Abstract
BackgroundGraft fixation is critical to the restoration of the medial patella of femoral ligament function and long-term success. Numerous fixations at the patella have been described, while the complications including patellar fractures, violation of the posterior patella and delay of tendon-to-bone healing remain significant challenges. Here, we describe a safe and firm fixation at the patellar for medial patellofemoral ligament (MPFL) reconstruction and explore the safety angle of drilling the suture anchor at different morphology of the patellar. Moreover, we evaluate the results at a 3-year follow-up.MethodsCombined bone groove and suture anchor fixation at the patella was performed on 26 patients (16 females, 10 males; mean age 26.3 ± 4.7 years) diagnosed with recurrent patellar dislocation. The drilling direction of the suture anchor referred to the safety angle according to the Wiberg type classification. The safety angle was defined as the angle between the drill tunnel and a line that connected the medial and lateral margins of the patella and was established following computed tomography assessment of 117 patients who were diagnosed with patellar dislocation in our hospital according to the Wiberg type classification (I:29, II:65, III:23). X-ray, Lysholm, Kujala and Tegner scores were obtained preoperatively and at the time of final follow-up.ResultsThere were no patellar complications, including fracture and redislocation. Average congruence, patella tilt angles and lateral patella angle were significantly changed (P < 0.01). The Lysholm, Kujala and Tegner scores were significantly increased (P < 0.01). The safe angles of male and female patients according to the patellar Wiberg type classification were less than 45.32 ± 1.76 and 41.20 ± 1.33, 69.74 ± 1.38 and 63.66 ± 1.45 and 84.11 ± 1.67 and 80.26 ± 1.73, respectively.ConclusionsWe achieved encouraging results with this fixation at the patellar. When drilling from Wiberg type I to type III patellar, the suture anchor should be more vertical. When fixing the patellar of female patients, the drilling suture anchor should be more sloping.
Highlights
Graft fixation is critical to the restoration of the medial patella of femoral ligament function and longterm success
The indication for medial patellofemoral ligament (MPFL) reconstruction was symptomatic patients who had experienced at least two lateral patellar dislocations. These lateral patellar dislocations were diagnosed by history taking, physical examination, X-rays, computed tomography (CT) scans and magnetic resonance imaging (MRI)
The safe angles of male and female patients according to the patellar Wiberg type classification were less than 45.32 ± 1.76 and 41.20 ± 1.33, 69.74 ± 1.38 and 63.66 ± 1.45 and 84.11 ± 1.67 and 80.26 ± 1.73 (Table 3)
Summary
Graft fixation is critical to the restoration of the medial patella of femoral ligament function and longterm success. We describe a safe and firm fixation at the patellar for medial patellofemoral ligament (MPFL) reconstruction and explore the safety angle of drilling the suture anchor at different morphology of the patellar. Patellar dislocation is primarily an injury of younger, female patients [1]. The medial patellofemoral ligament (MPFL) is viewed as the most important static structure in preventing the lateral dislocation of the patella [2, 3] and provides 57–63% of the patella’s medial soft tissue restraint [4, 5]. The MPFL is ruptured in a high percentage of patellar dislocations [6,7,8]. MPFL reconstruction has become a widespread surgical technique for reconstruction of patellofemoral stability
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