After MPFL reconstruction, femoral tunnel widening and migration increase with poor tunnel positioning and are related to poor clinical outcomes

Ewald, Fabien; Klasan, Antonio; Putnis, Sven; Farizon, Frédéric; Philippot, Rémi; Néri, Thomas

doi:10.1007/s00167-022-07277-9

Cited by 4 publications

(1 citation statement)

References 34 publications

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“…Medial patellofemoral ligament reconstruction (MPFL‐R) has been the go‐to surgical treatment option [ 3 , 30 ]. Outcomes of MPFL‐R as an isolated procedure are dependent on tunnel position [ 14 , 34 ] and adequately identifying and addressing other underlying pathomorphological changes [ 10 ]. Historically, the four major anatomical factors leading to patellar dislocation are trochlear dysplasia, patella alta, excessive TT‐TG distance and patellar tilt [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Promising results following derotational femoral osteotomy in patellofemoral instability with increased femoral anteversion: A systematic review on current indications, outcomes and complication rate

Klasan,

Compagnoni,

Grassi

et al. 2024

J. exp. orthop.

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PurposePatellofemoral joint instability (PFJI) can surgically be treated with a multitude of approaches, depending on the underlying pathology. In the presence of increased femoral anteversion, some authors have reported good results with a derotational distal femoral osteotomy (DeDFO). The purpose of the study was to investigate the indications, outcomes and complication rate of DeDFO for PFJI.MethodsA systematic review was performed according to the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta‐analyses) by searching Medline, Embase, Web of Science and Cochrane Library databases through 1 December 2023. Included were levels 1–4 clinical studies of skeletally mature patients undergoing a DeDFO for PFJI irrespective of concomitant procedures. Study characteristics, indications, radiological and clinical outcomes, surgical technique and concomitant procedures, re‐dislocation and complication rate were all analysed, as was methodological quality.ResultsA total of 12 studies including 310 patients (325 knees) were included. Three studies were cohort studies, all others were case series. The mean patient age across the studies was 22 years, and the mean follow‐up was 29.4 months. Femoral anteversion cut‐off was between 20° and 30°. Every study included at least one concurrent soft tissue, bony or combined procedure. Across all studies, one case of re‐dislocation was reported (0.3%) and four implant or osteotomy‐related complications (1.2%) were reported. All studies reported a statistically significant increase in clinical scores.ConclusionThis systematic review of DeDFO for patellofemoral instability in the presence of increased femoral anteversion demonstrates promising clinical results and an extremely low dislocation and complication rate. The heterogeneity of the cut‐off in anteversion and concomitant procedures, especially tibial tubercle osteotomy with seemingly identical results, indicates the need for high‐quality evidence for treating patellofemoral instability. Based upon this systematic review, we strongly recommend that DeDFO be added to the ‘menu à la carte’ of PFJI.Level of EvidenceLevel III Systematic Review.

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Section: Introductionmentioning

confidence: 99%

Promising results following derotational femoral osteotomy in patellofemoral instability with increased femoral anteversion: A systematic review on current indications, outcomes and complication rate

Klasan,

Compagnoni,

Grassi

et al. 2024

J. exp. orthop.

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Nonanatomical femoral tunnel positioning in isolated MPFL reconstruction is not associated with an increased risk of patellofemoral osteoarthritis after a minimum follow‐up of 10 years

Erard,

Olivier,

Gunst

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThe association between the prevalence of patellofemoral arthritis (PFA) and femoral tunnel positioning following isolated medial patellofemoral ligament reconstruction (MPFLr) has not been well described. The aim of this study was to analyse the relationship between femoral tunnel positioning and the prevalence of PFA.MethodsThis was a single‐centre study of patients undergoing an isolated MPFLr between 2006 and 2011 with a minimum of 10 years of follow‐up. Outcomes assessed were the presence of PFA on radiographs, recurrence of instability requiring revision surgery and patient‐reported outcomes, including Kujala, Tegner and IKDC scores. Tunnel positioning was assessed on postoperative radiographs using two radiographic methods: Schöttle's point and the grid method to localise the femoral tunnel. Patients were grouped based on tunnel positioning and compared.ResultsFifty patients were analysed at a mean follow‐up of 12.4 years. Thirty‐three patients (66%) had a femoral tunnel position within 7 mm of Schöttle's point and 39 (78%) within the anatomic quadrant, with the most common location according to the grid method in D4 (28%) and E4 (26%), respectively. Thirty‐seven patients (74%) had a satisfactory (>80 versus <80) Kujala score at long‐term follow‐up. None of the examined tunnel assessment methods demonstrated a significant relationship with Tegner, Kujala or International Knee Documentation Committee scores. Patients with a femoral tunnel position >7 mm outside Schöttle's point or were considered to be in a nonanatomic position were not significantly more likely to result in unsatisfactory Kujala scores at the last follow‐up. Tunnel positioning and the other tested parameters were not found to be significantly associated with the development of PFA.ConclusionNo correlation between femoral tunnel position and risk of PFA or poor outcomes was observed in patients undergoing isolated MPFLr at long‐term follow‐up. The impact of femoral tunnel placement on long‐term outcomes in patients with PFI may be less significant than originally considered.Level of EvidenceLevel IV.

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Returning to pre‐injury level of sports before 9 months after medial patellofemoral ligament reconstruction increases the incidence of anterior knee pain in young patients

Xu,

Zhao,

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThis study aimed to identify the risk factors for anterior knee pain (AKP) after medial patellofemoral ligament reconstruction (MPFLR).MethodsPatients aged 15–35 years who underwent isolated MPFLR between 2012 and 2022 were included in the study. These patients were divided into two groups (AKP and control group). Patient demographics and preoperative and postoperative clinical outcomes between the two groups were assessed and compared. Univariate logistic regression analysis was performed to explore the potential risk factors associated with postoperative AKP. Subgroup analysis stratified the results based on the time to return to sports (RTS) (>9 and ≤9 months). Furthermore, Spearman correlation analysis was performed to investigate the association between Kujala score and time to RTS.ResultsA total of 206 patients were included (AKP, n = 59; control, n = 147). At the 2‐year follow‐up, patients with AKP demonstrated a shorter duration in returning to their pre‐injury activity level compared to those without AKP (9.0 ± 3.6 vs. 10.3 ± 2.7 months, p < 0.05). RTS earlier than 9 months after MPFLR was the only significant risk factor associated with postoperative AKP (odds ratio, 2.13, 95% confidence interval, 1.03‐4.39; p < 0.05). Further subgroup analysis revealed that patient RTS earlier than 9 months exhibited worse patient‐reported outcomes in both the total cohort and control group (p < 0.05). Furthermore, among patient RTS within 9 months, a longer recovery duration before RTS strongly correlated with a higher Kujala score (R = 0.670, p < 0.001).ConclusionsYoung patients who RTS at their pre‐injury levels before 9 months after MPFLR have a higher incidence of postoperative AKP and poorer functional outcomes compared to those who delay their return. Specifically, within the first 9 months after MPFLR, the earlier the RTS, the more severe the AKP symptoms. Careful consideration of the timing for RTS may help reduce the incidence of postoperative AKP.Level of EvidenceLevel III.

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After MPFL reconstruction, femoral tunnel widening and migration increase with poor tunnel positioning and are related to poor clinical outcomes

Cited by 4 publications

References 34 publications

Promising results following derotational femoral osteotomy in patellofemoral instability with increased femoral anteversion: A systematic review on current indications, outcomes and complication rate

Promising results following derotational femoral osteotomy in patellofemoral instability with increased femoral anteversion: A systematic review on current indications, outcomes and complication rate

Nonanatomical femoral tunnel positioning in isolated MPFL reconstruction is not associated with an increased risk of patellofemoral osteoarthritis after a minimum follow‐up of 10 years

Returning to pre‐injury level of sports before 9 months after medial patellofemoral ligament reconstruction increases the incidence of anterior knee pain in young patients

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