Reconstruction of the medial patellofemoral ligament in cases of acute traumatic dislocation of the patella: current perspectives and trends in Brazil1

Arliani, Gustavo Gonçalves; Silva, Adriano Vaso Rodrigues da; Ueda, Léo Renato Shigueru; Astur, Diego da Costa; Yazigi Júnior, João Alberto; Cohen, Moises

doi:10.1016/j.rboe.2014.07.005

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Original Article • Rev. bras. ortop. 49 (5) • Sep-Oct 2014 • https://doi.org/10.1016/j.rboe.2014.07.005 copy

Reconstruction of the medial patellofemoral ligament in cases of acute traumatic dislocation of the patella: current perspectives and trends in Brazil1^☆ ☆ Please cite this article as: Arliani GG, da Silva AVR, Ueda LRS, Astur DC, Yazigi Júnior JA, Cohen M. Reconstrução do ligamento patelofemoral medial na luxação traumática aguda da patela: perspectivas e tendências atuais no Brasil. Rev Bras Ortop. 2014;49(5):499–506. ,^☆☆ ☆☆ Work developed at the Sports Traumatology Center, Department of Orthopedics and Traumatology, Universidade Federal de São Paulo, São Paulo, SP, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective:

To evaluate the approaches and procedures used by knee surgeons in Brazil for treating medial patellofemoral lesions (MPFL) of the knee in cases of acute traumatic dislocation of the patella.

Materials and methods:

A questionnaire comprising 15 closed questions on topics relating to treating MPFL of the knee following acute dislocation of the patella was used. It was applied to Brazilian knee surgeons during the three days of the 44th Brazilian Congress of Orthopedics and Traumatology, in 2012.

Results:

106 knee surgeons completely filled out the questionnaire and formed part of the sample analyzed. Most of them were from the southeastern region of Brazil. The majority (57%) reported that they perform fewer than five MPFL reconstruction procedures per year. Indication of non-surgical treatment after a first episode of acute dislocation of the patella was preferred and done by 93.4% of the sample. Only 9.1% of the participants reported that they had never observed postoperative complications. Intraoperative radioscopy was used routinely by 48%. The professionals who did not use this tool to determine the point of ligament fixation in the femur did not have a statistically greater number of postoperative complications than those who used it (p > 0.05).

Conclusions:

There are clear evolutionary trends in treatments and rehabilitation for acute dislocation of the patella due to MPFL, in Brazil. However, further prospective controlled studies are needed in order to evaluate the clinical and scientific benefit of these trends.

Knee; Knee joint; Medial patellofemoral ligament; Reconstruction; Rehabilitation

Variable		No			Yes			v
Variable		Mean	SD	N	Mean	SD	N	v
1/3 Medial patellar tendon		5.66	6.01	89	7.93	6.18	14	0.195
1/3 Medial quadriceps tendon		5.74	6.09	87	7.25	5.86	16	0.360
Gracilis and semitendinosus flexor tendons		5.34	5.38	76	7.74	7.49	27	0.077
Direct repair of MPFL (arthroscopic or open)		5.86	6.10	96	7.43	5.59	7	0.512
Gracilis flexor tendon		5.94	6.20	84	6.11	5.54	19	0.915
Semitendinosus flexor tendon		5.90	5.74	69	6.12	6.74	34	0.864
Other		6.22	6.14	97	2.00	1.67	6	0.098
Femur
	Endobutton	6.02	6.12	96	5.29	5.50	7	0.758
	Interference/Biotenodesis screw	5.03	5.99	33	6.41	6.08	70	0.281
	Anchors	6.00	6.03	93	5.7	6.57	10	0.882
	Screw (Post)	6.12	6.16	98	3.00	2.00	5	0.263
	Clips (AGRAF)	5.97	6.05	103			0	^a a Not possible to calculate the absence of professionals who perform the procedure.
	Direct suturing	5.93	5.85	91	6.25	7.71	12	0.866
	Others	5.97	6.05	103			0	^a a Not possible to calculate the absence of professionals who perform the procedure.
Patella
	Endobutton	5.82	6.01	93	7.40	6.57	10	0.435
	Interference/Biotenodesis screw	5.94	6.15	94	6.33	5.20	9	0.852
	Anchors	5.71	5.72	75	6.68	6.93	28	0.471
	Screw (Post)	5.97	6.05	103			0	^a a Not possible to calculate the absence of professionals who perform the procedure.
	Clips (AGRAF)	5.97	6.05	103			0	^a a Not possible to calculate the absence of professionals who perform the procedure.
	Direct suturing	5.66	5.70	86	7.53	7.61	17	0.247
	Others	6.17	6.24	94	3.89	3.02	9	0.282
	Surgical treatment indicated after first episode of patellar dislocation	5.65	5.85	96	12.00	6.93	6	0.012
	Use of intraoperative radioscopy to determine fixation point for femoral "neoligament"	6.35	6.43	52	5.81	5.76	48	0.664

Complications observed postoperatively		Time interval between injury/dislocation and surgery that was judged to be ideal												Total	p
		Up to 7 days		1-4 weeks		4-12 weeks		12-24 weeks		6-12 months		>1 year
		N	%	N	%	N	%	N	%	N	%	N	%
Pain															0.590
	No	3	12.5	8	33.3	4	16.7	1	4.2	7	29.2	1	4.2	24
	Yes	2	2.8	23	32.4	16	22.5	13	18.3	15	21.1	2	2.8	71
Quadriceps dysfunction															0.146
	No	5	7.6	22	33.3	15	22.7	9	13.6	13	19.7	2	3.0	66
	Yes	0	0.0	9	31.0	5	17.2	5	17.2	9	31.0	1	3.4	29
Presence of grip															0.701
	No	5	5.5	29	31.9	19	20.9	14	15.4	21	23.1	3	3.3	91
	Yes	0	0.0	2	50.0	1	25.0	0	0.0	1	25.0	0	0.0	4
Diminished knee range of motion															0.762
	No	5	7.5	19	28.4	16	23.9	12	17.9	12	17.9	3	4.5	67
	Yes	0	0.0	12	42.9	4	14.3	2	7.1	10	35.7	0	0.0	28
Lateral patellar subluxation/dislocation															0.274
	No	5	6.1	29	35.4	15	18.3	11	13.4	20	24.4	2	2.4	82
	Yes	0	0.0	2	15.4	5	38.5	3	23.1	2	15.4	1	7.7	13
Medial patellar subluxation/dislocation															0.854
	No	3	3.4	31	35.2	20	22.7	9	10.2	22	25.0	3	3.4	88
	Yes	2	28.6	0	0.0	0	0.0	5	71.4	0	0.0	0	0.0	7
Patellar fracture															0.298
	No	5	5.6	31	34.4	19	21.1	10	11.1	22	24.4	3	3.3	90
	Yes	0	0.0	0	0.0	1	20.0	4	80.0	0	0.0	0	0.0	5
Knee joint effusion															0.760
	No	3	4.6	23	35.4	12	18.5	10	15.4	16	24.6	1	1.5	65
	Yes	2	6.7	8	26.7	8	26.7	4	13.3	6	20.0	2	6.7	30
Infection															0.217
	No	5	5.4	31	33.7	19	20.7	13	14.1	22	23.9	2	2.2	92
	Yes	0	0.0	0	0.0	1	33.3	1	33.3	0	0.0	1	33.3	3
Without complications															0.238
	No	3	3.5	28	32.6	19	22.1	13	15.1	20	23.3	3	3.5	86
	Yes	2	22.2	3	33.3	1	11.1	1	11.1	2	22.2	0	0.0	9

Complications observed postoperatively		Use of intraoperative radioscopy to determine the fixation point of the neoligament in the femur				Total	p
		No		Yes
		N	%	N	%
Pain							0.680
	No	13	26.0	11	22.4	24
	Yes	37	74.0	38	77.6	75
Quadriceps dysfunction							0.099
	No	30	60.0	37	75.5	67
	Yes	20	40.0	12	24.5	32
Presence of grip							0.678^a a Results from Fisher's exact test.
	No	46	92.0	47	95.9	93
	Yes	4	8.0	2	4.1	6
Diminished knee range of motion							0.213
	No	32	64.0	37	75.5	69
	Yes	18	36.0	12	24.5	30
Lateral patellar subluxation/dislocation							0.076
	No	46	92.0	39	79.6	85
	Yes	4	8.0	10	20.4	14
Medial patellar subluxation/dislocation							0.160^a a Results from Fisher's exact test.
	No	48	96.0	43	87.8	91
	Yes	2	4.0	6	12.2	8
Patellar fracture							0.027^a a Results from Fisher's exact test.
	No	50	100.0	44	89.8	94
	Yes	0	0.0	5	10.2	5
Knee joint effusion							0.477
	No	35	70.0	31	63.3	66
	Yes	15	30.0	18	36.7	33
Infection							>0.999^a a Results from Fisher's exact test.
	No	47	94.0	47	95.9	94
	Yes	3	6.0	2	4.1	5
Without complications							0.741^a a Results from Fisher's exact test.
	No	46	92.0	44	89.8	90
	Yes	4	8.0	5	10.2	9

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[1] Conflicts of interest

The authors declare no conflicts of interest.