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MPFL Reconstruction Combined with a Modified Elmslie-Trillat Procedure for Recurrent Patellofemoral Instability
Genya Mitani1, Kenji Serigano2, Tomonori Takagaki2
1Department of Orthopaedic Surgery, Tokai University Oiso Hospital, Naka-gun, Kanagawa, Japan.
The Journal of Knee Surgery
|December 20, 2022
Summary
Medial patellofemoral ligament reconstruction combined with the Elmslie-Trillat procedure effectively treats recurrent patellofemoral instability. This combined surgery improved patient outcomes and corrected anatomical abnormalities in the knee.
Area of Science:
- Orthopedic Surgery
- Sports Medicine
- Biomechanical Engineering
Background:
- Recurrent patellofemoral instability (RPI) presents challenges in treatment, especially with associated morphological abnormalities.
- Existing combined procedures lack defined surgical threshold values for complex RPI cases.
Purpose of the Study:
- To evaluate the clinical and radiological outcomes of combined medial patellofemoral ligament (MPFL) reconstruction and modified Elmslie-Trillat (ET) procedure for RPI.
- To assess the efficacy of this combined approach in knees with elevated tibial tubercle-trochlear groove (TT-TG) distance, patella alta, and trochlear dysplasia.
Main Methods:
- A cohort of 24 knees with RPI and specific morphological abnormalities underwent MPFL reconstruction and modified ET procedure.
- Inclusion criteria involved specific measurements for sulcus angle, trochlear dysplasia, Caton-Deschamps index, lateral shift ratio, congruence angle, and TT-TG distance.
- Outcomes were assessed using Kujala score, IKDC subjective score, KOOS, and radiographic parameters, including patellar apprehension sign.
Main Results:
- Significant improvements were observed in Kujala, IKDC, and KOOS scores post-surgery.
- All preoperative patellar apprehension signs resolved, and no redislocations occurred.
- Radiographic analysis showed significant improvements in Q angle, tilting angle, lateral shift ratio, congruence angle, Caton-Deschamps index, Insall-Salvati index, and TT-TG distance.
Conclusions:
- Combined MPFL reconstruction and modified ET procedure demonstrate satisfactory clinical and radiological outcomes for RPI with specific morphological abnormalities.
- This surgical technique effectively addresses elevated TT-TG distance, patella alta, and trochlear dysplasia, leading to improved knee function and stability.
