POSTER ABSTRACTS - ISAKOS

Anterior knee pain has for many years been
attributed to the presence of an underlying
chondromalacia or patellofemoral arthritis.
Recent findings however would suggest that this
may actually be secondary to damage to the
articular cartilage of the patella and associated
strain to the peripatellar retinaculum. Such
findings have been further suggested to result
from an abnormality of the patellar alignment.
While most cases would respond to conservative
treatment, certain cases require surgical
intervention to adequately treat the condition.
Through the years, various extensor realignment
techniques have been developed to treat this
problem.
In the present study, a combined proximal and
distal re-alignment procedure was carried out on
108 knees. With a technique developed to ensure
anatomical patella tracking without over
correction, results obtained demonstrated 81.4%
to have good or excellent outcome. Complications
noted included anterior compartment syndrome
with foot drop in one case, which fully recovered,
and arthrofibrosis in another, which responded to
arthroscopic release. Second-look arthroscopic
findings in 65 patients demonstrated good
patellar tracking in all with Grade II articular
changes only in 16.
We conclude that extensor realignment surgery
with a combined proximal and distal realignment
procedure is a reliable technique in correcting
patellar malalignment and relieving
patellofemoral pain.
E-poster #608
Medial Patellofemoral Ligament
Reconstruction with Quadriceps-Patella
Autograft for Post-Traumatic Patellofemoral
Instability
Scott E Sexton, Manalapan, NJ, USA, Presenter
Harry A Bade III, Tinton Falls, NJ USA
Jonathan Stieber, Tinton Falls, NJ USA
Glenn Gabisan, Red Bank, NJ USA
Arthur Christiano, Boston, MA USA
Christopher Spagnoula, Fair Haven, NJ USA
Monmouth Medical Center, Long Branch, NJ, USA
Patellofemoral instability remains a challenging
orthopedic entity. The condition ranges in
severity from subtle instability to frank
dislocation. Causative mechanisms include
anatomic malalignment, ligamentous laxity, and
trauma. Most orthopedic surgeons employ
conservative measures to stabilize the
patellofemoral articulation, focusing on
strengthening the quadriceps mechanism,
specifically the vastus medialis obliquus, and
stabilizing the patella through bracing or taping.
Despite adequate nonoperative treatment, in
some cases, patellofemoral instability persists.
Recent clinical and cadaveric studies have
demonstrated that post-traumatic patellofemoral
instability results from disruption of the Medial
Patellofemoral Ligament (MPFL). This has
become the essential lesion of patella instability
and dislocation, similar to the Bankhart injury of
the shoulder. Based on this information, several
surgical procedures have been developed to
reconstruct the MPFL. To our knowledge, there
exists no documented procedure that utilizes an
autograft patella-quadriceps tendon composite
for recreation of the MPFL. This is a description of
the procedure and the results in five patients.
Five patients underwent reconstruction of the
MPFL using quadriceps-patella bone autograft.
There were three females and 2 males. The
average age at the time of surgery was 18 years
(17-20). The average follow-up was 15 months (7-
39). Patients underwent a physical examination,
specifically analyzing thigh circumference and
patella mobility, and completed a questionare,
including the Lysholm knee score with Tegner
activity scale. There were no recurrent
dislocations following surgical reconstruction of
the MPFL. Thigh circumference averaged 1 cm
less on the operative side. Lateral patella glide
was similiar on the operative and nonoperative
sides. The average Lysholm score was 74.4 (22-
96) with a Tegner score of 6 (3-7). One patient
suffered a patella fracture from a fall 4 months
following the surgery and is recovering from an
open reduction and internal fixation of his patella.
Excluding his results, the average Lysholm score
was 87.5 (83-96) with a Tegner score of 7. No
other complications were reported and the
remaining 4 patients were satisfied with their
results and would have the procedure done on the
opposite side if confronted with similar pathology.
Treatment of patellofemoral instability is
fraught with peril. The key to a successful
outcome is an accurate history and physical
examination, including radiographs. In the
absence of ligamentous laxity or anatomic
malalignment, traumatic disruption of the MPFL
will predispose to recurrent dislocations. We
present a new technique for surgical