Isolated reconstruction of the medial patellofemoral ligament in patients with patellofemoral instability
Project objectives
Patellofemoral instability is a disabling pathology frequently found in young and active patients, which greatly affects the quality of life and sports activity.
The mean annual incidence of primary patellar luxation is 5.8 per 100.000, increasing to 29 per 100.000 in the 10-17 year age group. Additionally, rates of recurrent dislocation vary between 17% and 44% after conservative treatment. Patellofemoral instability is a multifactorial disease. Among the various factors involved, the role of an altered TT-TG (Tibial Tubercletrochlear groove distance) has long been recognized as relevant. A distance greater than 20 mm (measured on extended knee CT images) was observed in 56% of patients with a history of patellar luxation. This finding represents an indication for surgical treatment by medialization of the tibial tuberosity in symptomatic patients. However, the aforementioned indication does not take into account the preponderant role that the reconstruction of the Medial Patello-Femoral Ligament (MPFL) can have, since the latter is a recently introduced surgical technique. The soft tissue procedures of the time included, in fact, the plastic or the advancement of the vastus medialis oblique, determining very different effects on the biomechanics of the joint. However, the association of tibial tuberosity transposition with MPFL reconstruction significantly increases the risk of complications and modifies the rehabilitation protocol. Therefore, it is crucial to clarify whether MPFL reconstruction alone could be sufficient for the treatment of patellar instability associated with impaired TT-TG, thus avoiding tibial tuberosity transposition burdened with increased morbidity'.
The aim of this research is to define the correct indication for isolated reconstruction of the MPFL in patients with increased TT-TG as an alternative to tibial tuberosity transposition
Start and end date
July 2015 - January 2016
Project managers
Prof. Vincenzo Denaro - Coordinator
Coordinating institution of the project
Università Campus Bio-Medico di Roma
Other Institutions involved in the project
Harvard Medical School teaching hospital, Center for Advanced Orthopedic Studies
Beth Israel Deaconess Medical Center - Boston, MA, USA