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Allograft Versus Autograft for Medial Patellofemoral Ligament Reconstruction
2017 ISAKOS ABSTRACTS
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Conclusion: This study describes the radiographic midpoint of the MPFC to be 18.8+/-14.3% of the articular surface from the superior pole of the patella. While previous anatomic studies of the MPFC have described this midpoint using anatomic landmarks at the junction of the medial border of the quadriceps tendon and superior pole of the patella, we describe this radiographic landmark for potential use as another reference during graft placement in the treatment of patellar instability.
(p ¼ 0.51). Recurrent subjective instability occurred in 9 patients in the allograft group (24.3%) and 5 patients in the autograft group (31.2%), (p ¼ 0.74). Conclusion: The use of either allograft or autograft tissue for MPFL reconstruction results in a very low (<3%) risk of repeat dislocation. Recurrent subjective instability occurs more frequently (1/4 to 1/3 of patients) at a similar rate for both graft types.
Category: Knee - Patellofemoral instability Paper #65: Allograft Versus Autograft for Medial Patellofemoral Ligament Reconstruction ROBERT A. MAGNUSSEN, MD, MPH, UNITED STATES NATHANIEL LUNDY, BS, UNITED STATES SCOTT SHEMORY, UNITED STATES MICHAEL STIJGEN, BS, UNITED STATES DAVID C. FLANIGAN, MD, UNITED STATES The Ohio State University, Columbus, OH, UNITED STATES
Category: Knee - Patellofemoral instability Paper #66: ’’Basket Weave’’ Technique Of Mpfl Reconstruction. A Prospective Study In 62 Knees PRANJAL SHARAD KODKANI, MS(ORTHO), D(ORTHO), MB, BS, INDIA Bombay Hospital, Shushrusha Hospital, Hinduja healthcare surgical, Mumbai, Maharashtra, INDIA
SUMMARY The use of either allograft or autograft tissue for MPFL reconstruction results in a very low (<3%) risk of repeat dislocation. ABSTRACT DATA Introduction: Patellofemoral instability with recurrent patellar dislocations is a debilitating condition that frequently affects a young, active patient population. Isolated medial patellofemoral ligament (MPFL) reconstruction has emerged as an effective treatment of recurrent patellar dislocations that occur in the absence significant patellofemoral malalignment or osseous abnormalities. Both allografts and autografts have been successful used for MPFL reconstruction. We hypothesize that MPFL reconstruction with allograft or autograft tissue yields similar low rates of recurrent dislocation and subjective patellar instability. Methods: Chart review identified 117 MPFL reconstructions (80 allograft and 37 autograft) without concurrent bony procedures (such as tibial tubercle osteotomy) performed between 2008 and 2014 by four sports medicine fellowship trained orthopedic surgeons at our center. Patient demographics (age and sex) and surgical data (graft type) were identified by chart review. Chart review and patient interviews were undertaken to identify recurrent patellar dislocations as well as recurrent subjective patellofemoral instability. Recurrent dislocation and subjective instability risk were compared between the allograft and autograft groups. Results: 53 patients (45%) with complete baseline data and minimum 1 year follow-up were contacted at a mean of 4.5 years following isolated MPFL reconstruction, including 37 patient with allograft reconstructions and 16 with autograft reconstructions. No significant differences in patient sex, age at reconstruction, body mass index, or time to follow-up were noted between groups. Recurrent dislocation occurred in 1 patient in the allograft group (2.7%) and 0 patients in the autograft group (0%),
SUMMARY “Basket Weave’ technique of MPFL reconstruction devised by the author has given encouraging results. It is anatomical and does not require bone tunnels or implants. It restores normal patellar stability and mobility. Combining it with other procedures for patellar instability does not compromise its results. It has a low failure rate. It is a safe, effective, reliable and reproducible technique. ABSTRACT DATA Background: MPFL reconstruction methods using bone tunnels and implant fixations are known to compromise results due to rigid fixations and non anatomical reconstructions. These methods are not advisable in the skeletally immature. Implant fixation and bone tunneling methods cannot reconstruct the medial quadriceps tendon femoral ligament (MQTFL) which has a soft tissue attachment to the quadriceps. The “Basket Weave” technique of MPFL reconstruction was devised by the author to overcome deficiencies of other techniques, to avoid bone tunnels and implants, provide an anatomical reconstruction and a physiometric construct with differential tensioning. A prospective study was performed to assess outcomes and complication rate. Materials and Methods: 62 knees of lateral patellar dislocation were treated in the past 60 months by “Basket Weave” technique of MPFL reconstruction. Cases selected for this reconstruction were symptomatic for patellofemoral instability, had a ‘dislocatable’ patella under examination or were subluxating patellae not responding symptomatically to appropriate physiotherapy. Cases with habitual patellar dislocation, chronic irreducible patellar dislocation, patello-femoral arthrosis and those responding well to physiotherapy were excluded. 42 were female and 20 male knees. The mean age was 20.3 years (range 9-48 years). Mean followup was 24 months. Five knees had previously failed stabilization procedure of lateral release with medial retinacular plication. 35 cases had Dejours
e69
Conclusion: This study describes the radiographic midpoint of the MPFC to be 18.8+/-14.3% of the articular surface from the superior pole of the patella. While previous anatomic studies of the MPFC have described this midpoint using anatomic landmarks at the junction of the medial border of the quadriceps tendon and superior pole of the patella, we describe this radiographic landmark for potential use as another reference during graft placement in the treatment of patellar instability.
(p ¼ 0.51). Recurrent subjective instability occurred in 9 patients in the allograft group (24.3%) and 5 patients in the autograft group (31.2%), (p ¼ 0.74). Conclusion: The use of either allograft or autograft tissue for MPFL reconstruction results in a very low (<3%) risk of repeat dislocation. Recurrent subjective instability occurs more frequently (1/4 to 1/3 of patients) at a similar rate for both graft types.
Category: Knee - Patellofemoral instability Paper #65: Allograft Versus Autograft for Medial Patellofemoral Ligament Reconstruction ROBERT A. MAGNUSSEN, MD, MPH, UNITED STATES NATHANIEL LUNDY, BS, UNITED STATES SCOTT SHEMORY, UNITED STATES MICHAEL STIJGEN, BS, UNITED STATES DAVID C. FLANIGAN, MD, UNITED STATES The Ohio State University, Columbus, OH, UNITED STATES
Category: Knee - Patellofemoral instability Paper #66: ’’Basket Weave’’ Technique Of Mpfl Reconstruction. A Prospective Study In 62 Knees PRANJAL SHARAD KODKANI, MS(ORTHO), D(ORTHO), MB, BS, INDIA Bombay Hospital, Shushrusha Hospital, Hinduja healthcare surgical, Mumbai, Maharashtra, INDIA
SUMMARY The use of either allograft or autograft tissue for MPFL reconstruction results in a very low (<3%) risk of repeat dislocation. ABSTRACT DATA Introduction: Patellofemoral instability with recurrent patellar dislocations is a debilitating condition that frequently affects a young, active patient population. Isolated medial patellofemoral ligament (MPFL) reconstruction has emerged as an effective treatment of recurrent patellar dislocations that occur in the absence significant patellofemoral malalignment or osseous abnormalities. Both allografts and autografts have been successful used for MPFL reconstruction. We hypothesize that MPFL reconstruction with allograft or autograft tissue yields similar low rates of recurrent dislocation and subjective patellar instability. Methods: Chart review identified 117 MPFL reconstructions (80 allograft and 37 autograft) without concurrent bony procedures (such as tibial tubercle osteotomy) performed between 2008 and 2014 by four sports medicine fellowship trained orthopedic surgeons at our center. Patient demographics (age and sex) and surgical data (graft type) were identified by chart review. Chart review and patient interviews were undertaken to identify recurrent patellar dislocations as well as recurrent subjective patellofemoral instability. Recurrent dislocation and subjective instability risk were compared between the allograft and autograft groups. Results: 53 patients (45%) with complete baseline data and minimum 1 year follow-up were contacted at a mean of 4.5 years following isolated MPFL reconstruction, including 37 patient with allograft reconstructions and 16 with autograft reconstructions. No significant differences in patient sex, age at reconstruction, body mass index, or time to follow-up were noted between groups. Recurrent dislocation occurred in 1 patient in the allograft group (2.7%) and 0 patients in the autograft group (0%),
SUMMARY “Basket Weave’ technique of MPFL reconstruction devised by the author has given encouraging results. It is anatomical and does not require bone tunnels or implants. It restores normal patellar stability and mobility. Combining it with other procedures for patellar instability does not compromise its results. It has a low failure rate. It is a safe, effective, reliable and reproducible technique. ABSTRACT DATA Background: MPFL reconstruction methods using bone tunnels and implant fixations are known to compromise results due to rigid fixations and non anatomical reconstructions. These methods are not advisable in the skeletally immature. Implant fixation and bone tunneling methods cannot reconstruct the medial quadriceps tendon femoral ligament (MQTFL) which has a soft tissue attachment to the quadriceps. The “Basket Weave” technique of MPFL reconstruction was devised by the author to overcome deficiencies of other techniques, to avoid bone tunnels and implants, provide an anatomical reconstruction and a physiometric construct with differential tensioning. A prospective study was performed to assess outcomes and complication rate. Materials and Methods: 62 knees of lateral patellar dislocation were treated in the past 60 months by “Basket Weave” technique of MPFL reconstruction. Cases selected for this reconstruction were symptomatic for patellofemoral instability, had a ‘dislocatable’ patella under examination or were subluxating patellae not responding symptomatically to appropriate physiotherapy. Cases with habitual patellar dislocation, chronic irreducible patellar dislocation, patello-femoral arthrosis and those responding well to physiotherapy were excluded. 42 were female and 20 male knees. The mean age was 20.3 years (range 9-48 years). Mean followup was 24 months. Five knees had previously failed stabilization procedure of lateral release with medial retinacular plication. 35 cases had Dejours