Patellar Dislocation and Subluxation Medial Patellofemoral Ligamant Reconstruction |
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Patellar dislocation or subluxation of the patella is a disorder that most
commonly in adolescents, especially in young athletes and dancers. Nonoperative
treatment often results in recurrent dislocations and diminished knee function.
However, surgical treatments have associated morbidity and are not guaranteed
to relieve symptoms. Many surgical techniques, both proximal and distal
realighment, have been used with varying success and postoperative morbidity. Numerous etiologic predisposing factors for recurrent dislocation or subluxation of the@patella have been mentioned in the literature, and over 130 different operative methods have been described with the goal of correcting and/or eliminating patellofemoral instability and pain. Operation methods can be classified as proximal realignment, distal realignment, proximal and distal realignment, lateral retinacular release and medial retinacular plication.The purpose of these realignment procedures has been focused especially on the correction of the dynamic elements that intend to straighten the direction of the pull of the extensor mechanism and reduce the force tending to laterally displace the patella from the troclea. Although most authors indicated that the results are usually satisfactory and recurrence is uncommon, various problems have been indicated. These include recurrence of dislocation, remaining patellofemoral instability without redislocation, patellofemoral osteoarthritis, loss of flexion, and medial subluxation. Fithian stated that surgical treatment has not been uniformly successful. Aichroth described that no single procedure would be appropriate dfor all types of recurrent patellar dislocation and consequently, combinations of different methods are frequently necessary. And all the combinations of the various operations are chosen, unavoidably, in severe cases or failed operative treatments. Hughston noted in 1984 that we come to three-quarters of a century from the time of Roux (1888) and Krogius (1904) and yet their concepts and techniques are still with us today. Over the past decade, attention has begun to be directed to the medial patellofemoral ligament (MPFL) as a restraint of lateral patellar translation. In 1957, Kaplan first referred to the transverse retinacular ligament that afterwards became known as the MPFL. Although there were few reports before 1990, many clinical and basic reports indicating the importance of the MPFL in patellar subluxation and dislocation have been published in the past decade. Several researchers have reported that the MPFL has 50-60% of the total medial restraining force and the MPFL is the primary restraint among the medial patellar stabilizers. We reported that the MPFL is injured in most cases with acute patellar dsilocation and MPFL insufficiency is present in all cases with recurrent patellar dislocation. Now, the importance of the MPFL has been almost established. @@@2) Surgical technique which can be performed consistently in spite of the different degrees of patellar instability, @ @ 3) Surgical technique that minimizes damage to the extensor mechanism. To date, we have performed more than 400 MPFL reconstructions. From the results, we stress that MPFL reconstruction is better than all former operations. In 2008, we have developed a new MPFL reconstruction technique. This is the most reliable and safest technique. It s very difficult to treat haitual patellar dislocation. There have been no reliable reconstruction technique for habitual patellar dislocation cases. However, we recently have developed new reconstruction technique for habitual patellar dislocation. The success rate is very high. We are going to present these results in the near future in the world congress.
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