Mean Kujala Score Research Articles

Clinical and Radiological Outcomes After Isolated Double-Bundle Medial Patellofemoral Ligament Reconstruction: A 5-Year Analysis.

There are few studies that have examined clinical and radiological outcomes at 5 years after isolated medial patellofemoral ligament (MPFL) reconstruction. To date, midterm outcomes after isolated double-bundle (DB) MPFL reconstruction are not well known. Isolated DB MPFL reconstruction using a patellar suture anchor technique would lead to improved functional scores and radiological findings, and these improvements would remain stable over the 5-year postoperative period. Case series; Level of evidence, 4. Isolated MPFL reconstruction was performed in patients with recurrent patellar instability between March 2013 and February 2017. Clinical and functional evaluations were performed via an interview using the Kujala, Lysholm, and Tegner scores preoperatively and at 6, 12, 24, and 60 months postoperatively. Radiographs were taken preoperatively, immediately postoperatively, and at 24 and 60 months after surgery. Radiographic assessments included measuring the modified Insall-Salvati ratio, congruence angle, and lateral patellofemoral angle. A total of 31 patients (31 knees) underwent isolated MPFL reconstruction; 4 patients did not complete 5-year follow-up, and thus, 27 patients (27 knees) were enrolled in the study. The mean age at the time of surgery was 22.0 ± 6.4 years (range, 14-32 years). All clinical and functional scores significantly improved in the first 2 years (P < .001), with the mean Kujala, Lysholm, and Tegner scores improving from 52.7 to 90.7, 49.6 to 92.7, and 2.9 to 5.1, respectively. There was no significant difference in scores between 2- and 5-year follow-up. All radiographic parameters significantly improved between preoperatively and immediately postoperatively (P < .001), with mean values for the modified Insall-Salvati ratio, congruence angle, and lateral patellofemoral angle improving from 1.7° to 1.6°, 5.7° to -6.6°, and 3.0° to 5.9°, respectively. No significant differences were observed in radiographic measurements between the postoperative time points. No patients experienced a patellar redislocation or fracture. The prospective analysis of isolated DB MPFL reconstruction at 5-year follow-up showed that clinical and radiological outcomes significantly improved postoperatively and were maintained to 5 years. These midterm results suggest that isolated DB MPFL reconstruction is an effective treatment option for patients with patellar instability.

Results of medial patellofemoral ligament reconstruction with and without tibial tubercle osteotomy in patellar instability: a systematic review and single-arm meta-analysis

PurposeTo confirm which method provides lower rate of recurrent instability and superior clinical outcomes.MethodWe searched PubMed, Embase and Web of Science for the trials involving one intervention or both for patellar instability: medial patellofemoral ligament reconstruction (MPFLR) with and without tibial tubercle osteotomy (TTO). The postoperative Kujala score, Lysholm score, Tegner scores and the rate of recurrent instability (dislocation or subluxation) were analyzed as the primary clinical outcome parameters in a random or fixed effects meta-analysis.ResultsIn total, 43 articles met inclusion criteria after full-text review. A total of 2046 patients were analyzed. The overall mean age was 20.3 years (range, 9.5–60.0 years), with a mean follow-up time of 3.2 years (range, 1–8 years). The mean Kujala scores in MPFLR and MPFLR + TTO were 89.04 and 84.44, respectively. There was significant difference in Kujala scores between MPFLR and MPFLR + TTO (MD = 4.60, 95%CI: 1.07–8.13; P = 0.01). The mean Lysholm scores in MPFLR and MPFLR + TTO were 90.59 and 88.14, respectively. There was no significant difference in Lysholm scores between MPFLR and MPFLR + TTO (MD = 2.45, 95%CI: -3.20-8.10; P = 0.40). The mean Tegner scores in MPFLR and MPFLR + TTO were 5.30 and 4.88, respectively. There was no significant difference in Tegner scores between MPFLR and MPFLR + TTO (MD = 0.42, 95%CI: -0.39-1.23; P = 0.31). At final follow-up, the rates of recurrent instability in MPFLR and MPFLR + TTO were 3% and 4%, respectively. There was no significant difference in the rates between MPFLR and MPFLR + TTO (OR = 0.99, 95%CI: 0.96–1.02; P = 0.4848).ConclusionMPFLR and MPFLR + TTO are effective and reliable treatments in the setting of patellofemoral instability. MPFLR seems to show a better performance in functional outcomes than MPFLR + TTO. Moreover, their rates of recurrent instability are very low, and no significant difference exists.

Clinical Outcome of Anterior Cruciate Ligament Reconstruction Using Hamstring Tendon Autograft versus Tibialis Tendon Allograft Allograft

Abstract: Objectives: The present study aimed to examine the clinical outcome of anterior cruciate Ligament (ACL) reconstruction using hamstring tendon autograft versus tibialis tendon Allograft. Materials/Patients and Methods: Local institutional review board approval (Code number 930971) was obtained before the commencement of the study. Thereafter, the patients who had undergone anatomical arthroscopic ACL reconstruction with hamstring tendon autograft and allograft tibialis were retrospectively reviewed. A number of 82 eligible Patients in autograft and 100 patients in the allograft group who met inclusion criteria were examined regarding knee stability by clinical examinations and KT-2000 arthrometer from 2008-2014. Results: Anterior drawer test was reported negative in 23.18% of patients in autograft and 23% of patients in the allograft group which was not statistically meaningful (P=0.870). The mean follow-up time was reported as 36.34 and 38.34 months in autograft and allograft groups, respectively. Final score of Knee Injury and Osteoarthritis Outcome Score (KOOS) in autograft and allograft groups was measured at 70.87±19.76 and 71.83%, respectively. In addition, the mean Lysholm score in autograft And allograft groups was reported to be 90±4.77 and 3.3±92, respectively. Moreover, Mean International Knee Documentation Committee (IKDC) score in the autograft and Allograft groups was estimated as 85±14.11 and 7.03±9, respectively. Furthermore, the Mean Kujala score in autograft and allograft groups was measured at 79±3.07 and 3.75±81, respectively. Conclusions: Apart from the mainstay treatment which is the surgical technique, the Use of quadrupled hamstring tendon autograft and tibialis allograft would yield dramatic Results in ACL reconstruction both subjectively and objectively. Moreover, the use of Hamstring tendon autograft and tibialis allograft is reported to have similar medical Results.

Plantaris Tendon Autograft Can Restore Patellar Stability in Adolescent Medial Patellofemoral Ligament Reconstruction: A Technical Note.

Medial patellofemoral ligament reconstruction is a standard treatment option for patients with patellar instability. The main purpose of this study was to determine whether isolated anatomic medial patellofemoral ligament reconstruction using double folded, four-strand plantaris tendon autograft restores patellar stability in adolescent patients. Plantaris tendon autografts were harvested through proximal approach and used in four adolescent patients. A four-strand autograft was prepared in a double-limbed configuration and fixed on the patella and the femur with suture anchors and interference screws, respectively. The mean Kujala score improved significantly from 44 ± 24 SD (range, 19 to 69) points preoperatively to 94 ± 10 SD (range, 78 to 100) points postoperatively (P< 0.001). All patients reported excellent subjective outcomes and returned to their pre-injury level of sporting activities. The use of a four-strand plantaris tendon autograft in isolated anatomic medial patellofemoral ligament reconstruction can restore patellar stability in adolescents.

Reduction of Operative Time, Intraoperative Radiographs, and Anterior Knee Pain With the Lateral Parapatellar Approach for Tibial Shaft Fracture Nailing: A Case Series.

Background Tibia fracture is a common indication for operative intervention in orthopedics. Usage of Intramedullary nailing provides a minimally invasive technique with good results. Positioning, operative time, and radiation exposure are major points in such cases. This study described the semi-extended lateral parapatellar intramedullary technique as a technique that helps achieve and maintain reduction, simplifies nail insertion, and decreases fluoroscopy and operative time. Methodology This prospective case series study included nine patients with tibial shaft fractures operated at Royal Rehabilitation Center from April to October 2023 by intramedullary nailing and extra-articular lateral parapatellar insertion technique using the semi-extended knee position. Duration of surgery, intraoperative radiation exposure, and anterior knee pain score were assessed for all patients. Results The average duration of surgery was 63.78 ± 5.3 minutes, and the average intraoperative imaging was 94 (85-103). The average union time was 18 ±2 weeks. The mean Kujala score was 90.9% ± 2.3% six months after the surgery. All patients regained a comparable range of motion in their knees and ankles. One patient reported minimal pain at the pin site but did not require any analgesia. Conclusion The lateral parapatellar approach for tibial shaft fracture nailing has the advantage of reducing operative time, the number of intraoperative radiographs, and lower postoperative anterior knee pain. Additionally, this approach did not cause patellar instability.

Transillumination method in total knee arthroplasty: new approach with old tools

PurposeIn this study, we evaluated the possibility of precise intraoperative localization of the lateral genicular arteries by an orthopaedic surgeon using the transillumination method.MethodsTwelve patients underwent cemented TKA with patella-friendly Zimmer Biomet NexGen Legacy Posterior Stabilized prostheses (without patellar resurfacing), seven right knees and five left knees. The mean age of patients in the study group was 66.636 ± 7.003 years. The minimal follow-up period was 13 months (mean—16.363 ± 2.5 months). Functional outcomes were assessed using Knee Society and a specific patellar questionnaire—Kujala Score. Intraoperative detection of insufficient patellar stability and/or patellar maltracking was based on the no-thumb technique. In pre- and postoperative period X-ray investigation, standard standing X-ray and Merchant view were used to evaluate implant position and patellofemoral congruency.ResultsIn this study, ten out of twelve knee joints (83.3%) had at least one artery visible by the proposed method in the lateral parapatellar area. Five out of ten knee joints had more than one artery that could be visualized and identified as an arterial vessel. Postoperative Knee Society Score showed significant improvement from a mean 51.181 ± 3.868 to a mean 88.727 ± 3.663. Mean hospital length of stay is 8.545 ± 1.863 days. X-ray assessment using standard anteroposterior, lateral, and Merchant skyline views showed appropriate implant positioning and patellofemoral congruency. The mean Kujala Score in the postoperative period (3 and 6 months) was 67.3 ± 6.75 and 75.6 ± 6.42, respectively.ConclusionsUsing the proposed transillumination method can help preserve the lateral blood supply to the patella and to avoid devascularized patella-related complications.Trial registrationRetrospectively registered on 5 of May 2023, Registration number – 3/3-1757.

Medium-term outcome of medial patellofemoral ligament reconstruction using synthetic graft

BackgroundRecurrent patella instability is a common and debilitating condition which affects mainly adolescents and young adults. Medial patellofemoral ligament (MPFL) reconstruction is the most popular surgical treatment for recurrent patella instability. The most common graft choice in the literature is ipsilateral hamstring tendon (gracilis or semitendinosis) but the complication rate remains high (11–26%). Conversely, there are very few papers on the use of modern, synthetic grafts. MethodsA total of 85 patients who underwent MPFL reconstruction using a modern, synthetic graft (Xiros, UK) from 2014 to 2022 were retrospectively reviewed. Exclusion criteria were patella alta, malalignment, trochlea dysplasia and significant pain between episodes of instability. The author has developed an operative technique which is anatomic, minimally invasive and reproducible. Pre- and post-operative Kujala and Oxford knee scores were collected and analysed. ResultsThe male to female ratio was 27:58, the average age was 28 years, and the follow up range was 1–9 years (mean follow up 4.84 years). We found a statistically significant improvement in mean Kujala and Oxford knee scores (P < 0.001) postoperatively. No major complications such as knee stiffness, soft tissue reaction, re-dislocation, patella fracture were identified in the series. There were nine minor complications (10.6%): five cases of medial knee pain, two cases of residual instability and two of superficial infection. ConclusionThis study demonstrates that modern, synthetic graft is a viable option for MPFL reconstruction. The technique described, achieves good clinical outcomes with low complication rates when compared with the published literature.

129 Evaluating Long-Term (≫5 Years) Patient Reported Outcome Measures and Kneeling Function in Patients with Tibial Intramedullary Nails

Abstract Aim 1) To assess the long-term (&amp;gt;5 years) patient reported outcome measures (PROMs) and kneeling ability in patients with tibial intra-medullary nails (IMNs). 2) To correlate the PROMs with superior and anterior IMN cortex protrusion, measured radiologically. Method 129 patients, from one UK centre, were invited to participate by completing a KOOS score, Kujala score, EQ-5D-5L and a four-posture kneeling assessment. Superior and anterior IMN prominence was measured using lateral radiographs. Pearson’s two-tailed correlation test was performed using SPSS v28. Results 45 patients responded to the questionnaire. 81.8% of patients were satisfied with their surgery. 20.5% of patients experienced daily AKP. The mean Kujala score was 80.7 (74.5, 86.8). The mean KOOS score was 83.2 (77.9, 88.5), 83.9 (78.3, 89.5), 85.8 (79.6, 92.0), 70.7 (60.8, 80.7) and 72.8 (64.8, 80.8) for symptoms, pain, daily living, sport and quality of life, respectively. Participants found the praying position and high flexion kneel the most difficult postures, with pain being the most common limiting factor. More than half of participants found all four kneeling postures easy to achieve. No significant correlation was found between the overall KOOS or Kujala score and nail-plateau distance (p = 0.408, p = 0.979), nail-anterior cortex distance (p = 0.552, p = 0.492) or the overall nail prominence (p = 0.608, p = 729). Conclusions AKP effects a subset of patients more than five years post-tibial IMN, limiting their ability to kneel. Most patients experience little or no pain with good knee functionality. Tibial IMN prominence does not seem to be associated with AKP in our sample.

Medium to long-term outcomes of medial patellofemoral ligament reconstruction using the superficial quadriceps versus a hamstring autograft in patellar instability patients

Medial patellofemoral ligament (MPFL) reconstruction is a standard procedure in patellar dislocation patients. Superficial quadriceps autografts (QA) and hamstring autografts (HA) are popular graft choices in MPFL reconstruction with the lack of directly compared clinical studies between both methods. A total of 43 patellar instability patients, who underwent QA and HA for patellar stabilization at a specified center between 2012 and 2021, were retrospectively reviewed. 21 QA and 22 HA patients were 52.4% of males and 47.6% females with a median age of 25 years (range 12–58) in the QA group, while 63.6% were females with a median age of 21 years (range 14–58) in the HA group. The mean follow-up period was 46.9 months (range 24–77) in QA and 61 months (range 24–100) in the HA group. At the final follow-up, no complications were observed with either technique. No patients presented with recurrent dislocations after surgery. There was no statistically significant difference in postoperative mean Kujala scores (QA = 94.9+/− 4.1 and HA = 94.2+/− 8.0, p = 0.73) or the mean Lysholm scores (QA = 94.1+/− 5.0 and HA = 93.2+/− 7.0, p = 0.61).

Medial Patellofemoral Ligament Reconstruction Using Pedicled Quadriceps Tendon Autograft Yields Similar Clinical and Patient-Reported Outcomes but Less Donor-Site Morbidity Compared With Gracilis Tendon Autograft

To compare clinical and patient-reported outcome measures (PROMs) in patients with recurrent patellar dislocation after medial patellofemoral ligament (MPFL) reconstruction using either a gracilis tendon (GT) or quadriceps tendon autograft (QT). All MPFL reconstruction performed between 2017 and 2019 were reviewed retrospectively. Only patients with isolated MPFL reconstruction, without any major patellofemoral risk factors and a minimum follow-up of 24 months, were included in the study. Patients were matched with respect to sex, age, and body mass index. All patients were evaluated clinically and using PROMs. A total of 64 patients with an average follow up of 28.7 ± 7.5 months were included in this study. The mean Kujala score (GT: 84.8 ± 12.9, QT: 88.9 ± 10.1), Lysholm score (GT: 89.4 ± 10.2, QT: 88.4 ± 5.0), and visual analog scale score for pain (GT: 1.9 ± 1.8, QT: 1.1 ± 1.3) did not significantly differ between both groups. Tegner activity level was significantly greater (P= .027) in the QT group (5.5 ± 1.9) compared with the GT group (4.6 ± 1.8), but within the minimal clinically important differences. Occasional patellar instability events, but no recurrent dislocation, were reported in 12.5% in the GT group and 6.3% in the QT group (P= .39). Of all patients, 90.6% in the QT and 68.8% in the HT group exceeded the PASS for the Kujala score (P= .06). Significantly more patients (59.4%) treated with GT reported donor-site morbidity in the form of sensitivity deficit at the lower leg compared with those treated with QT (3.1%, P= .001). GT and QT MPFL reconstruction have comparable PROMs and patellar redislocation rates 2 years' postoperatively. Significantly more patients treated with GT reported lower-leg sensitivity deficit compared with those treated with QT. Level III, retrospective case-control study.

Poster 241: Outcomes of Trochleoplasty for Recurrent Patellar Dislocation in Adolescents with Open Physes

Objectives: Patellofemoral dislocation, the most severe presentation on the spectrum of patellar instability, is most common in adolescent populations. Trochlear dysplasia is an integral component of the disorder, and procedures aimed at correcting instability by addressing this dysplasia are often necessary. A theoretical risk of injury to the distal femoral physis exists in these surgeries. At our institution, a thick-flap sulcus deepening technique is used to re-shape the trochlear groove. The risk of injury to the physis in this procedure is not clearly delineated in the current literature. We investigated the outcomes in adolescent patients undergoing this procedure, hypothesizing that patients with open distal femoral physes and less than 2 years of remaining growth can safely and successfully undergo thick-flap sulcus deepening trochleoplasty. Methods: Seventeen adolescents (21 knees) with open physes underwent thick-flap trochleoplasty at our institution. Preoperative radiographs were used to evaluate leg axis and patella alta. Preoperative MRI was used to determine trochlear dysplasia (sulcus depth, spur height, patellofemoral index) and tibial tuberosity to trochlear groove distance (TTTG) distance. Preoperative and postoperative AP and lateral radiographs were used to evaluate and compare the lateral distal femoral angle (LDFA) and Blumensaat’s angle (BA). Preoperative and postoperative IKDC and Kujala outcome scores were measured to evaluate clinical improvement. Results: Median age at time of operation was 14.9 years for girls and 15.5 for boys. Mean follow up was 5.4 years from surgery. At two-year follow up, growth plates were closed in all but one knee. No clinical differences to the leg length or alignment were appreciated. There was no statistically significant change in lateral distal femoral angle (mean change 0.74 degrees, p = 0.1074). There was a statistically significant change in Blumensaat’s angle (mean change 0.89 degrees, p = 0.0477). Mean Kujala score improved significantly from 60.19 preoperatively to 90.36 postoperatively, p= 0.0008. Mean IKDC score improved significantly from 59.37 preoperatively to 87.21 postoperatively, p = 0.00064. There was recurrent instability in one knee, requiring revision surgery with distal femur and Fulkerson osteotomies. Conclusions: Adolescent patients nearing skeletal maturity can safely and successfully undergo thick- flap sulcus deepening trochleoplasty for patellar instability resulting from trochlear dysplasia. At follow- up, there was no clinical evidence of growth disturbances, and postoperative imaging demonstrated less than 1 degree difference in LDFA and BA at skeletal maturity, which are unlikely to be of clinical significance. These findings should be interpreted very carefully, as specific patient selection, trochleoplasty expertise, and extreme caution are still necessary to prevent iatrogenic injury to the distal femoral physis.

Medial Patellofemoral Ligament Reconstruction Using Allografts in Skeletally Immature Patients

Background: Patellar instability has the highest incidence in adolescents aged between 14 and 18 years. The unique relationship between the medial patellofemoral ligament (MPFL) and the distal femoral physis in skeletally immature patients warrants precisely positioned MPFL graft insertion. A paucity of data are available evaluating the results of MPFL reconstruction using allograft tendon before skeletal maturity. Purposes: (1) To assess the results of MPFL reconstruction using allograft tendon in skeletally immature patients by analyzing redislocation and reoperation rates, radiological outcomes, and patient-reported outcomes and (2) to determine whether epidemiological, intraoperative, or radiographic factors influence recurrent instability and clinical outcomes. Study Design: Case series; Level of evidence, 4. Methods: Prospectively collected data were retrospectively analyzed for 69 skeletally immature patients who experienced a first-time or recurrent lateral patellar dislocation and were treated with anatomic MPFL reconstruction. Inclusion criteria were MPFL reconstruction using allograft and the availability of preoperative magnetic resonance imaging scans in the presence of open or partially open physes. Patients with <2 years of follow-up and patients with previous surgeries on the same knee were excluded from the study. Preoperative radiographic imaging was reviewed and analyzed. Trochlear dysplasia, tibial tubercle–trochlear groove distance, and patellar height were evaluated. Descriptive data, concomitant injuries, surgical procedure details, complications, and postoperative history were assessed via review of medical records and patient charts. Validated patient-reported and surgeon-measured outcomes were collected pre- and postoperatively, including Kujala score, Lysholm score, and Tegner activity score. Return-to-sports rate was assessed. The influence of epidemiological, intraoperative, and radiographic parameters on the redislocation rates and clinical outcomes was assessed using a multiple linear regression model. Results: A total of 79 physeal-sparing MPFL reconstructions (69 patients) met the inclusion criteria. The mean age of the patient cohort was 14.7 ± 1.8 years (range, 8.5-16.9 years). Within the mean follow-up time of 37.9 ± 12.1 months (range, 24-85 months after surgery, there were 12 patients with clinical failures resulting in reoperation. Eleven patients experienced a redislocation of the patella, and 1 patient sustained a transverse noncontact patellar fracture 6 months after index surgery that required operative fixation. No injuries to the distal femoral physes were clinically observed. At the final follow-up, patients had a mean Lysholm score (1-100) of 96.5 ± 6.7, a mean Kujala score (1-100) of 96.5 ± 7.4, and a mean Tegner Activity Scale score (1-10) of 4.9 ± 1.3. Patellar height and trochlear dysplasia did not influence redislocation or clinical scores. In total, 57 of the 63 patients (90.5%) who were engaged in sports before injury returned to the same or higher level of competition. In a subgroup analysis of patients who underwent isolated MPFL reconstruction (n = 44) without concomitant procedures, 9 patients (20.5%) experienced failure and had a redislocation. A univariate analysis of hazards for failure based on patient-specific variables was carried out. A body mass index ≥30 conveyed a hazard ratio of 2.51 (95% CI, 0.63-10.1; P = .19), and the tibial tubercle-trochlear groove distance by increments of 1 mm was associated with a hazard ratio of 2.02 (95% CI, 0.51-8.11; P = .32). Conclusion: Physeal-sparing anatomic reconstruction of the MPFL using an allograft tendon in skeletally immature patients was a safe and effective treatment for patellar instability, regardless of patellar height and trochlear dysplasia. Failure rates decreased when the MPFL reconstruction was performed concomitantly with a tibial tubercle osteotomy.

Surgical versus conservative management of patellar re-dislocation: clinical and radiological results at a mid-term follow-up of 5 years

Background: Patellar dislocation accounts for 2–3% of all knee lesions and is the second most common cause of traumatic hemarthrosis of the knee. Proper treatment is essential to minimize long term sequelae, such as recurrent dislocation, painful subluxation, and osteoarthritis. Aim: The purposes of this perspective randomized study were: 1) to evaluate the mid-term clinical and radiological results of the Elmslie–Trillat procedure for the treatment of traumatic patellar re-dislocation; and 2) to compare the results, especially radiological osteoarthritis development, with those of non-operative management for traumatic patellar re-dislocation. Methods: From June 2013 to February 2015, 65 patients were admitted to our Emergency Department for a first patellar dislocation episode. All patients were treated non-operatively. When a second episode occurred within two years, patients were randomly assigned in two groups: Group A, patients treated surgically with Elmslie-Trillat procedure, and Group B, patients were further treated non-operatively. The Knee Society Score (KSS), Lysholm scale and Kujala questionnaire were administered immediately after the re-dislocation and at the final follow-up. Tangential patella radiographs were evaluated for patellofemoral osteoarthritis and graded according to Sperner’s classification. Results: The mean follow-up was 6.4±1.7 years (range 5-8) in Group A and 6.3±2.1 years (range 5-9) in Group B. In Group A, the KSS and Lysholm scale showed significant differences between pre- and post-operatively values (p&lt;0.05). The mean Kujala score was significantly lower in Group B when compared with the mean value of Group A (p&lt;0.05). At the final follow-up of more than 5 five years, the mean grade of patellofemoral osteoarthritis according to Sperner’s classification changed in Group A and Group B, with respectively 25% and 29% of patients having a grade greater than or equal to 3. Conclusion: This study confirms that Elmslie-Trillat is a safe and effective procedure in the treatment of patellar instability, relieving pain and inability, and reducing recurrence risk. However, it cannot avoid the degenerative changes occurring in the natural evolution of patellar dislocation.

Artículo traducido] Resultados a medio plazo de la artroplastia femoropatelar

BackgroundThe purpose of this study is the evaluation of the patellofemoral arthroplasty (PFA) survival and clinical and radiological outcomes in our institution. MethodsA retrospective evaluation of our institution patellofemoral arthroplasty cases from 2006 to 2018 was performed; the n sample after applying exclusion and inclusion criteria was 21. All patients excepting one were female with a median age of 63 (20-78). A Kaplan-Meier survival analysis at ten years was calculated. Informed consent was obtained from all patients prior being included in the study. ResultsThe total revision rate was 6 out of 21 patients (28.57%). The progression of the osteoarthritis in the tibiofemoral compartment was the main cause (50% of revision surgeries). The degree of satisfaction with the PFA was high, with a mean Kujala score of 70.09 and a mean OKS of 35.45 points. The VAS score improved significantly (P<.001) from a preoperative mean of 8.07 to a postoperative mean of 3.45, with an average improvement of 5 (2-8). Survival at 10 years, with revision for any reason as the endpoint, was 73.5%. A significant positive correlation between BMI and the WOMAC pain (r=.72, P<.01) and between BMI and the post-operative VAS (r=.67, P<.01) was observed. ConclusionsThe results of the case series under consideration suggest that PFA could be a possibility in the joint preservation surgery on the isolated patellofemoral osteoarthritis. BMI >30 seems to be a negative predictor factor in relationship with the postoperative satisfaction, increasing the pain proportionally to this index and requiring more replacement surgery than patients with BMI <30. Meanwhile the radiologic parameters of the implant are not correlated with the clinical or functional outcomes.

3D-printed individualized navigation template versus the fluoroscopic guide to defining the femoral tunnel for medial patellofemoral ligament reconstruction: A retrospective study.

During medial patellofemoral ligament (MPFL) reconstruction, fluoroscopic determination of the femoral tunnel point is the most common method. However, there is a decrease in tunnel position accuracy due to rotation of the femur during fluoroscopy, as well as the damage to the operator from multiple fluoroscopies, whereas the 3D-printed individualized navigation template is not affected by this factor. This study focuses on the accuracy and early clinical efficacy of 2 different ways to determine the femoral tunnel (Schöttle point) for double-bundle isometric MPFL reconstruction. This is a retrospective study, conducted between 2016 and 2019, in which 60 patients with recurrent patellar dislocation were divided into 2 groups: 30 with MPFL reconstruction at the Schöttle point determined by 3D-printed individualized navigation template (group A) and 30 with MPFL reconstruction at the Schöttle point determined by fluoroscopic guidance (group B). The changes in patella congruence angle and patella tilt angle before and after surgery were assessed using computed tomography scans of the knee, knee function was assessed using the Kujala knee score and the international knee documentation committee (IKDC) score, and the 2 approaches were compared for the intraoperative establishment of the femoral tunnel position at a distance from Schöttle point. At a minimum of 3 years follow-up, patella tilt angle and patella congruence angle returned to normal levels and were statistically different from the preoperative range, with no significant differences between the 2 groups at the same period, and Kujala and IKDC scores of knee function were significantly improved in both groups after surgery. The mean Kujala and IKDC scores were statistically different between groups A and B at 3 and 6 months postoperatively. No statistically significant differences were seen between the 2 groups at the final follow-up. Both femoral tunnel localization approaches for double-bundle isometric MPFL reconstruction resulted in good knee function. At no < 3 years of follow-up, the use of a 3D-printed individualized navigation template did result in more accurate isometric points and higher knee function scores in the early postoperative period.

Medial patellofemoral ligament reconstruction using a digital tensiometer to determine graft tension: Surgical technique and mid-term follow-up.

The optimal method for achieving proper graft tension during patellofemoral ligament reconstruction is a topic of debate. In the past, a digital tensiometer was used to simulate the knee structure, and a tension of approximately 2N was identified as suitable for restoring the patellofemoral track. However, it is unclear whether this tension level is sufficient during the actual surgery. The objective of this study was to verify the efficacy of graft tension using a digital tensiometer for medial patellofemoral ligament (MPFL) reconstruction and to conduct a mid-term follow-up. The study enrolled 39 patients who had experienced recurrent patellar dislocation. Preoperative computed tomography scans and X-rays confirmed patellar instability, patellar tilt angle patellar congruence angle and the history of dislocation and patellar apprehension test. Knee function was evaluated using preoperative and postoperative Lysholm and Kujala scores. The study included 39 knees, comprising 22 females and 17 males, with an average age of 21.10 ± 7.26. The patients were followed up for at least 24months through telephone or face-to-face questionnaires. All patients had a preoperative history of ≥2 patellar dislocations, none of which were surgically treated. During surgery, all patients underwent isolated MPFL reconstruction and lateral retinacula release. The mean Kujala and Lysholm scores were 91.28 ± 4.90 and 90.67 ± 5.15, respectively. The mean PTA and PCA were 11.5 ± 2.63 and 2.38 ± 3.58, respectively. The study found that a tension of approximately 27.39 ± 5.57N (14.3-33.5N) was required to restore the patellofemoral track in patients with recurrent patellar dislocation. No patients required reoperation during the follow-up period. Overall, 36 out of 39 patients (92.31%) reported no pain when completing daily activities at the last follow-up. In conclusion, a tension level of approximately 27.39 ± 5.57N is necessary to restore normal patellofemoral relationships during clinical practice, which indicates that using a tension of 2N is too low. The use of a tensiometer during patellofemoral ligament reconstruction is a more accurate and reliable surgical procedure for treating recurrent patellar dislocation.

Midterm outcomes of patellofemoral arthroplasty

BackgroundThe purpose of this study is the evaluation of the patellofemoral arthroplasty (PFA) survival and clinical and radiological outcomes in our institution. MethodsA retrospective evaluation of our institution patellofemoral arthroplasty cases from 2006 to 2018 was performed; the n sample after applying exclusion and inclusion criteria was 21. All patients excepting one were female with a median age of 63 (20–78). A Kaplan–Meier survival analysis at ten years was calculated. Informed consent was obtained from all patients prior being included in the study. ResultsThe total revision rate was 6 out of 21 patients (28.57%). The progression of the osteoarthritis in the tibiofemoral compartment was the main cause (50% of revision surgeries). The degree of satisfaction with the PFA was high, with a mean Kujala score of 70.09 and a mean OKS of 35.45 points. The VAS score improved significantly (p<0.001) from a preoperative mean of 8.07 to a postoperative mean of 3.45, with an average improvement of 5 (2–8). Survival at 10 years, with revision for any reason as the endpoint, was 73.5%. A significant positive correlation between BMI and the WOMAC pain (r=0.72, p<0.01) and between BMI and the post-operative VAS (r=0.67, p<0.01) was observed. ConclusionsThe results of the case series under consideration suggest that PFA could be a possibility in the joint preservation surgery on the isolated patellofemoral osteoarthritis. BMI >30 seems to be a negative predictor factor in relationship with the postoperative satisfaction, increasing the pain proportionally to this index and requiring more replacement surgery than patients with BMI <30. Meanwhile the radiologic parameters of the implant are not correlated with the clinical or functional outcomes.

Isolated medial patellofemoral ligament reconstruction results in similar postoperative outcomes as medial patellofemoral ligament reconstruction and tibial-tubercle osteotomy: a systematic review and meta-analysis.

To determine the effect of isolated medial patellofemoral ligament reconstruction (MPFLR) versus concomitant MPFLR and tibial-tubercle osteotomy (TTO) on patient-reported functional outcomes, rate of patellar redislocation, and rate of return to sport in skeletally mature patients with recurrent patellar instability and lateralization as defined by elevated tibial-tubercle trochlear groove (TT-TG) distance. Three databases MEDLINE, PubMed and EMBASE were searched from inception to July 10th, 2022 for literature outlining the management of patients with TT-TG indices greater than 15mm with either isolated MPFLR or concomitant MPFLR and TTO procedures. The authors adhered to the PRISMA and R-AMSTAR guidelines as well as the Cochrane Handbook for Systematic Reviews of Interventions. Data on functional outcomes via the Kujala anterior knee pain score, redislocation rates, return to sport rates, and complications were recorded. The MINORS score was used for all studies to perform a quality assessment of included studies. A total of 31 studies comprising 1405 patients (1452 knees) were included in this review. The mean Kujala score in 13 studies comprising 848 total patients in the isolated MPFLR group was 85.0 (range 80.9-97.5) compared to a score of 83.7 (range 77.2-94.0) in 14 studies comprising 459 patients in the concomitant group. The mean pooled redislocation rate in 19 studies examining isolated MPFLR procedures comprising 948 patients was 3.1% (95% CI 2.1-4.4%, I2 = 7%) as opposed to 3.2% (95% CI 1.9-5.0%, I2 = 0%) in 15 studies comprising 486 patients in the concomitant group. The mean pooled return to sport rate in seven studies with 472 total patients in the isolated MPFLR group was 82% (95% CI 78-86%, I2 = 16%) compared to a score of 92% (95% CI 78-99%, I2 = 58%) in four studies comprising 54 patients in the concomitant group. There were similar complication rates between both treatment groups, including range of motion deficits, fractures, infections, and graft failures. Isolated MPFLR leads to similar anterior knee pain, similar redislocation rates and lower return to sport rates than concomitant MPFLR and TTO procedures in patients with TT-TG distances greater than 15mm. Information from this review can aid surgeons in their decision to choose MPFLR versus concomitant procedures for this patient population, and can also guide future studies on this topic. Level IV.

At 10-Year Minimum Follow-Up, One-Third of Patients Have Patellofemoral Arthritis After Isolated Medial Patellofemoral Ligament Reconstruction Using Gracilis Tendon Autograft

To report the long-term clinical outcomes after isolated medial patellofemoral ligament reconstruction (MPFLr) to treat recurrent patellar instability. This was a single-center study of patients undergoing an isolated MPFLr between 2000 and 2011. All patients underwent reconstruction using hamstring autograft. The inclusion criteria were a minimum 10-year follow-up period and skeletally mature patients with more than 1 episode of patellar dislocation who underwent MPFLr without an associated bony procedure. A total of 54 knees were available for final analysis. The mean follow-up period was 12.3 years (range, 10-14 year). The mean age at surgery was 25 years. No patients had patellofemoral arthritis (PFA) prior to surgery. Preoperatively, the mean Caton-Deschamps index was 1.1 and the mean tibial tubercle-trochlear groove distance was 14.9 ± 2 mm (range, 7-17 mm). All patients had trochlear dysplasia according to the Dejour classification. At final follow-up, the mean Kujala score was 82.9 ± 15.3; mean International Knee Documentation Committee score, 78.3 ± 18.5; and mean Tegner score, 4.0 ± 1.7. Patients with an unsatisfactory outcome as determined by a Kujala score lower than 80 had a higher Caton-Deschamps index preoperatively and were more likely to be female patients; however, neither factor reached significance. Of the patients, 33 (66%) had no radiographic evidence of PFA whereas 15 (30%) had Iwano stage 1 and 2 had Iwano stage 2 (4%). At final follow-up, 4 patients (7.4%) had recurrent instability requiring revision surgery. Isolated MPFLr with gracilis tendon autograft in appropriately selected patients is an effective long-term treatment for recurrent patellofemoral instability with low rates of recurrence. One-third of patients exhibit radiographic evidence of PFA more than 10 years after isolated MPFLr. Level IV, case series.

Paper 52: Sex-Based Differences in Outcomes After MPFL Reconstruction

Objectives:The purpose of the current study was to investigate whether pain, function, satisfaction, or return to play (RTP) differ between sexes post-operatively in those undergoing MPFL reconstruction for symptomatic patellar instability.Methods:A retrospective review of patients who underwent an MPFL reconstruction for symptomatic patellar instability was performed. Kujala score, Visual Analogue Scale (VAS), patient satisfaction, willingness to undergo surgery again, revisions, return to play (RTP) and MPFL-RSI score were evaluated. Clinical outcomes were compared between male and female patients. A p value of <0.05 was considered to be statistically significant.Results:Our study included 141 knees that underwent MPFLR, and the patient population was 69.5% female. Post-operatively, the mean VAS score at rest was 1.0 ± 1.7 in male patients and 1.6 ± 2.1 in female patients (p= 0.0963). The mean Kujala score was 88.8 ± 13.3 and 83.5 ± 16.1 for male and female patients respectively (p=0.1062). Overall, there was a significant difference in RTP, with male patients returning at higher rates (58.1% vs 33.3%, p = 0.0479). The mean VAS score during activity was significantly lower in male patients at 1.8 compared to female patients at 3 (p=0.016). MPFL-RSI-score was also significantly worse in female patients (69.5 vs 55.6, p = 0.0098). While female patients had slightly higher rates of recurrent subjective instability (14.3% vs 11.7%) and re-dislocation (2% vs 0%), the difference was not statistically significant (p = 0.6731 and 0.3490, respectively). Female patients demonstrated higher rates of additional surgery at long term follow up, though this difference was also not statistically significant (12.2% vs 4.6%, p = 0.1674).Conclusions:Female patients had worse clinical outcomes than males undergoing MPFLR for patellar instability, with significantly lower rates of RTP, VAS score during sport and MPFL-RSI scores with a trend towards lower Kujala score and VAS score.