Abstract
The purpose of this study was to describe two anatomical medial patellofemoral ligament
(MPFL) reconstruction methods: reconstruction with two-strand grafts and reconstruction
with four-strand grafts and to evaluate the clinical and radiological results. From
January 2010 to January 2013, patients who sustained recurrent patella dislocation
and met inclusion criteria were included in the study and divided into two groups
randomly to undergo MPFL reconstruction either by two-strand grafts (T group) or four-strand
grafts (F group). Patients were followed up 1 month, 1 year, 2 years, and 3 years
postoperatively. The apprehension test was applied to test patella stability. The
Kujala score, Lysholm score, and Crosby–Insall grading were used to evaluate the function
of the affected knee. The patellar congruence and patellar tilt angle were used to
measure the morphology of the patellofemoral joint. In addition, patients' subjective
assessments and complications were recorded. Thirty-eight patients in T group and
38 patients in F group were followed for at least 36 months. The apprehension test
was positive in all patients preoperatively but was negative at follow-up. The Kujala
score, Lysholm score, patellar congruence angle, and the patellar tilt angle of patients
in both groups improved significantly at 36-month follow-up when compared with those
assessed preoperatively. However, patients in the F group achieved better clinical
results in terms of Kujala score, patellar congruence angle, patellar tilt angle,
and Crosby–Insall grading when compared with those in the T group 3 years after the
operation. Most patients (92% of patients in the T group and 97% of patients in the
F group) were satisfied with the surgery. The anatomical MPFL reconstruction with
two-strand grafts or four-strand grafts were both safe techniques for recurrent patella
dislocation with satisfactory clinical outcomes. The anatomical fixation with four-strand
grafts achieved better clinical and radiographic results in the follow-up, which may
be a better reconstruction method.
Keywords
anatomical MPFL reconstruction - medial patellofemoral ligament - patellar dislocation
- patella instability
