Effectiveness of medial patellofemoral ligament reconstruction in young athletes with chronic patellar instability

Julio C. Vélez-de Lachica, Orthopedics Service, Hospital Regional Tlalnepantla, Instituto de Seguridad Social del Estado de México y Municipios (ISSEMyM), Tlalneplanta, State of Mexico; Orthopedics Service, Star Medica Tlalnepantla Hospital, Tlalnepantla, State of Mexico; Mexico
Juan A. Pages-Ureña, Orthopedics Service, Star Medica Tlalnepantla Hospital, Tlalnepantla, State of Mexico; Orthopedics Service, Hospital Angeles Queretaro, Queretaro, Queretaro; Mexico
Susana Serrano-Reyes, Orthopedics Service, Star Medica Tlalnepantla Hospital, Tlalnepantla, State of Mexico; Orthopedics Service, Hospital Angeles México, Mexico City; Mexico
Miguel A. Ruiz-Fragoso, Orthopedics Service, Star Medica Tlalnepantla Hospital, Tlalnepantla, State of Mexico, Mexico

Background: Recurrent patellofemoral dislocation is a major concern among athletic adolescents, particularly in cases with anatomical predispositions like trochlear dysplasia or increased femoral anteversion. This condition can lead to chronic instability and osteoarthritis. The medial patellofemoral ligament (MPFL) plays a crucial role in patellar stability, and its injury often necessitates surgical treatment. However, reconstruction in skeletally immature individuals poses challenges due to growth plate proximity. Objective: To assess the functional outcomes and complications of MPFL reconstruction using an autologous gracilis tendon graft in 22 adolescent patients with recurrent patellar dislocation. Material and methods: A threeyear prospective cohort study evaluated knee function pre- and post-surgery using Kujala and Tegner-Lysholm scales, alongside patient satisfaction with the Oxford Knee Score. Surgical techniques aimed to avoid growth plate injury, and rehabilitation emphasized quadriceps strengthening and range-of-motion exercises. Results: Significant functional improvements were noted, with Kujala scores increasing from 59 to 78 (p = 0.001) and Tegner-Lysholm scores from 72 to 86 (p = 0.0002). Patient satisfaction was high, averaging 41 on the Oxford Knee Score. Complications were minimal, with one case of arthrofibrosis requiring secondary intervention. No growth plate injuries or recurrent dislocations were reported. Conclusion: MPFL reconstruction using an autologous gracilis tendon graft is effective and safe for adolescent patellar dislocation, but careful postoperative monitoring and optimized rehabilitation are key to minimizing complications. Additional research is needed to validate these findings.

Keywords: Medial patellar femoral ligament. Knee. Adolescent. Athletes. Patellar instability. Knee pain.