Abstract
PurposeTo analyze postoperative physical and sexual activity as well as Quality of Life (QoL) after complex patellofemoral reconstructions in female patients suffering from chronic patellofemoral instability (PFI).MethodsFemale patients aged > 18 years undergoing complex patellofemoral reconstruction for chronic PFI were included. Complex patellofemoral reconstruction was defined as medial patellofemoral ligament reconstruction (MPFL-R) combined with at least one major bony procedure (distal femoral osteotomy, high tibial osteotomy, and trochleoplasty). Outcome was evaluated retrospectively after a minimum follow-up of 12 months using Tegner activity scale, Banff Patellofemoral Instability Instrument 2.0 (BPII 2.0), EuroQol-5D-3L (EQ-5D-3L), EuroQol Visual analog scale (EQ-VAS), and a questionnaire about sexual activity.ResultsA total of 34 females (mean age, 26 ± 5 years) with a mean follow-up of 45 ± 16 months were included. Seventy-seven percent had one major bony correction + MPFL-R and 24% had at least two major bony corrections + MPFL-R. The re-dislocation rate was 6%. Median Tegner activity scale improved from 3 (range 0–10) to 4 (range 2–6) (n.s.) and an improved activity level was observed in 49% of subjects. QoL scores showed an EQ-5D-3L Index Value of 0.89 ± 0.15, EQ-VAS of 80.3 ± 11.4, and BPII of 68.3 ± 19.1. Thirty-four percent of patients reported restrictions of sexual activities due to PFI preoperatively with an improved sexual function observed in 60% postoperatively due to less pain, improved mobility, and less apprehension. Postoperative return to sexual activity was 91%, whereof 19% reported current restrictions of sexual function because of pain and/or limited range of motion.ConclusionDespite the complexity and invasiveness of complex patellofemoral reconstruction, combined bony procedures and MPFL-R resulted in a low redislocation rate, improved physical activity and QoL comparable to values reported after isolated MPFL-R. Furthermore, sexual activity was improved in 60% of females with preoperative restrictions.Level of evidenceIV.
Highlights
Patellofemoral instability (PFI) includes recurrent dislocation and subluxation of the patella with the highest prevalence observed in young females [11, 15]
Continuous variables are shown as mean ± standard deviation, categorical variables are shown as number of patients and percentages of the total patient cohort in 77% of patients and combined medial patellofemoral ligament (MPFL) reconstruction (MPFL-R) (± tubercle osteotomy (TTO)) with two or more major bony procedures was performed in 24% (Table 2)
The present study focused on outcomes of female patients since young female patients have a higher risk of a primary and recurrent patellar dislocations [7, 11, 15] and tend to predispose to poorer functional outcomes [9, 25] as well as poorer Quality of Life (QoL) outcomes after MPFL-R [5, 17]
Summary
Patellofemoral instability (PFI) includes recurrent dislocation and subluxation of the patella with the highest prevalence observed in young females [11, 15]. Given the complex interaction between dynamic muscle action, passive soft tissue restrains, surface geometry of the patellofemoral joint, and limb alignment, PFI is based on a multifactorial pathogenesis [10, 27, 46]. Anatomic risk factors, including trochlear dysplasia, valgus malalignment, torsional deformity, patella alta, and a lateralized position of the tibial tuberosity as well as insufficiency of the medial patellofemoral ligament (MPFL) must be taken into consideration for surgical treatment [3, 10, 27, 28, 47]. Combined MPFL-R and bony corrections such as realignment osteotomies and trochleoplasty are invasive and technically demanding, but have proven to be effective for the treatment of chronic PFI [13, 24, 26, 38]
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