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Introduction
Acute dislocation of the patella is an infrequent
injury accounting for only 2 to 3% of cases of
knee trauma [1]. Its treatment was classically
always conservative until the medial patello
femoral ligament (MPFL) was described and
became known. This stimulated some authors to
study repair or reconstruction of this ligament as
a treatment for acute dislocation of the patella.
In the literature, few studies reported on
surgical treatment for acute dislocation of the
patella before the MPFL became known. In
1978, Boring and O’Donoghue [2] reported
suturing the medial retinaculum in 18 patients
who evolved without recurrence of their acute
dislocations.
Conservative treatment leads to recurrence
rates ranging from 15 to 44% [1, 3].
We started our work on the MPFL by seeking
data through an anatomical and biomechanical
study [4]. From this, we assessed our results
that had been obtained from conservative
treatment and then we analyzed repair and
reconstruction of the MPFL.
Anatomical studies on
the medial patello
femoral ligament
We began our studies on the MPFL in the
1990s, with an anatomical and arthroscopic
study on 15 cadavers in order to identify it. We
found the MPFL in all the specimens and
describeditanatomicallyandunderarthroscopic
viewing [4].
We found that there was a variable femoral
insertion, which was always close to the
epicondyle and to the tubercle of the adductors,
but with variation in its width and size. The
origin in the patella was, in all cases, at the
transition between the proximal and middle
thirds. We did not observe any significant
variations in the insertions in the patella (fig. 1).
Our biomechanical studies demonstrated that
the tensile strength of the MPFL was around 80
N, and that in resistance tests under axial
traction, rupture occurred in the substance of
the ligament and at its femoral insertion. It did
not occur at the patellar insertion in any case in
the series that we studied.
Acute Patellar Dislocation.
Mini- Battle- Conservative
treatment versus surgical
treatment
G.L. Camanho