Medial Retinacular Plication Versus Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Instability

Medial Retinacular Plication Versus Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Instability

Functional Outcome of Surgical Treatment for Recurrent Patellar Instability: A Prospective Comparative Study Between Medial Retinacular Plication Versus Medial Patellofemoral Ligament Reconstruction

Rambam Health Care Campus, Hadassah Medical Organization, Assaf-Harofeh Medical Center, Soroka University Medical Center

The purpose of this study is to determine whether medial patellofemoral ligament reconstruction results in superior functional outcomes compared to medial retinacular plication surgery in cases of recurrent patellar instability.

Patients with recurrent lateral patellar instability will be assigned to undergo one of two surgical approaches aimed to prevent recurrent patellar instability and result in improvement in function. One surgical approach will be medial retinacular plication with multiple stitches while the other surgical approach will include medial patellofemoral ligament reconstruction using a hamstring tendon graft. Prior to surgery, and then during follow-up after surgery as well as at the completion of minimum two years follow-up after surgery, patients will be asked to complete subjective functional questionaires that will rate their knee function, and to undergo detailed physical examination and objective functional tests that will quantify the success of surgery. The outcomes of the surgical treatment options will be compared to determine whether medial patellofemoral ligament reconstruction results in superior function and patient subjective satisfaction compared to medial retinacular plication only.

Patient undergoing surgical treatment for recurrent patellar instability that includes medial retinacular plication

Patient undergoing surgical treatment for recurrent patellar instability that includes medial patellofemoral ligament reconstruction using a tendon graft

A validated international outcome score that evaluates knee functional outcome in relation to patellofemoral symptoms

Evaluates limb asymmetry index between operated and nonoperated limbs during a single legged hop for distance

Evaluates limb asymmetry index between operated and nonoperated limbs performing side to side repetaed hops during 30 seconds

Evaluates normal patellar tracking and patient's feeling of subjective comfort while the examiner apply a provocative force that translates the patella lateraly

Infectious event of the operated knee documented by number of events that required antibiotics treatment with or without joint lavage

Infection of the surgical site as a severe complication of surgery, requirng antibiotics with or without joint lavage

Inclusion Criteria: Recurrent lateral patellar instability has been described by the patient Imaging criteria include: TT-TG distance (on CT or MRI) is between 10-20 mm Insall-Salvati Index is between 0.9 - 1.2 Trochlea angle is lower than 145 degrees Exclusion Criteria: Only a single event of lateral patellar instability occured Imaging criteria include: TT-TG distance (on CT or MRI) is below 10 mm or above 20 mm Insall-Salvati Index is below 0.9 or above 1.2 Trochlea angle is above 145 degrees Other concomitant intra-articular patholgies, injuries, and surgeries, besides the patella instability, with were recorded at the lower limbs and did not uneventfuly healed, and as a result cause dysfunction of the lower limbs Significant ligamentous injuries of the knees, including cruciate and collateral injuries, as well as meniscal injuries that interfere with function