Comparative study of transosseous suture and suture anchor technique in medial patellofemoral ligament double bundle reconstruction_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SUN Rui , DUAN Mingyi , LIU Xunqi , CHEN Siqi , WANG Junyuan ,  ZHANG Hangzhou

Department of Orthopedics-Sports Medicine/Joint Surgery, First Affiliated Hospital of China Medical University, Shenyang Liaoning, 110000, P. R. China;

Corresponding?author：

ZHANG Hangzhou, Email: zhanghz1000@sina.com

Keywords：

Patella dislocation; medial patellofemoral ligament reconstruction; fixation technique; transosseous suture; suture anchor

DOI：

10.7507/1002-1892.202108010

Video：

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Objective To investigate the effectiveness of transosseous suture in medial patellofemoral ligament (MPFL) double bundle reconstruction. Methods The clinical data of 75 patients with recurrent patella dislocation who met the selection criteria between January 2014 and December 2017 were retrospectively analyzed. All of them were treated with MPFL double bundle reconstruction, and divided into study group (39 cases, using new transosseous suture technique) and control group (36 cases, using traditional suture anchor fixation) depending on the intraoperative fixation technique. There was no significant difference in gender, age, body mass index, affected knee side, preoperative tibial tuberosity-trochlear groove distance, Insall-Salvati ratio, knee range of motion, Kujala score, International Knee Documentation Committee (IKDC) score, congruence angle, and tilt angle between the two groups (P>0.05). The operation time, intraoperative blood loss, hospital stay, and postoperative complications were recorded and compared between the two groups. Kujala score, IKDC score, and knee range of motion were used to evaluate the functional improvement of patients before and after operation. The congruence angle and tilt angle were measured on X-ray films. Results There was no significant difference in operation time, intraoperative blood loss, and hospital stay between the two groups (P>0.05). Patients in both groups were followed up 24-36 months, with an average of 29.4 months. There was no complication such as incision infection, fat liquefaction, patellar redislocation, and prepatellar pain during follow-up. At last follow-up, the Kujala score, IKDC score, knee range of motion, congruence angle, and tilt angle of two groups significantly improved when compared with those before operation (P<0.05), while there was no significant difference between the two groups (P>0.05). Conclusion The application of suture anchor or transosseous suture to complete MPFL double bundle reconstruction can restore patellar stability, and there is no significant difference in the short-term effectiveness between them.

Citation： SUN Rui, DUAN Mingyi, LIU Xunqi, CHEN Siqi, WANG Junyuan, ZHANG Hangzhou. Comparative study of transosseous suture and suture anchor technique in medial patellofemoral ligament double bundle reconstruction. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(1): 45-51. doi: 10.7507/1002-1892.202108010 Copy

1.	Huber C, Zhang Q, Taylor WR, et al. Properties and function of the medial patellofemoral ligament: A systematic review. Am J Sports Med, 2020, 48(3): 754-766.
2.	Wolfe S, Varacallo M, Thomas JD, et al. Patellar instability. Treasure Island (FL): StatPearls Publishing, 2021: 1-10.
3.	沙霖, 代振振, 李海, 等. 規避骺板的內側髕股韌帶重建治療兒童青少年習慣性及復發性髕骨脫位. 中國骨與關節雜志, 2021, 10(6): 424-430.
4.	張輝, 馮華. 髕骨脫位的治療方案. 中國骨傷, 2017, 30(11): 979-981.
5.	O’Malley O, Choudhury A, Biggs A, et al. Association between patellofemoral anatomy and chondral lesions of the knee in patellofemoral instability. J Knee Surg, 2021. doi: 10.1055/s-0041-1731351.
6.	Huntington LS, Webster KE, Devitt BM, et al. Risk assessment and management of primary patellar dislocation is complex and multifactorial: a survey of Australian knee surgeons. J ISAKOS, 2021. doi: 10.1136/jisakos-2020-000609.
7.	Marcheggiani Muccioli GM, Lullini G, Grassi A, et al. Good results are reported at 60-month follow-up after medial patello-femoral ligament reconstruction with fascia lata allograft for recurrent patellar dislocation. Knee Surg Sports Traumatol Arthrosc, 2021, 29(4): 1191-1196.
8.	曹晏維, 向川. 內側髕股韌帶重建術治療復發性髕骨脫位的進展. 實用骨科雜志, 2020, 26(7): 624-627.
9.	Lee D, Stinner D, Mir H. Quadriceps and patellar tendon ruptures. J Knee Surg, 2013, 26(5): 301-308.
10.	Massey PA, Myers M, McClary K, et al. Biomechanical analysis of patellar tendon repair with knotless suture anchor tape versus transosseous suture. Orthop J Sports Med, 2020, 8(10): 2325967120954808. doi: 10.1177/2325967120954808.
11.	王亦璁, 姜保國. 骨與關節損傷. 5版. 北京:人民衛生出版社, 2014: 1340-1346.
12.	Reagan J, Kullar R, Burks R. MPFL reconstruction: technique and results. Clin Sports Med, 2014, 33(3): 501-516.
13.	Heo JW, Ro KH, Lee DH. Patellar redislocation rates and clinical outcomes after medial patellofemoral ligament reconstruction: Suture anchor versus double transpatellar tunnel fixation. Am J Sports Med, 2019, 47(5): 1254-1262.
14.	Sezer HB, Armağan R, Kanar M, et al. A novel medial patellofemoral ligament reconstruction technique; preliminary clinical results. Orthopaedic Journal of Sports Medicine, 2017, 5(2_suppl2): 2325967117S0007. doi: 10.1177/2325967117S00077.
15.	Mackay ND, Smith NA, Parsons N, et al. Medial patellofemoral ligament reconstruction for patellar dislocation: A systematic review. Orthop J Sports Med, 2014, 2(8): 2325967114544021. doi: 10.1177/2325967114544021.
16.	李良軍, 丑克, 何志勇, 等. 關節鏡輔助下解剖重建內側髕股韌帶治療復發性髕骨脫位. 中南大學學報 (醫學版), 2015, 40(11): 1239-1245.
17.	Migliorini F, Trivellas A, Colarossi G, et al. Single- versus double-bundle patellar graft insertion for isolated MPFL reconstruction in patients with patellofemoral instability: a systematic review of the literature. Arch Orthop Trauma Surg, 2020, 140(6): 769-776.
18.	Raoulis VA, Zibis A, Chiotelli MD, et al. Biomechanical evaluation of three patellar fixation techniques for MPFL reconstruction: Load to failure did not differ but interference screw stabilization was stiffer than suture anchor and suture-knot fixation. Knee Surg Sports Traumatol Arthrosc, 2021, 29(11): 3697-3705.
19.	Russ SD, Tompkins M, Nuckley D, et al. Biomechanical comparison of patellar fixation techniques in medial patellofemoral ligament reconstruction. Am J Sports Med, 2015, 43(1): 195-199.
20.	Ibrahim SA, Shohdy EM, Ramadan SA, et al. Medial patellofemoral ligament reconstruction in traumatic patellar dislocation without patellar fixation. J Knee Surg, 2020, 33(10): 998-1003.
21.	Deasey MJ, Moran TE, Lesevic M, et al. Small, short, oblique patellar tunnels for patellar fixation do not increase fracture risk or complications in MPFL reconstruction: A retrospective cohort study. Orthop J Sports Med, 2020, 8(10): 2325967120954430. doi: 10.1177/2325967120954430.
22.	Mohammed R, Hunt N, Gibbon AJ. Patellar complications in single versus double tunnel medial patellofemoral ligament reconstruction. J Orthop Surg (Hong Kong), 2017, 25(1): 2309499017691007. doi: 10.1177/2309499017691007.
23.	Shah JN, Howard JS, Flanigan DC, et al. A systematic review of complications and failures associated with medial patellofemoral ligament reconstruction for recurrent patellar dislocation. Am J Sports Med, 2012, 40(8): 1916-1923.
24.	Ji G, Wang H, Su X, et al. The modified semi-tunnel bone bridge technique achieved statistically better knee function than the suture anchor technique. Knee Surg Sports Traumatol Arthrosc, 2020, 28(3): 995-1001.
25.	Calanna F, Pulici L, Carimati G, et al. Medial patello-femoral ligament (MPFL) reconstruction using suture anchors fixation: preliminary results. Muscles Ligaments Tendons J, 2016, 6(1): 64-70.
26.	朱威宏, 陳游, 唐琪, 等. 雙縫合錨釘技術雙束解剖重建內側髕股韌帶治療青少年髕股關節不穩定. 中南大學學報 (醫學版), 2017, 42(7): 808-813.
27.	Ene R, Panti Z, Nica M, et al. Bioabsorbable anchors for medial patellofemoral ligament reconstruction. Key Engineering Materials, 2017, 745: 101-110.
28.	Migliorini F, Driessen A, Quack V, et al. Patellar fixation graft via suture anchors versus tunnel techniques during isolated MPFL reconstruction for recurrent patellofemoral instability: a systematic review of the literature. Arch Orthop Trauma Surg, 2020, 140(9): 1201-1210.
29.	Yoon KH, Kim EJ, Kwon YB, et al. Comparison of clinical and radiological outcomes between transosseous tunnel and suture anchor patellar fixation for medial patellofemoral ligament reconstruction: A cohort study with 2-year follow-up. Orthop J Sports Med, 2020, 8(5): 2325967120917660. doi: 10.1177/2325967120917660.
30.	Lakey E, Kumparatana P, Moon DK, et al. Biomechanical comparison of all-soft suture anchor single-row vs double-row bridging construct for insertional achilles tendinopathy. Foot Ankle Int, 2021, 42(2): 215-223.
31.	Brown GD, Ahmad CS. The docking technique for medial patellofemoral ligament reconstruction. Am J Sports Med, 2007, 17(4): 216-222.

1. Huber C, Zhang Q, Taylor WR, et al. Properties and function of the medial patellofemoral ligament: A systematic review. Am J Sports Med, 2020, 48(3): 754-766.
2. Wolfe S, Varacallo M, Thomas JD, et al. Patellar instability. Treasure Island (FL): StatPearls Publishing, 2021: 1-10.
3. 沙霖, 代振振, 李海, 等. 規避骺板的內側髕股韌帶重建治療兒童青少年習慣性及復發性髕骨脫位. 中國骨與關節雜志, 2021, 10(6): 424-430.
4. 張輝, 馮華. 髕骨脫位的治療方案. 中國骨傷, 2017, 30(11): 979-981.
5. O’Malley O, Choudhury A, Biggs A, et al. Association between patellofemoral anatomy and chondral lesions of the knee in patellofemoral instability. J Knee Surg, 2021. doi: 10.1055/s-0041-1731351.
6. Huntington LS, Webster KE, Devitt BM, et al. Risk assessment and management of primary patellar dislocation is complex and multifactorial: a survey of Australian knee surgeons. J ISAKOS, 2021. doi: 10.1136/jisakos-2020-000609.
7. Marcheggiani Muccioli GM, Lullini G, Grassi A, et al. Good results are reported at 60-month follow-up after medial patello-femoral ligament reconstruction with fascia lata allograft for recurrent patellar dislocation. Knee Surg Sports Traumatol Arthrosc, 2021, 29(4): 1191-1196.
8. 曹晏維, 向川. 內側髕股韌帶重建術治療復發性髕骨脫位的進展. 實用骨科雜志, 2020, 26(7): 624-627.
9. Lee D, Stinner D, Mir H. Quadriceps and patellar tendon ruptures. J Knee Surg, 2013, 26(5): 301-308.
10. Massey PA, Myers M, McClary K, et al. Biomechanical analysis of patellar tendon repair with knotless suture anchor tape versus transosseous suture. Orthop J Sports Med, 2020, 8(10): 2325967120954808. doi: 10.1177/2325967120954808.
11. 王亦璁, 姜保國. 骨與關節損傷. 5版. 北京:人民衛生出版社, 2014: 1340-1346.
12. Reagan J, Kullar R, Burks R. MPFL reconstruction: technique and results. Clin Sports Med, 2014, 33(3): 501-516.
13. Heo JW, Ro KH, Lee DH. Patellar redislocation rates and clinical outcomes after medial patellofemoral ligament reconstruction: Suture anchor versus double transpatellar tunnel fixation. Am J Sports Med, 2019, 47(5): 1254-1262.
14. Sezer HB, Armağan R, Kanar M, et al. A novel medial patellofemoral ligament reconstruction technique; preliminary clinical results. Orthopaedic Journal of Sports Medicine, 2017, 5(2_suppl2): 2325967117S0007. doi: 10.1177/2325967117S00077.
15. Mackay ND, Smith NA, Parsons N, et al. Medial patellofemoral ligament reconstruction for patellar dislocation: A systematic review. Orthop J Sports Med, 2014, 2(8): 2325967114544021. doi: 10.1177/2325967114544021.
16. 李良軍, 丑克, 何志勇, 等. 關節鏡輔助下解剖重建內側髕股韌帶治療復發性髕骨脫位. 中南大學學報 (醫學版), 2015, 40(11): 1239-1245.
17. Migliorini F, Trivellas A, Colarossi G, et al. Single- versus double-bundle patellar graft insertion for isolated MPFL reconstruction in patients with patellofemoral instability: a systematic review of the literature. Arch Orthop Trauma Surg, 2020, 140(6): 769-776.
18. Raoulis VA, Zibis A, Chiotelli MD, et al. Biomechanical evaluation of three patellar fixation techniques for MPFL reconstruction: Load to failure did not differ but interference screw stabilization was stiffer than suture anchor and suture-knot fixation. Knee Surg Sports Traumatol Arthrosc, 2021, 29(11): 3697-3705.
19. Russ SD, Tompkins M, Nuckley D, et al. Biomechanical comparison of patellar fixation techniques in medial patellofemoral ligament reconstruction. Am J Sports Med, 2015, 43(1): 195-199.
20. Ibrahim SA, Shohdy EM, Ramadan SA, et al. Medial patellofemoral ligament reconstruction in traumatic patellar dislocation without patellar fixation. J Knee Surg, 2020, 33(10): 998-1003.
21. Deasey MJ, Moran TE, Lesevic M, et al. Small, short, oblique patellar tunnels for patellar fixation do not increase fracture risk or complications in MPFL reconstruction: A retrospective cohort study. Orthop J Sports Med, 2020, 8(10): 2325967120954430. doi: 10.1177/2325967120954430.
22. Mohammed R, Hunt N, Gibbon AJ. Patellar complications in single versus double tunnel medial patellofemoral ligament reconstruction. J Orthop Surg (Hong Kong), 2017, 25(1): 2309499017691007. doi: 10.1177/2309499017691007.
23. Shah JN, Howard JS, Flanigan DC, et al. A systematic review of complications and failures associated with medial patellofemoral ligament reconstruction for recurrent patellar dislocation. Am J Sports Med, 2012, 40(8): 1916-1923.
24. Ji G, Wang H, Su X, et al. The modified semi-tunnel bone bridge technique achieved statistically better knee function than the suture anchor technique. Knee Surg Sports Traumatol Arthrosc, 2020, 28(3): 995-1001.
25. Calanna F, Pulici L, Carimati G, et al. Medial patello-femoral ligament (MPFL) reconstruction using suture anchors fixation: preliminary results. Muscles Ligaments Tendons J, 2016, 6(1): 64-70.
26. 朱威宏, 陳游, 唐琪, 等. 雙縫合錨釘技術雙束解剖重建內側髕股韌帶治療青少年髕股關節不穩定. 中南大學學報 (醫學版), 2017, 42(7): 808-813.
27. Ene R, Panti Z, Nica M, et al. Bioabsorbable anchors for medial patellofemoral ligament reconstruction. Key Engineering Materials, 2017, 745: 101-110.
28. Migliorini F, Driessen A, Quack V, et al. Patellar fixation graft via suture anchors versus tunnel techniques during isolated MPFL reconstruction for recurrent patellofemoral instability: a systematic review of the literature. Arch Orthop Trauma Surg, 2020, 140(9): 1201-1210.
29. Yoon KH, Kim EJ, Kwon YB, et al. Comparison of clinical and radiological outcomes between transosseous tunnel and suture anchor patellar fixation for medial patellofemoral ligament reconstruction: A cohort study with 2-year follow-up. Orthop J Sports Med, 2020, 8(5): 2325967120917660. doi: 10.1177/2325967120917660.
30. Lakey E, Kumparatana P, Moon DK, et al. Biomechanical comparison of all-soft suture anchor single-row vs double-row bridging construct for insertional achilles tendinopathy. Foot Ankle Int, 2021, 42(2): 215-223.
31. Brown GD, Ahmad CS. The docking technique for medial patellofemoral ligament reconstruction. Am J Sports Med, 2007, 17(4): 216-222.

Chinese Journal of Reparative and Reconstructive Surgery

Comparative study of transosseous suture and suture anchor technique in medial patellofemoral ligament double bundle reconstruction

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