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Femoral tunnel enlargement after medial patellofemoral ligament reconstruction: prevalence, risk factors, and clinical effect.
[trochlear dysplasia]
In
recent
years
,
significantly
more
attention
has
been
focused
on
the
role
of
the
medial
patellofemoral
ligament
(
MPFL
)
in
patellar
stability
,
and
MPFL
reconstruction
has
become
a
mainstay
of
surgical
treatment
of
episodic
patellar
dislocations
.
Although
previously
described
in
detail
after
reconstruction
of
the
anterior
cruciate
ligament
,
tunnel
enlargement
has
not
been
investigated
after
MPFL
reconstruction
.
(
1
)
Femoral
tunnel
enlargement
occurs
after
MPFL
reconstruction
.
(
2
)
Patella
alta
,
trochlear
dysplasia
,
and
tunnel
malposition
are
risk
factors
for
tunnel
enlargement
.
(
3
)
The
presence
of
tunnel
enlargement
is
not
associated
with
recurrent
dislocations
or
poorer
patient-reported
outcome
scores
after
MPFL
reconstruction
.
Case-control
study
;
Level
of
evidence
,
3
.
Fifty
-
five
of
59
knees
treated
for
episodic
patellar
dislocations
with
MPFL
reconstruction
between
2005
and
2010
were
evaluated
at
1
year
postoperatively
for
the
presence
of
tunnel
enlargement
on
lateral
radiographs
.
Tunnel
enlargement
was
defined
as
a
tunnel
area
greater
than
2
times
that
of
the
original
tunnel
.
Knees
with
tunnel
enlargement
at
1
year
were
compared
with
those
without
tunnel
enlargement
.
Patients
were
assessed
for
recurrent
subluxations
or
dislocations
at
a
mean
of
3
years
postoperatively
,
and
patient-reported
outcome
scores
were
assessed
in
a
subset
of
patients
at
a
mean
of
3
.
7
years
postoperatively
.
Tunnel
enlargement
was
noted
in
23
knees
(
41
.
8
%
)
.
No
differences
in
patient
age
or
body
mass
index
were
noted
between
the
2
groups
.
The
mean
patellar
height
was
significantly
higher
in
the
enlarged
tunnel
group
(
P
=
.
03
)
.
A
higher
prevalence
of
trochlear
dysplasia
or
tunnel
malposition
was
not
demonstrated
in
the
enlarged
tunnel
group
.
Patient-reported
outcome
scores
and
the
risk
of
recurrent
patellar
instability
were
equal
in
the
2
groups
.
Femoral
tunnel
enlargement
after
MPFL
reconstruction
is
common
,
with
patients
with
patella
alta
at
an
increased
risk
.
The
influence
of
tunnel
malposition
and
trochlear
dysplasia
on
this
condition
requires
further
research
.
Recurrent
instability
and
patient-reported
outcome
scores
are
not
affected
by
tunnel
enlargement
.