Clinical Outcome Of Double-bundle Anatomical Medial Patellofemoral Ligament Reconstruction

ObjectiveThe medial patellofemoral ligament (medial patellofemoral ligament MPFL) is the mostimportant soft tissue structures around the patella.The MPFL has to prevent lateral dislocationor subluxation of the patella.The successful medial patellofemoral ligament reconstructionhave been described in patients with patellofemoral instability. Appropriate graft tensioning isessential to the success of the medial patellofemoral ligament reconstruction.Femoral tunnelplacement is the most important. to the isometry of the medial patellofemoral ligame-nt.Scholars has found that the single most important point affecting isometry is the femoralattachment site of the medial patellofemoral ligament in the course of knee flexion0-90degr-ees.The femoral tunnel should be placed at the anatomic insertion point of MPFL.The patellartunnel should begin at the anatomic insertion of the ligament used to reconstruct the func-tional bundle structure In the patella attachment.This article described the surgery methods ofthe anatomical double-bundle MPFL reconstruction.To afford an effective method of patellardislocation surgery treatment and discuss its indications.MethodsA retrospective analysis of24cases (22knees) with patellar dislocation underwent double-bundle anatomical MPFL reconstruction from January2010to December2012in the Jointdepartment of Affiliated Hospital of Taishan Medical university.Assessment was performedbased on physical examination,X-ray for Merchant and patellar hypermobility,Q angle meas-ureement,Postoperatively knee, X-ray was used to measure the sulcus angle, congruance ang-le,Knee function Was assessed by the Kujala and Lysholm scores. Statistical analysis was con-ducted with the SPSS software(SPSS13.0Chicago,III),paired student t test was for compa-rison between preopertive and lastest follow-up.The significace level was set at P <0.05．ResultsAccording to the grading system of Insall et al.12knees(50%)were classified as exce-llent,10knees(41%)as good,2knees(9%)as fair/poor,and none as worse at the final follow-up.One knee that had good results infrequently had mild patellofemoral knee pain.At the final follow-up,23knees had a full range of motion and1knee had a10°decrease in flexion,and noknees had a positive apprehension sign.No patient experienced re-dislocation of the patella,subluxation or patellar fracture,The incisions were healed well without deep venous throm-bosis occurred.The mean Kujala score improved significantly from62.33points (range,26-80points;SD,11.63points) preoperatively to92.33points (range,80-100points;SD,5.10points)at final follow-up (P<0.05,paired t test).The mean Lysholm score improved from70.08points(range,60-79points;SD,5.27points) preoperatively to94.639points (range,89-98points;SD,2.20points) at final follow-up (P<0.05,paired t test). On the preoperative axial radiogram-phs,The mean preoperative Q angle was18.29°(range,10°to25°;SD,4.55°). The mean co-ngruence angle improved significantly from17.42°(range,-6°to58°;SD,17.0) preoper-ativelyto-5.62°(range,-20°to10°;SD,8.23°) at follow-up (P<0.05,paired t test).The me-an sulcusangle had a statistically significant decrease from147.58°(range,138°to171°; SD,8.06°)preoperatively to142.42°(range,130°to167°;SD,9.72°) at follow-up (P<0.05,paired t test).All data were statistically significant．ConclusionThe double-bundle anatomical medial patellofemoral ligament reconstruction for patellardislocation,In clinic practices,double bundle reconstruction enable to restore the anatomicalfeature and the function of the native medial patellofemoral ligament,can correct poor patellartrack,Short-term follow-up show non-recurrent dislocation,it can get satisfactory results.It isworthy to be popularized.