Medial Patellofemoral Ligament Reconstruction With a Divergent Patellar Transverse 2-Tunnel Technique

Background: The medial patellofemoral ligament (MPFL) is the primary passive restraint to lateral patellar dislocation and there is increasing awareness of its role in recurrent lateral patellar instability. Purpose: This study was conducted to prospectively analyze the functional results of a modified MPFL reconstruction technique in recurrent patellar dislocation. Study Design: Case series; Level of evidence, 4. Methods: Forty-eight patients (51 knees) with at least 3 episodes of lateral patellar dislocation who had been treated with a 6-month rehabilitation protocol were included in this study. All patients practiced sports regularly. Reconstruction was with a semitendinosus tendon using a divergent 2-tunnel technique. Outcome was evaluated with the Kujala, Larsen, modified Lysholm, and Fulkerson outcome scores. Patient satisfaction with range of motion, pain, and sporting activities was also assessed. Results: Three patients were lost at the final follow-up, giving a follow-up rate of 94%. The mean follow-up was 33 months. There was no patella dislocation postoperatively. The mean Kujala score improved significantly (P < .01) from 56.7 +/- 17.7 (2 x standard deviation) preoperatively to 86.8 +/- 14.4 postoperatively. The mean Larsen score improved significantly (P < .01) from 12.4 +/- 3.2 to 17.1 +/- 2.7. The mean Fulkerson score improved significantly (P < .01) from 59.2 +/- 21.8 to 90.1 +/- 14. The mean modified Lysholm score improved significantly (P < .01) from 57.6 +/- 19.6 to 88.1 +/- 16.2. Sixty-four percent of patients returned to the same type of sport at the same level, 16% reduced the level or type of sport for reasons unrelated to the surgery, while 20% reduced the level of sport or changed it for reasons related to surgery. Eighty-seven percent were either satisfied or very satisfied with the pain relief achieved. The patellar tilt decreased significantly from a preoperative mean of 11.1 degrees to 8.9 degrees at the last follow-up (P = .02). The mean preoperative Insall-Salvati ratio of 1.1 decreased to 1.06, although the change was not significant (P = .1). Conclusion: The results of modified MPFL reconstructions are encouraging, with minimal risks of redislocation and an overall patient satisfaction rate of over 80%. These early and medium-term results are comparable with those of other MPFL reconstruction techniques reported in the literature.