HOME HELP CONTACT US SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:
Sign In to gain access to subscriptions and/or personal tools.

This Article Full Text Full Text (PDF) All Versions of this Article: 35/11/1851    most recent 0363546507306161v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Request Reprints Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Nomura, E. Articles by Kobayashi, S. Search for Related Content PubMed PubMed Citation Articles by Nomura, E. Articles by Kobayashi, S. Related Collections Degenerative Joint Disease Dislocations Patella

Long-term Follow-up and Knee Osteoarthritis Change After Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Dislocation

Eiki Nomura, MD, PhD^,*, Motoyasu Inoue, MD and Shigeru Kobayashi, MD, PhD

From Department of Orthopaedic Surgery, Saitama Municipal Hospital, Saitama, Japan, Department of Orthopaedic Surgery, Isehara-Kyodo Hospital, Isehara, Japan, and Department of Orthopaedics and Rehabilitation Medicine, Fukui University School of Medicine, Fukui, Japan

^* Address correspondence to Eiki Nomura, MD, PhD, Department of Orthopaedic Surgery, Saitama Municipal Hospital, 2460, Mimuro, Midori-ku, Saitama 336-8522, Japan (e-mail: edknom{at}nifty.com).

Background: Proximal or distal realignment procedures have long been selected as treatment for recurrent patellar dislocation, but associated knee osteoarthritis has been a substantial problem that leads to poor results. A new approach, medial patellofemoral ligament reconstruction, has recently started, but there have been no reports on the long-term follow-up.

Hypothesis: Anatomical medial patellofemoral ligament reconstruction can lead to satisfactory long-term outcome and a low association rate of knee osteoarthritis.

Study Design: Case series; Level of evidence, 4.

Methods: Twenty-four knees from 22 patients who underwent medial patellofemoral ligament reconstruction for recurrent patellar dislocation were reviewed at a mean follow-up of 11.9 years (range, 8.5–17.2 years). A lateral release was done on 14 of 24 knees. The clinical/physical outcome and the association of knee osteoarthritis were investigated. Patellofemoral and femorotibial osteoarthritis on the radiographs was evaluated using the Crosby/Insall and the Kellgren/Lawrence grading systems.

Results: According to the Crosby/Insall criteria, 11 knees (46%) were classified as excellent, 10 (42%) as good, 3 (12%) as fair/poor, and none as worse at follow-up. Further lateral subluxation or dislocation occurred in only 2 knees. The mean Kujala score improved significantly from 63.2 points preoperatively to 94.2 points at follow-up (P < .0001). According to the Crosby/Insall grading system, patellofemoral osteoarthritis was none to mild in 23 of the 24 knees and moderate in 1 knee, pre-operatively. At the final follow-up, 21 knees were none to mild, and 3 knees were moderate. There were only 2 knees that had definite progression from none to mild to a moderate grade.

Conclusion: The association of definite knee osteoarthritis in medial patellofemoral ligament reconstruction with or without lateral release was small in the long-term follow-up. The conclusion is that medial patellofemoral ligament reconstruction not only prevents further patellar dislocation but also shows no or only slight progression of knee osteoarthritis.

Key Words: osteoarthritis • medial patellofemoral ligament (MPFL) • patella • dislocation