Abstract
ObjectivesAn isolated medial patellofemoral ligament (MPFL) reconstruction (MPFLR) has been demonstrated to be an effective treatment option in the prevention of patellar instability, but there is growing support for performing a tibial tubercle osteotomy (TTO) in patients with an elevated tibial tubercle-trochlear groove distance. The purpose of this study was to evaluate the impact of adding a TTO to MPFLR on patient-reported outcomes. MethodsA retrospective review of patients who underwent MPFLR with or without TTO with a minimum of 12-month follow-up was performed. Patients in both groups were matched based on age, gender, and follow-up time. Recurrent instability (including redislocation and subluxation), visual analogue scale (VAS) score, Kujala score, and satisfaction were evaluated. ResultsThere were 59 patients who underwent MPFLR with concomitant TTO performed at our institution and met our inclusion and exclusion criteria. These patients were then matched to patients undergoing isolated MPFLR based on demographics and follow-up time. The mean age was 25.0 years, 76.3% were female, and the mean follow-up time was 49 months. There was a significant difference in mean tibial tubercle-trochlear groove distance (19.8 ± 3.9 vs. 14.1 ± 2.8) between groups. There was no significant difference in VAS (1.48 ± 2.0 vs. 1.49 ± 2.1, p = 0.972), satisfaction (86.1% ± 24.2% vs. 81.2% ± 27.9, p = 0.311) or revision surgeries (10.2% vs. 10.2%) between groups. ConclusionMatched patients undergoing MPFLR with TTO compared with isolated MPFLR demonstrate no statistically significant difference in patient-reported outcomes, levels of pain, and satisfaction postoperatively. Furthermore, the addition of a TTO does not increase the risk of further surgery or complications. Level of evidenceIII, retrospective comparative study.
Highlights
Lateral patellar instability is a common clinical pathology, comprising approximately 3%of all knee injuries and a leading cause of traumatic hemarthrosis seen in orthopedic clinics.[1]
The literature surrounding whether the added benefit of a realignment procedure justifies the potential risk of complications is sparce and contradictory, as some authors posit that MPFL reconstruction (MPFLR) can stand alone regardless of bony anatomy and that a tubercle osteotomy (TTO) may not be required.[10, 16]
There were 59 patients who underwent MPFLR with concomitant TTO performed at our institution that met our inclusion and exclusion criteria
Summary
Lateral patellar instability is a common clinical pathology, comprising approximately 3%of all knee injuries and a leading cause of traumatic hemarthrosis seen in orthopedic clinics.[1]. An isolated MPFL reconstruction (MPFLR) has been demonstrated to be an effective treatment option in the prevention of recurrent patellar instability episodes.[7,8,9,10] there is growing support for performing a bony realignment procedure such as a tibial tubercle osteotomy (TTO) in conjunction with MPFLR if an elevated tibial tubercle-trochlear groove (TTTG) distance, patella alta, or excessive femoral anteversion is present.[11, 12] The optimal course of management in the setting of patellar instability remains a challenge, as numerous surgical options exist without a clear consensus regarding superior surgical technique or graft choice.[13, 14] while evidence exists supporting the roles trochlear morphology and malalignment play in patellar instability, concerns are present regarding the morbidity introduced with the addition of bony realignment procedures.[15] The literature surrounding whether the added benefit of a realignment procedure justifies the potential risk of complications is sparce and contradictory, as some authors posit that MPFLR can stand alone regardless of bony anatomy and that a TTO may not be required.[10, 16]
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