Recovery from Medial Patellofemoral Ligament Reconstruction with and Without Tibial Tubercle Osteotomy: An Assessment by Promis

Abstract

Introduction:Patellar instability is a common problem in the active pediatric and adolescent population. Medial patellofemoral ligament (MPFL) reconstruction with or without associated tibial tubercle osteotomy (TTO) are the most commonly utilized surgical treatment. Patient-Reported Outcomes Measurements Information System (PROMIS) has been shown to be a valid and reliable means to assess patient-reported outcomes in the pediatric orthopedic population. Currently, little is known about the relative recovery of isolated MPFL reconstruction compared to MPFL reconstruction with combined TTO.Purpose:To assess the outcomes of patients undergoing an isolated MPFL Reconstruction or MPFL with TTO utilizing PROMIS during post-operative recovery period.Methods:Patients undergoing patellofemoral surgery were prospectively given PROMIS assessments at each clinical visit. Inclusion criteria included a diagnosis of patellar instability, no prior MPFL procedures, <18 years old and follow up of at least 6 months. Additionally, subjects must have had a pre-operative evaluation and at least 3 FU visits within 6 months. Pediatric PROMIS domains assessed were Pain Interference and Mobility. Time points for PROMIS were labeled as pre-operative, 1 week, 1 month, 3 months, 6 months, and 1 year. Time points were then compared utilizing a mixed-linear regression model. Significance was set at p < 0.05. Ceiling or Floor Effects were present when ≥15% of study cohort had reached the maximum or minimum possible score.Results:A total of 58 patients were identified, 40 patients that underwent isolated MPFL and 18 patients that underwent MPFL + TTO. Both groups were relatively similar in terms of mean age (14.4 v. 15.3) and sex (62.5% v. 77.8% female). Changes in Mobility and Pain Interference were seen compared to baseline in both groups. For both Mobility and Pain interference, postoperative PROMIS changes were similar between isolated MPFL and MPFL + TTO groups (no significant differences at any timepoint) (Figure 1 and 2).Conclusions:MPFL reconstruction with or without TTO demonstrate improvements in PROMIS Mobility and Pain Interference after surgical treatment. The postoperative recovery of isolated MPFL reconstruction or MPFL reconstruction with TTO were very similar at all timepoints for PROMIS Mobility and Pain Interference.Figure 1:Performance of (a) Isolated MPFL Reconstruction patients and (b) MPFL with a tibial tubercle osteotomy (TTO) on the Pain Interference PROMIS domain. Time points assessed were pre-operative, 1 week, 1 month, 3 month (3 Mo), 6 month (6 Mo) and 1 year.*denotes significant improvement from pre-operative valuesFigure 2:Performance of (a) Isolated MPFL Reconstruction patients and (b) MPFL with a tibial tubercle osteotomy (TTO) on the Mobility PROMIS domain. Time points assessed were pre-operative, 1 week, 1 month, 3 month (3 Mo), 6 month (6 Mo) and 1 year.*denotes significant improvement from pre-operative values