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Does degree of trochlear dysplasia and position of femoral tunnel influence outcome after medial patellofemoral ligament reconstruction?
[trochlear dysplasia]
The
medial
patellofemoral
ligament
(
MPFL
)
is
the
main
restraining
force
against
lateral
patellar
displacement
.
It
is
disrupted
after
patellar
subluxation
or
dislocation
.
Reconstruction
of
the
MPFL
is
frequently
performed
when
nonoperative
management
fails
and
the
patient
experiences
recurrent
patellar
dislocation
.
To
determine
the
relationship
between
the
degree
of
trochlear
dysplasia
and
femoral
tunnel
position
and
outcome
after
MPFL
reconstruction
.
C
ase
series
;
Level
of
evidence
,
4
.
A
total
of
68
patients
(
72
knees
)
with
recurrent
dislocation
of
the
patella
underwent
MPFL
reconstruction
.
The
mean
follow-up
was
31
.
3
months
(
range
,
13
-
72
months
)
.
Clinical
and
functional
outcomes
were
recorded
using
the
Kujala
,
Lysholm
,
and
Tegner
scores
.
Postoperative
complications
,
participation
in
sporting
activity
,
and
overall
patient
satisfaction
were
determined
.
Radiographs
were
analyzed
to
evaluate
congruence
angle
,
lateral
patellofemoral
angle
,
patellar
height
,
trochlear
dysplasia
,
trochlear
boss
height
,
and
position
of
the
femoral
tunnel
.
The
mean
Kujala
,
Lysholm
,
and
Tegner
scores
postoperatively
were
76
.
2
,
73
.
8
,
and
3
.
6
,
respectively
(
n
=
61
)
.
The
mean
congruence
angle
(
n
=
30
)
improved
from
22
.
5
°
to
1
.
0
°
postoperatively
(
P
=
.
000038
)
,
the
lateral
patellofemoral
angle
(
n
=
30
)
improved
from
7
.
4
°
to
7
.
8
°
postoperatively
(
P
=
.
048
)
,
and
the
patellar
height
(
n
=
46
)
using
the
Caton
-
Deschamps
method
improved
from
1
.
1
to
1
.
0
postoperatively
(
P
=
.
000016
)
.
Mild
trochlear
dysplasia
grade
A
/
B
was
found
in
89
%
of
patients
(
n
=
54
)
,
and
11
%
of
patients
(
n
=
7
)
had
severe
grade
C
/
D
dysplasia
.
The
mean
distance
from
the
anatomic
insertion
of
the
MPFL
to
the
center
of
the
tunnel
was
9
.
3
mm
(
range
,
0
.
5
-
28
.
2
mm
)
,
with
71
.
7
%
thought
to
be
within
10
mm
of
the
anatomic
position
defined
by
Schottle
(
n
=
46
)
.
When
patients
with
high
-grade
trochlear
dysplasia
were
excluded
,
anatomically
placed
femoral
tunnels
demonstrated
significantly
better
clinical
scores
than
did
tunnels
not
placed
anatomically
(
Kujala
score
,
P
=
.
028
;
Lysholm
score
,
P
=
.
012
)
.
A
multivariate
logistic
regression
analysis
also
demonstrated
that
the
distance
of
the
femoral
tunnel
from
the
anatomic
position
predicted
clinical
outcome
(
Kujala
score
,
P
=
.
043
;
Lysholm
score
,
P
=
.
028
)
.
All
of
the
patients
with
severe
trochlear
dysplasia
(
n
=
7
)
suffered
from
recurrent
dislocations
postoperatively
,
compared
with
only
9
.
3
%
of
patients
(
n
=
5
)
with
mild
trochlear
dysplasia
(
P
=
.
0001
)
.
Four
patients
had
patellar
fractures
postoperatively
.
Of
patients
with
mild
dysplasia
,
83
%
were
either
very
satisfied
or
satisfied
with
the
outcome
of
their
surgery
compared
with
only
57
%
with
severe
dysplasia
(
P
=
.
05
)
.
Of
patients
with
mild
trochlear
dysplasia
,
56
%
returned
to
sport
postoperatively
compared
with
only
43
%
of
patients
with
severe
trochlear
dysplasia
(
P
=
.
526
)
.
This
study
demonstrates
the
importance
of
restoration
of
the
anatomic
insertion
point
of
the
MPFL
when
performing
MPFL
reconstruction
and
proposes
that
this
procedure
should
not
be
performed
in
isolation
in
patients
with
high
-grade
trochlear
dysplasia
.
Diseases
Validation
Diseases presenting
"dislocations"
symptom
kabuki syndrome
trochlear dysplasia
This symptom has already been validated