Combination of medial patellofemoral ligament reconstruction with vastus medialis advancement for chronic patellar dislocation

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Author:
WANG Fei(Department of Joint Surgery, Third Hospital of Hebei Medical University,Shijiazhuang, Hebei 050051, China)
KANG Hui-jun(Department of Joint Surgery, Third Hospital of Hebei Medical University,Shijiazhuang, Hebei 050051, China)
CHEN Bai-cheng(Department of Joint Surgery, Third Hospital of Hebei Medical University,Shijiazhuang, Hebei 050051, China)
CHEN Wei(Orthopedic Institute, Third Hospital of Hebei Medical University,Shijiazhuang, Hebei 050051, China)
SU Yan-ling(Orthopedic Institute, Third Hospital of Hebei Medical University,Shijiazhuang, Hebei 050051, China)
ZHANG Ying-ze(Center of Trauma, Third Hospital of Hebei Medical University,Shijiazhuang, Hebei 050051, China)
Journal Title:
CHINESE MEDICAL JOURNAL
Issue:
Volume 123, Issue 21, 2010
DOI:
10.3760/cma.j.issn.0366-6999.2010.21.014
Key Word:
patellar dislocation;medial patellofemoral ligament;isometric reconstruction;combined reconstruction;vastus medialis advancement

Abstract: Background The medial patellofemoral ligament (MPFL) reconstruction is popular in clinical practice for chronic patellar dislocation; however, the combination with vastus medialis advancement is rare. The aim of this study was to evaluate the clinical outcome of the combination of MPFL reconstruction with vastus medialis advancement.Methods We retrospectively analyzed 69 patients with chronic patellar dislocation between July 2004 and October 2008: twenty eight cases with isolated MPFL reconstruction (group Ⅰ), forty one cases with the combination of MPFL reconstruction with vastus medialis advancement (group C). All patients had CT scans available for review with knee flexion at 30 degree, on which the congruence angle, patellar tilt angle and patellar lateral shift were measured. Physical apprehension tests were examined and the redislocation was recorded. In addition, knee function was evaluated using the Kujala score and subjective questionnaires.Results Patients were followed up for a mean of 42 months (12-65 months) without a recurrent dislocation reported.Postoperatively, all indexes on CT scan were within the normal range without a statistical difference between the two groups. Results from the apprehension test showed eight patients in group Ⅰ and three in group Chad patellar lateral shift exceeding 1.5 cm with a hard end point (P <0.05). The Kujala score improved significantly from 51.3±4.5 to 79.9±6.2 in group Ⅰ and from 53.7±5.2 to 83.9±6.5 in group C (P >0.05). However, the subjective questionnaire revealed a significant difference (P <0.05), including 12 excellent, seven good and nine fair in group Ⅰ and 30 excellent, six good and five fair in group C.Conclusion The combination of MPFL reconstruction with vastus medialis advancement is better than isolated reconstruction to improve the subjective effects and decrease the patellar instability rate for chronic patellar dislocation.

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