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Ligament Reconstruction versus Distal Realignment for Patellar Dislocation

  • Original Article
  • Knee
  • Published:
Clinical Orthopaedics and Related Research

Abstract

Recently, medial patellofemoral ligament reconstruction has been emphasized for the treatment of patellar dislocation. This study compared the results of medial patellofemoral ligament reconstruction by adductor magnus tenodesis with distal patellar realignment in patients with recurrent patellar dislocation. Additionally, the development of patellofemoral osteoarthrosis was compared for these two procedures at a median 10-year followup. Between 1994 and 2000, 47 consecutive patients were treated for recurrent patellar dislocation by adductor magnus tenodesis (18 knees) or Roux-Goldthwait procedure (29 knees). Redislocations, subjective symptoms, and functional outcomes were evaluated. Magnetic resonance imaging was performed at followup. The incidence of patellar redislocation after surgery was 7% in the adductor magnus group and 14% in the Roux-Goldthwait group. Median Kujala scores were 88 for the adductor magnus group and 86 for the Roux-Goldthwait group. Magnetic resonance imaging revealed patellofemoral articular cartilage lesions in 22 knees (73.3%) at followup, including 14 (46.6%) with full-thickness cartilage loss. Radiographs revealed patellofemoral osteoarthritis in five patients in the Roux-Goldthwait group and in none of the patients in the adductor magnus group. Adductor magnus tenodesis is a reliable method to treat recurrent patellar dislocation. The medial patellofemoral ligament reconstruction seems to reduce the risk of osteoarthrosis compared with distal realignment surgery.

Level of Evidence: Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We gratefully acknowledge the surgical expertise of Olli Kiviluoto, MD, PhD (Central Military Hospital, Helsinki, Finland) and the radiologic expertise of Martti Kiuru, MD, PhD (Central Military Hospital, Helsinki, Finland). We thank Marja Vajaranta (University of Tampere, Tampere, Finland) for editing the language.

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Authors and Affiliations

  1. Centre for Military Medicine, Lahti, Finland

    Petri Sillanpää MD, Ville M. Mattila MD, PhD, Tuomo Visuri MD, PhD & Harri Pihlajamäki MD, PhD

  2. Research Department, Centre for Military Medicine, Helsinki, Finland

    Petri Sillanpää MD, Ville M. Mattila MD, PhD & Harri Pihlajamäki MD, PhD

  3. Kerkkäkatu 5, 33820, Tampere, Finland

    Petri Sillanpää MD

  4. Department of Orthopaedic Surgery, Central Military Hospital, Helsinki, Finland

    Tuomo Visuri MD, PhD & Harri Pihlajamäki MD, PhD

  5. Department of Orthopaedic Surgery, Tampere University Hospital, Tampere, Finland

    Heikki Mäenpää MD, PhD

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  1. Petri Sillanpää MD
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  2. Ville M. Mattila MD, PhD
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Correspondence to Petri Sillanpää MD.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Sillanpää, P., Mattila, V.M., Visuri, T. et al. Ligament Reconstruction versus Distal Realignment for Patellar Dislocation. Clin Orthop Relat Res 466, 1475–1484 (2008). https://doi.org/10.1007/s11999-008-0207-6

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  • DOI: https://doi.org/10.1007/s11999-008-0207-6

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