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A. Lenting, A. Rood en A. van Kampen ■reconstructie goede resultaten zien in vergelijkingmet de eerder gebruikte technieken, de statischeMPFL reconstructie en de VMO-plastiek. De dynamischetechniek laat een goede VAS-tevredenheid,een goede Kujala-score en minder re-operatieszien. Bovendien is sprake van een kleiner wondoppervlakten aanzien van de statische methode, isgeen gipsimmobilisatie nodig waardoor er sprakeis van een snelle mobilisatie en is het risico opfracturen minimaal. Verder onderzoek in detoekomst zal uitwijzen of de techniek ook op langetermijn een goed resultaat laat zien.AbstractIn the last couple of years, the treatment of patellofemoralinstability has changed. In the past, VMO-plasties were usedto restore stability when the soft tissues on the medial sideof the knee functioned insufficiently. Nowadays, the MPFLreconstruction has gained popularity. During the years therehas been a change of technique, from a static to a moredynamic reconstruction. We performed this retrospectivestudy to look at the results of the different techniques usedin patellofemoral instability.In a group of 31 patients 8 received a VMO plasty, 8 a staticMPFL reconstruction and 14 a dynamic MPFL reconstruction.We looked at recurrent dislocations, subluxation experiencesand de VAS score for satisfaction, pain in rest and duringexercise. We also scored each patient by using the Kujalaquestionnaire. Preoperative data were collected by lookingin the medical files.The dynamic MPLF reconstruction has a better outcome thanthe other two techniques when we look at recurrent dislocations,reoperations and Kujala score. The VAS score for satisfactionwas almost equal for the two MPFL-groups but theVMO-group scored less. The VAS score for pain was higher inthe dynamic MPFL-group, although not significantly.Dynamic MPFL reconstruction seems to be a good techniqueto restore patellofemoral instability.Literatuur1. Fithian DC, Paxton EW, Stone ML, Silva P, Davis DK, EliasDA et al. Epidemiology and natural history of acutepatellar dislocation. Am J Sports Med 2004; 32(5):1114-1121.2. Atkin DM, Fithian DC, Marangi KS, Stone ML, Dobson BE,Mendelsohn C. Characteristics of patients with primaryacute lateral patellar dislocation and their recoverywithin the first 6 months of injury. Am J Sports Med2000; 28(4):472-479.3. Tuxoe JI, Teir M, Winge S, Nielsen PL. The medial patellofemoralligament: a dissection study. Knee Surg SportsTraumatol Arthrosc 2002; 10(3):138-140.4. Conlan T, Garth WP, Jr., Lemons JE. Evaluation of themedial soft-tissue restraints of the extensor mechanismof the knee. J Bone Joint Surg Am 1993; 75(5):682-693.5. Hautamaa PV, Fithian DC, Kaufman KR, Daniel DM,Pohlmeyer AM. Medial soft tissue restraints in lateralpatellar instability and repair. Clin Orthop Relat Res1998;(349):174-182.6. Desio SM, Burks RT, Bachus KN. Soft tissue restraints tolateral patellar translation in the human knee. Am JSports Med 1998; 26(1):59-65.7. Nomura E. Classification of lesions of the medial patello-femoralligament in patellar dislocation. Int Orthop1999; 23(5):260-263.8. Sallay PI, Poggi J, Speer KP, Garrett WE. Acute dislocationof the patella. A correlative pathoanatomic study.Am J Sports Med 1996; 24(1):52-60.9. Sanders TG, Morrison WB, Singleton BA, Miller MD,Cornum KG. Medial patellofemoral ligament injuryfollowing acute transient dislocation of the patella:MR findings with surgical correlation in 14 patients. JComput Assist Tomogr 2001; 25(6):957-962.10. Buckens CF, Saris DB. Reconstruction of the medial patellofemoralligament for treatment of patellofemoralinstability: a systematic review. Am J Sports Med 2010;38(1):181-188.11. Fisher B, Nyland J, Brand E, Curtin B. MedialPatellofemoral Ligament Reconstruction for RecurrentPatellar Dislocation: A Systematic Review IncludingRehabilitation and Return-to-Sports Efficacy. Arthroscopy2010; 26(10):1384-1394.12. Kujala UM, Jaakkola LH, Koskinen SK, Taimela S, HurmeM, Nelimarkka O. Scoring of patellofemoral disorders.Arthroscopy 1993; 9(2):159-163.13. Christiansen SE, Jacobsen BW, Lund B, Lind M.Reconstruction of the medial patellofemoral ligamentwith gracilis tendon autograft in transverse patellar drillholes. Arthroscopy 2008; 24(1):82-87.14. Mikashima Y, Kimura M, Kobayashi Y, Miyawaki M,Tomatsu T. Clinical results of isolated reconstruction ofthe medial patellofemoral ligament for recurrent dislocationand subluxation of the patella. Acta Orthop Belg2006; 72(1):65-71.15. Thaunat M, Erasmus PJ. Recurrent patellar dislocationafter medial patellofemoral ligament reconstruction.Knee Surg Sports Traumatol Arthrosc 2008; 16(1):40-43.16. Chassaing V, Tremoulet J. Plastie du ligament fémoropatellairemédial avec le tendon du gracile pour stabilisationde la patella. Rev Chir Orthop Reparatrice ApparMot 2005; 91(4):335-340.17. Smirk C, Morris H. The anatomy and reconstructionof the medial patellofemoral ligament. Knee 2003;10(3):221-227.Vol18dec’11<strong>Nederlands</strong> <strong>Tijdschrift</strong> <strong>voor</strong> <strong>Orthopaedie</strong>, Vol 18, Nr 4, december 2011 ■ 165
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