The double-pulley technique for anatomical double-bundled medial patellofemoral ligament reconstruction

Introduction: Majority of the current medial patellofemoral ligament (MPFL) reconstruction techniques vary with respect to methods of fixation on the patella. In an effort to maximise the area of patellar footprint coverage and minimise the complication of patellar fracture, we developed a procedure that implemented the double-pulley suture anchors technique. Design: Prospective case series. Setting: A primary medical centre in Kaohsiung, Taiwan. Patients and methods: Eighteen consecutive patients (18 knees) who met the inclusion criteria underwent the aforementioned operation between January 2010 and March 2012. Patients were evaluated using functional scores (Kujala and Tegner-Lysholm scores), apprehension test, and radiographic examination (congruence angle and patellar tilting angle) preoperatively and at the follow-up. Results: The mean follow-up was 35 months. A firm endpoint to lateral patellar translation was noted in all patients at the last follow-up with a mean lateral translation quadrant of 1.5 (improved from 3.5 preoperatively, p < 0.001). Both clinical and radiographic assessment improved significantly (p < 0.001); the mean Kujala score improved from 55.3 +/- 6.8 preoperatively to 95.2 +/- 3.5 at the last follow-up; Tegner Lysholm from 43.6 +/- 8.1 to 93.6 +/- 6.8; the mean congruence angle improved from 20.68 +/- 2.18 preoperatively to +/- 5.28 +/- 2.48 at the last follow-up; and the patellar tilting angle from 23.88 +/- 2.38 to 9.68 +/- 1.38. Conclusion: The double-pulley patellar fixation technique, by having a result that is comparable with those of other studies that used aperture fixation techniques, can be a promising surgical option for anatomically reconstructing the medial petellofemoral ligament. (C) 2015 Elsevier Ltd. All rights reserved.