. Further it is a predisposing factor for patello-femoral joint arthritis. Although many surgeries have been described, literature has supported the good outcome with MPFL reconstruction. We conducted a prospective study to evaluate our results with looped semitendinosus graft and also the advantages of arthroscopic assistance during the procedure.
Materials and Methods: Prospective study was done between 2007 and 2012 which included 25 cases with patellar instability. Of these 20 were females and left knee was involved in majority of cases. The average age was 29 years (15 – 56 years). The duration of symptoms ranged from 1.5 months to 30 years. Pre-operatively 4 cases had 10-20 degrees of FFD in the knee, others had painless full ROM. MRI had revealed thinning or tear in MPFL and cartilage defect over patella in all the cases; trochlea dysplasia with shallow groove was seen in 4 cases, osteochondral fractures in 8 cases and patellafemoral arthritis in 1 case. All the patients underwent MPFL reconstruction using looped semitendinosus autograft passed through vertical tunnel in patella simulating double bundle reconstruction. Arthroscopy of the knee was done for removal of osteochondral loose bodies, for careful placement of bone tunnels avoiding intra-articular penetration and to confirm patella final tracking.
Results: None of the patients had recurrence of dislocation or apprehension of the knee joint. The average Kujala’s score in our cases improved from 49 (42-84) preoperatively to 90 (86-96) at final follow up. Post-operatively 3 patients had stiffness of the knee of which one patient had associated DVT and was managed by anticoagulants and knee physiotherapy. Other two patients regained ROM after manipulation under anaesthesia and arthrolysis respectively. Cases were followed up for average of 38 months (26 – 49 months). Anterior knee pain was noted in 2 cases of which one had a documented patello-femoral joint arthritis.
Conclusion: Our technique of using looped semitendinosus tendon graft for reconstruction has given good results. Arthroscopic assistance used in our method of reconstruction has many advantages and improve the results. Management of patellar instability is aimed at returning to daily activities without apprehension of instability and also to avoid patellofemoral joint arthritis. This is achieved by MPFL reconstruction which has become the gold standard.
|How to Cite this Abstract|
|Sundararajan S R, Rajasekaran S. Patellar instability – Arthroscopy assisted double bundled MPFL reconstruction using looped semitendinosus autograft. Is there an advantage? A prospective study of 25 cases. International Journal of Conference Proceedings 2015;(2015):96|