Medial patellofemoral ligament reconstruction using a central strip of the quadriceps tendon in patients with recurrent patellar instability: a prospective case series

Abstract

Background: Patellar fractures and chondral injuries are serious complications after medial patellofemoral ligament (MPFL) reconstruction. Using a central strip from the quadriceps tendon avoids these complications. Moreover, this technique maintains an anatomical attachment of the tendon at the proximal patella at the position of the native MPFL. The quadriceps strip is biomechanically comparable to the intact MPFL, whereas the hamstring tendon graft is stiffer than the native MPFL. Methods: Thirty-four patients were involved in this study. Conservative treatment failed in all after an initial episode of patellar dislocation. Their mean age was 19.4 yr. The mean duration of symptoms was 14.3 mo. The mean follow-up period was 28.7 mo. Their preoperative visual analogue scale (VAS) was 5 and their preoperative Kujala score was 69.5. Mean Caton-Deschamps index was 1.1. Patella alta was found in seven patients. Thirteen patients had trochlear dysplasia. All had MPFL reconstruction using 10-cm long, 10-mm wide, 3 mm thick strip harvested from the central portion of the quadriceps tendon. Results: The mean VAS score was significantly reduced from 5 to 1. Mean Kujala score significantly improved from 69.5 to 94.8. The patellar tilt decreased significantly. There was no significant correlation between final Kujala scores and the presence of anatomical predisposing factor. All patients had negative patellar apprehension tests. Conclusions: Using a central strip of the quadriceps tendon in the reconstruction of MPFL in patients with recurrent patellar dislocation is an excellent option. Level of Evidence: Level IV.