Outcomes of MPFL reconstruction with tibial tubercle transfer for recurrent patellar instability with high grade trochlear dysplasia in Indian population

Abstract

BackgroundPatellar instability is a painful condition which affects the quality of life and mobility of young individuals. The aim of this study is to observe the results of medial patello-femoral ligament reconstruction with hamstring autograft along with a modified Fulkerson osteotomy, for recurrent instability of patella with high-grade trochlear dysplasia in Indian population. Materials & methodsWe conducted a prospective observational study of 26 knees (21 patients) who attended our outpatient department from June 2014 to February 2019, with recurrent instability of the patella and high-grade trochlear dysplasia. All knees were treated with MPFL reconstruction with hamstring autograft and modified Fulkerson osteotomy. ResultsThe mean follow-up period was 30 months (range: 24–50). The mean Lysholm scores improved from 49.9 (range: 30–63) preoperatively to 82.5 (range: 51–100) (p < 0.05), Kujala scores from 55.5 (36–67) to 85.9 (55–100) and International Knee Documentation Committee (IKDC) scores from 50.2 (31.6–62.3) to 82.9 (54.7–98.3) (p < 0.05) at 2 years follow-up. TT-TG distance decreased from 21.2 mm (18–25) to 11.6 mm (10–13) (p < 0.05) and patellar tilt angle decreased from 24.2° (18°-35°) to 7.2° (5°-10°) (p < 0.05). One knee had superficial skin infection in immediate post-operative period. Three knees had postoperative stiffness, which improved on manipulation under anesthesia. Six knees had implant irritation from the osteotomy screws which were removed after bony union was achieved. Functional scores were low in two knees due to patello-femoral pain, but they did not have recurrent instability. ConclusionMPFL reconstruction with tibial tubercle transfer gives good functional outcomes in 92.3% patients with recurrent patellar instability, associated with high-grade trochlear dysplasia in Indian population.