Clinical Insights into the Treatment of Patellofemoral Instability with Medial Patellofemoral Ligament Reconstruction: Pearls and Pitfalls—Lessons Learned from 20 Years
Abstract
:1. Introduction
2. Materials and Methods
3. Results
3.1. Patient Selection
3.2. Surgical Indications
3.3. Graft Selection
3.4. Location of Fixation
3.5. Choice of Fixation
3.6. Graft Tensioning
3.7. Postoperative Care
4. Discussion
5. Conclusions
- For isolated MPFL reconstruction, it is preferable to consider individuals under the age of 30 without arthrosis or obesity.
- MPFL reconstruction alone is not suitable for patients with bony anomalies such as trochlear dysplasia, increased femoral antetorsion, genu valgum, or patella alta. In such cases, bony correction should be considered to achieve successful postoperative outcomes.
- There is no evidence supporting the necessity of surgical therapy after a single patellar dislocation. However, the psychological stress and impact on everyday activities and sports should be taken into account.
- When harvesting the graft, it is important to ensure a sufficient length of approximately 7 cm.
- The femoral fixation of the graft should be placed between the adductor tubercle and the medial femoral epicondyle. Intraoperative imaging from a pure lateral view can assist in locating the correct tunnel placement.
- In patients with open physis, the location of femoral fixation should be distal to the physis to ensure optimal functionality without causing growth disturbances.
- The patellar fixation should be positioned on the proximal medial two-thirds, and a 3.2 mm drill head should be used instead of 4.5 mm to minimize complications.
- It is important to avoid prominent hardware in the fixation process.
- Intraoperatively, the patellar motion should be assessed, and a translation of two or three quadrants should be allowed for, similar to the healthy contralateral side. This helps ensure proper patellar tracking. Additionally, graft fixation should be performed at approximately 30° flexion of the knee, as supported by literature references [28].
- Postoperative care should include a tailored physical therapy program that addresses the specific needs of the patient. It is important to have open discussions with patients about their expectations regarding returning to sports activities, ensuring that expectations are realistic and aligned with their individual recovery progress.
Author Contributions
Funding
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Papp, K.; Speth, B.M.; Camathias, C. Clinical Insights into the Treatment of Patellofemoral Instability with Medial Patellofemoral Ligament Reconstruction: Pearls and Pitfalls—Lessons Learned from 20 Years. J. Pers. Med. 2023, 13, 1240. https://doi.org/10.3390/jpm13081240
Papp K, Speth BM, Camathias C. Clinical Insights into the Treatment of Patellofemoral Instability with Medial Patellofemoral Ligament Reconstruction: Pearls and Pitfalls—Lessons Learned from 20 Years. Journal of Personalized Medicine. 2023; 13(8):1240. https://doi.org/10.3390/jpm13081240
Chicago/Turabian StylePapp, Kata, Bernhard M. Speth, and Carlo Camathias. 2023. "Clinical Insights into the Treatment of Patellofemoral Instability with Medial Patellofemoral Ligament Reconstruction: Pearls and Pitfalls—Lessons Learned from 20 Years" Journal of Personalized Medicine 13, no. 8: 1240. https://doi.org/10.3390/jpm13081240