A prospective randomized trial evaluating two different tensioning techniques for medial patellofemoral ligament reconstruction

• Appropriate graft tension is one of the most important factors for a successful MPFL reconstruction.
• In the literature, the graft tension was most assessed under direct vision via the arthroscopy.
• In present study, graft tension with self-balance technique yielded similar patellar stability and knee function with the arthroscopy-view procedure in MPFL reconstruction.
• The self-balance technique as a simple procedure was recommended as a good alternative for graft tension in the MPFL reconstruction.

BackgroundIn the literature, graft tension was mostly assessed under direct arthroscopy vision for a MPFL reconstruction. The purpose of this study was to prospectively assess the outcomes of MPFL reconstruction with graft tension of self-balance technique in comparison with arthroscopy-view technique.MethodsSixty patients with recurrent patellar dislocation were randomly divided into two groups to undergo MPFL reconstruction with graft tension either by the self-balance technique (SB group) or the arthroscopy-view technique (AV group). At a minimum of 24 months of follow up, patellar stability was evaluated with the apprehension test. Patellofemoral morphology was measured on an axial CT scan and knee function was evaluated using the Kujala and Lysholm scores.ResultsTwenty-three patients in the SB group and 25 patients in the AV group were followed for a minimum of 24 months. No recurrent dislocation or subluxation was reported. Apprehension signs remained in two patients in the SB group and in one patient in the AV group. The postoperative Kujala score for the SB group and AV group were 91.4 ± 5.1 and 90.3 ± 5.5, respectively, and the Lysholm score was 90.1 ± 6.4 and 88.4 ± 6.3, respectively, with no significant differences. On CT images, congruence angle, patellar tilt angle and lateral patellar angle were restored to the normal range.ConclusionsAt a minimum of 24 months of follow-up, graft tensioning using the self-balance technique yielded similar patellar stability and knee function compared with the arthroscopy-view procedure in the MPFL reconstruction. The self-balance technique as a simple procedure is recommended as a good alternative method for graft tensioning in the MPFL reconstruction.