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the adductors using an interference screw or
anchors, with the knee at 60 degrees of flexion.
The vastus medialis muscle was dissected and
sutured to the new ligament in all cases [12]
(fig. 4).
We treated 20 patients conservatively, with at
least two years of follow-up, and 21 patients
with MPFL reconstruction, also with a mini
mum follow-up of two years.
The conservative treatment consisted of
intermittent use of a brace for three weeks,
along with a rehabilitation program that
continued until the patient’s range of motion
and muscle strength had been restored. The
mean duration of these patients’ treatment was
three months. Among the results from this
conservative treatment, there were five patients
with recurrent dislocation and three patients
with complaints of instability.
We performed MPFL reconstruction on
21 patients, using a previously described
technique [12] in all cases. After a minimum
follow-up of two years, there were no cases of
recurrence and no complaints of instability in
this group. Our results were concordant with
those of Sillanpaa
et al.
[13].
We took occurrences of a high patella and signs
of a flat trochlea on true lateral and axial
radiographs to be predisposing factors [6].
However, in this group of 41 patients, the
presence of predisposing factors did not affect
the results, with regard to recurrence of
dislocation or complaints of instability.
We used the Kujala score and observed that
patients treated surgically had better scores.
With regard to predisposing factors, there was
a difference in quantitative Kujala scores,
which were worse in patients with predisposing
factors, especially in cases of a flat trochlea.
Comments
We described and studied the MPFL at the end
of the 1990s. Subsequently, we decided to
assess our results from conservative treatment
for acute dislocation of the patella, which was
the method of choice until that time.
From a retrospective study on 16 patients, we
found that there was a high percentage of
recurrence. We chose to operate the patients
with acute dislocation of the patella, thus
repairing the lesionswhen thiswas anatomically
possible.
In that initial series, we reinserted the MPFL in
the patella when we judged that the lesion was
closer to the patella, or in the femur when we
judged that the lesion was closer to the femoral
insertion. There were cases in which the lesion
was diffuse and it was difficult to distinguish
its real anatomical site. We found that there
was a significant improvement in the results, in
comparison with conservative treatment. A
further group presented complaints of instability
in situations of reinsertion in lesions due to
deinsertion close to the femur. We therefore
developed a reconstruction technique that used
a medial strip from the patellar tendon, for
cases in which the lesion was diffuse.
We began a series of 41 patients with a
multicenter randomized study in which the
patients who were treated conservatively were
Fig. 4 : Diagram showing insertion of the graft from
the patellar tendon, while maintaining its origin in
the proximal third of the patella, and demonstrating
the suturing of the vastus medialis muscle of the
neo-ligament.