AI Article Synopsis
- The systematic review focused on the effectiveness of hardware-free MPFL reconstruction for patients with recurrent patellofemoral instability, assessing outcomes like patient-reported results and redislocation rates.
- Eight studies met the criteria, showing a significant improvement in the Kujala Anterior Knee Pain Scale, with redislocation occurring in only 8.33% of patients.
- The findings suggest that hardware-free techniques are reliable and safe alternatives to traditional methods, highlighting benefits such as fewer complications and preservation of femoral growth in young patients.
Article Abstract
Purpose: This systematic review evaluated the clinical outcomes of hardware-free MPFL reconstruction techniques in patients with recurrent patellofemoral instability, focusing on patient-reported outcome measures (PROMs), redislocation rate, and complications. The hypothesis was that hardware-free MPFL reconstruction in patients with recurrent patellofemoral instability is safe and effective.
Methods: This systematic review was conducted following the PRISMA guidelines. PubMed, Scopus, and Virtual Health Library databases were accessed in October 2021. All the clinical studies investigating the efficacy and feasibility of hardware-free MPFL reconstruction were screened for inclusion. Only studies with a minimum 24-month follow-up were considered eligible. Kujala Anterior Knee Pain Scale improvement and redislocation rate after surgical treatment were evaluated as primary outcomes. The rate of postoperative complications was evaluated as a secondary outcome. The quality of the methodological assessment was assessed using the Modified Coleman Methodology Score.
Results: Eight studies were included in the present systematic review. The quality of the methodological assessment was moderate. Short- to long-term improvement of Kujala score was observed in all included studies. Mean score improvement ranged from + 13.2/100 to + 54/100, with mean postoperative scores ranging from 82/100 to 94/100. Patellar redislocation was observed in 8.33% (8 of 96) patients.
Conclusion: Hardware-free MPFL reconstruction with or without associated soft-tissue or bony realignment procedures provided reliable clinical improvements and was associated with a low rate of redislocation in patients with recurrent patellofemoral instability. Advantages such as safety, femoral physis preservation, and comparable complication profiles with implant-based techniques endorse its implementation. Orthopedic surgeons in cost-sensitive environments may also benefit their patients with lower costs, no need for implants, lack of implant-related complications, or surgery for implant removal.
Level Of Evidence: Level IV.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8864882 | PMC |
| http://dx.doi.org/10.1186/s13018-022-03008-5 | DOI Listing |
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Hardware-free MPFL reconstruction in patients with recurrent patellofemoral instability is safe and effective.
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Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy.
Article Synopsis
- The systematic review focused on the effectiveness of hardware-free MPFL reconstruction for patients with recurrent patellofemoral instability, assessing outcomes like patient-reported results and redislocation rates.
- Eight studies met the criteria, showing a significant improvement in the Kujala Anterior Knee Pain Scale, with redislocation occurring in only 8.33% of patients.
- The findings suggest that hardware-free techniques are reliable and safe alternatives to traditional methods, highlighting benefits such as fewer complications and preservation of femoral growth in young patients.
A computed tomography cadaveric study of the radiological anatomy of the patella: the size of the patella correlates with bone bridge between tunnels and R angles are introduced for safe tunnel drilling during MPFL reconstruction.
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Department of Anatomy, University Hospital of Larissa, Larissa, Greece.
Purpose: To measure the safe range of angles during tunnel drilling and map ideal patella tunnel placement with the use of preoperative computed tomography (CT) scan and compare results after medial patellofemoral ligament (MPFL) reconstruction using a hardware-free patellar fixation technique with two semi-patellar tunnels between a) a free-hand technique, and b) its modification with the use of an anterior cruciate ligament (ACL) tibia aiming device.
Methods: CT scan was performed on 30 fresh-frozen cadaveric knees a) prior to any intervention and b) after MPFL reconstruction. For MPFL reconstruction, specimens were randomly allocated to 1) Group A, which consisted of knees operated with free-hand, hardware-free patellar fixation technique with two semi-patellar tunnels and 2) Group B, which consisted of knees operated on with a technique modification with the ACL tibia device.
Medial Patellofemoral Ligament Reconstruction with Semi-Patellar Tunnel Fixation: Surgical Technique and Mid-Term Follow-Up.
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December 2017
Department of Orthopedics, The Third Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland).
BACKGROUND The present study aimed to describe a new safe and economical technique for medial patellofemoral ligament (MPFL) reconstruction with satisfactory clinical outcomes, and present the results of a four-year follow-up. MATERIAL AND METHODS Thirty-two patients with recurrent patella dislocation, who underwent MPFL reconstruction with two semi-patellar tunnels and hardware-free patellar fixation between 2011 and 2013, were included in the study. Patella stability was tested by an apprehension test preoperatively and at follow-up.
View Article and Find Full Text PDFEffective patellofemoral joint stabilization and low complication rates using a hardware-free MPFL reconstruction technique with an intra-operative adjustment of the graft tension.
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Department of Orthopedics, Trauma and Sports Medicine, Johanna-Etienne-Krankenhaus, Am Hasenberg 46, 41462, Neuss, Germany.
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Purpose: In adults, reconstruction of the medial patellofemoral ligament (MPFL) has shown good results. Treatment for recurrent patellar instability in children and adolescents with open growth plates, however, requires alternative MPFL reconstruction techniques. This study presents the outcomes of a minimally invasive technique for anatomic reconstruction of the MPFL in children using a pedicled superficial quadriceps tendon graft, hardware-free patellar graft attachment, and anatomic femoral fixation that spares the distal femoral physis.
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