Combined Medial Patellofemoral Ligament Reconstruction and Tibial Tubercle Osteotomy Has a Lower Risk of Recurrent Instability Requiring Revision Stabilization at 2 Years Than Either Procedure Alone

Abstract

PurposeThe goal of this study was to utilize a large nationwide administrative database to directly compare usage, complications, and need for revision stabilization surgery after medial patellofemoral ligament reconstruction (MPLFR), tibial tubercle osteotomy (TTO), and combined MPFLR and TTO (MPFLRTTO). MethodsThe PearlDiver Mariner database was queried for all reported cases of MPLFR, TTO, and combined MPFLR and TTO performed between 2010 and 2020 using Current Procedural Terminology codes. Subsets from those cohorts with laterality-specific International Classification of Diseases, Tenth Revision codes for patellar instability were used to evaluate 2-year incidence of infection, stiffness, fracture, and revision stabilization with MPFLR and/or TTO. Multiple Linear regression and chi-squared analysis were used to analyze incidence trends and to compare complication rates. ResultsA total of 70,070 patients were identified. MPFLR was found to be the most common procedure (73.1%) followed by TTO (19.2%) and then MPFLRTTO (7.6%). MPLFR was observed to have the lowest overall complication rate (5.4%), while both TTO (7.5%) and MPFLRTTO (7.1%) had higher complication rates (P<.001). MPFLR had the highest rate of revision stabilization surgery at 3.7% compared with TTO at 2.7% and MPFLRTTO which carried the lowest risk for revision at 2.4% (P<.001). ConclusionIsolated MPFLR is the most common modality used for patellar instability, with increasing prevalence and the lowest 2-year complication rate. Isolated tibial tubercle osteotomy was unchanged in its utilization and had the highest overall complication rate. Combined MPFLR and TTO increased the overall complication rate but had a lower 2-year rate of recurrent instability requiring revision than MPFLR alone.