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The novel dynamic MPFL-reconstruction technique: cheaper and better?

Hauke Horstmann1, Roman Karkosch2, Annika Berg2

  • 1Department of Orthopaedic Surgery, Diakovere Annastift, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany. hauke.horstmann@diakovere.de.

Archives of Orthopaedic and Trauma Surgery
|October 11, 2021
PubMed
Summary

Dynamic medial patellofemoral ligament (MPFL) reconstruction effectively restores patellar stability. While complication rates are higher than static methods, this technique offers a reproducible and efficient solution for recurrent patellar dislocations.

Keywords:
KneeMPFL reconstructionPatella dislocationPatella instabilityStabilization

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Area of Science:

  • Orthopedic surgery
  • Sports medicine
  • Biomechanics

Background:

  • Medial patellofemoral ligament (MPFL) reconstruction is a standard procedure for managing patellar instability.
  • Recurrent lateral patellar dislocation necessitates surgical intervention to restore stability.
  • Dynamic MPFL reconstruction offers an alternative surgical technique.

Purpose of the Study:

  • To evaluate the outcomes of a dynamic MPFL reconstruction technique.
  • To assess the efficacy of this method in a large university hospital setting.
  • To analyze patient-reported outcomes and complication rates.

Main Methods:

  • A cohort of 213 patients (221 knees) with recurrent lateral patellar dislocation underwent dynamic MPFL reconstruction.
  • The procedure involved gracilis tendon transfer with patellar fixation via an oblique transpatellar tunnel.
  • Follow-up included Kujala and BANFF scores, pain assessment, and evaluation of recurrent instability over a minimum of 2 years.

Main Results:

  • 158 patients (71%) were followed up for a mean of 5.4 years.
  • Positive outcomes included a mean VAS pain score of 1.9, Kujala score of 78.4, and BANFF score of 62.4.
  • Higher surgeon experience correlated with shorter surgical times. Male patients reported greater satisfaction. Complications occurred in 27.2%, with 9.5% related to recurrent instability.

Conclusions:

  • Dynamic MPFL reconstruction is a reproducible technique for restoring patellar stability.
  • It demonstrates efficiency in a large-scale setting without requiring intraoperative fluoroscopy.
  • Although complication rates are higher compared to static reconstructions, patient satisfaction remains significant, with 78% willing to undergo the procedure again.