Middle-to long-term outcome after medial patellofemoral ligament reconstruction with Insall’s proximal realignment for patellar instability
Background: Recently, medial patellofemoral ligament (MPFL) reconstruction has become a common, widely used procedure to treat patellar instability. However, few reports exist on the long-term outcome after MPFL reconstruction. We elucidated the middle- to long-term outcome after MPFL reconstruction...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2019-07-01
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| Series: | Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2214687318301705 |
| _version_ | 1811299227142193152 |
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| author | Ryo Shimizu Yoshio Sumen Kazuki Sakaridani Masaki Matsuura Nobuo Adachi |
| author_facet | Ryo Shimizu Yoshio Sumen Kazuki Sakaridani Masaki Matsuura Nobuo Adachi |
| author_sort | Ryo Shimizu |
| collection | DOAJ |
| description | Background: Recently, medial patellofemoral ligament (MPFL) reconstruction has become a common, widely used procedure to treat patellar instability. However, few reports exist on the long-term outcome after MPFL reconstruction. We elucidated the middle- to long-term outcome after MPFL reconstruction with Insall’s proximal realignment. Methods: From 1999 to 2012, 42 knees of 32 patients who underwent MPFL reconstruction with Insall’s proximal realignment were reviewed with a minimum follow-up of five years. Patients who could visit our office and receive some designated examinations were included in this study. The re-dislocation rate and patellar apprehension sign postoperatively were evaluated. The Kujala score and Knee Injury and Osteoarthritis Outcome Score (KOOS) were calculated. We assessed the images using plane x-ray and magnetic resonance imaging (MRI). The tilting angle (TA), congruence angle (CA), and lateral shift ratio (LSR) on the plane x-ray were measured pre- and postoperatively and at final follow-up. Using MRI, osteochondral lesions at the patellofemoral joint were evaluated. Results: A total of 20 knees of 15 patients (two male, 13 female) who could visit our office were studied. The follow-up rate was 47.6%. The mean age at operation was 19.9 (11–41) years and mean follow-up was 123 (60–215) months. One knee (5.5%) had a history of postoperative subluxation, and five (25%) had a positive apprehension sign. The mean Kujala score significantly improved from 65.5 to 86.1 points (P < 0.05). The mean KOOS (symptom, pain, activities of daily living [ADL], sports, quality of life [QOL]) was 74.4, 92.4, 97.3, 84.1, and 73.2 points, respectively, at final follow-up. On the plane x-ray, patellofemoral alignment was improved postoperatively, and this improvement was maintained at final follow-up. On MRI, in five of 20 cases, the patellofemoral osteoarthritic change was observed at final follow-up. However, in four of these five knees with severe osteochondral lesions, osteochondral fixation or transplantation surgery had been performed. Only one of the remaining 15 knees had a patellofemoral osteoarthritic change observed at final follow-up. Conclusion: Middle- to long-term outcome after MPFL reconstruction with Insall’s proximal realignment at our institution was evaluated, and good clinical results were observed. Most patients who did not have a severe cartilage lesion preoperatively did not develop osteoarthritic change. |
| first_indexed | 2024-04-13T06:32:04Z |
| format | Article |
| id | doaj.art-8ff8f315622c45ccaf650c7152eee03d |
| institution | Directory Open Access Journal |
| issn | 2214-6873 |
| language | English |
| last_indexed | 2024-04-13T06:32:04Z |
| publishDate | 2019-07-01 |
| publisher | Elsevier |
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| series | Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology |
| spelling | doaj.art-8ff8f315622c45ccaf650c7152eee03d2022-12-22T02:58:05ZengElsevierAsia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology2214-68732019-07-011759Middle-to long-term outcome after medial patellofemoral ligament reconstruction with Insall’s proximal realignment for patellar instabilityRyo Shimizu0Yoshio Sumen1Kazuki Sakaridani2Masaki Matsuura3Nobuo Adachi4Department of Orhopaedic Surgery, JA Onomichi General Hospital, 1-10-23, Hirahara, Onomichi, Hiroshima, 722-8508, Japan; Corresponding author.Department of Orhopaedic Surgery, JA Onomichi General Hospital, 1-10-23, Hirahara, Onomichi, Hiroshima, 722-8508, JapanDepartment of Orhopaedic Surgery, JA Onomichi General Hospital, 1-10-23, Hirahara, Onomichi, Hiroshima, 722-8508, JapanDepartment of Orhopaedic Surgery, JA Onomichi General Hospital, 1-10-23, Hirahara, Onomichi, Hiroshima, 722-8508, JapanDepartment of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, JapanBackground: Recently, medial patellofemoral ligament (MPFL) reconstruction has become a common, widely used procedure to treat patellar instability. However, few reports exist on the long-term outcome after MPFL reconstruction. We elucidated the middle- to long-term outcome after MPFL reconstruction with Insall’s proximal realignment. Methods: From 1999 to 2012, 42 knees of 32 patients who underwent MPFL reconstruction with Insall’s proximal realignment were reviewed with a minimum follow-up of five years. Patients who could visit our office and receive some designated examinations were included in this study. The re-dislocation rate and patellar apprehension sign postoperatively were evaluated. The Kujala score and Knee Injury and Osteoarthritis Outcome Score (KOOS) were calculated. We assessed the images using plane x-ray and magnetic resonance imaging (MRI). The tilting angle (TA), congruence angle (CA), and lateral shift ratio (LSR) on the plane x-ray were measured pre- and postoperatively and at final follow-up. Using MRI, osteochondral lesions at the patellofemoral joint were evaluated. Results: A total of 20 knees of 15 patients (two male, 13 female) who could visit our office were studied. The follow-up rate was 47.6%. The mean age at operation was 19.9 (11–41) years and mean follow-up was 123 (60–215) months. One knee (5.5%) had a history of postoperative subluxation, and five (25%) had a positive apprehension sign. The mean Kujala score significantly improved from 65.5 to 86.1 points (P < 0.05). The mean KOOS (symptom, pain, activities of daily living [ADL], sports, quality of life [QOL]) was 74.4, 92.4, 97.3, 84.1, and 73.2 points, respectively, at final follow-up. On the plane x-ray, patellofemoral alignment was improved postoperatively, and this improvement was maintained at final follow-up. On MRI, in five of 20 cases, the patellofemoral osteoarthritic change was observed at final follow-up. However, in four of these five knees with severe osteochondral lesions, osteochondral fixation or transplantation surgery had been performed. Only one of the remaining 15 knees had a patellofemoral osteoarthritic change observed at final follow-up. Conclusion: Middle- to long-term outcome after MPFL reconstruction with Insall’s proximal realignment at our institution was evaluated, and good clinical results were observed. Most patients who did not have a severe cartilage lesion preoperatively did not develop osteoarthritic change.http://www.sciencedirect.com/science/article/pii/S2214687318301705 |
| spellingShingle | Ryo Shimizu Yoshio Sumen Kazuki Sakaridani Masaki Matsuura Nobuo Adachi Middle-to long-term outcome after medial patellofemoral ligament reconstruction with Insall’s proximal realignment for patellar instability Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology |
| title | Middle-to long-term outcome after medial patellofemoral ligament reconstruction with Insall’s proximal realignment for patellar instability |
| title_full | Middle-to long-term outcome after medial patellofemoral ligament reconstruction with Insall’s proximal realignment for patellar instability |
| title_fullStr | Middle-to long-term outcome after medial patellofemoral ligament reconstruction with Insall’s proximal realignment for patellar instability |
| title_full_unstemmed | Middle-to long-term outcome after medial patellofemoral ligament reconstruction with Insall’s proximal realignment for patellar instability |
| title_short | Middle-to long-term outcome after medial patellofemoral ligament reconstruction with Insall’s proximal realignment for patellar instability |
| title_sort | middle to long term outcome after medial patellofemoral ligament reconstruction with insall s proximal realignment for patellar instability |
| url | http://www.sciencedirect.com/science/article/pii/S2214687318301705 |
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