Combined Medial Patellofemoral Ligament Reconstruction and Tibial Tubercle Transfer Results at a Follow-Up of 2 years

Ahmad, Riaz; Calciu, Marius; Jayasekera, Narlaka; Schranz, Peter; Mandalia, Vipul

doi:10.1055/s-0036-1579665

Cited by 13 publications

(5 citation statements)

References 22 publications

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“…19.1% of knees were classified to have a normal trochlea, type A TD was observed in 27.9 %, type B was observed in 29.4 %, type C was observed in 19.1%, and 4.4% had TD type D. Another three knees could not be classified (4.4 %). Mean CDI was 1.4 [ 1 , 2 ]. In 77.5 % of the knees, patella alta (CDI > 1.2) was observed (Table 1 ).…”

Section: Resultsmentioning

confidence: 99%

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Why compromise the patella? Five-year follow-up results of medial patellofemoral ligament reconstruction with soft tissue patellar fixation

Boelch

Gurok

Gilbert

et al. 2021

International Orthopaedics (SICOT)

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Purpose This study investigates the redislocation rate and functional outcome at a minimum follow-up of five years after medial patellofemoral ligament (MPFL) reconstruction with soft tissue patellar fixation for patella instability. Methods Patients were retrospectively identified and knees were evaluated for trochlea dysplasia according to Dejour, for presence of patella alta and for presence of cartilage lesion at surgery. At a minimum follow-up of five years, information about an incident of redislocation was obtained. Kujala, Lysholm, and Tegner questionnaires as well as range of motion were used to measure functional outcome. Results Eighty-nine knees were included. Follow-up rate for redislocation was 79.8% and for functional outcome 58.4%. After a mean follow-up of 5.8 years, the redislocation rate was 5.6%. There was significant improvement of the Kujala score (68.8 to 88.2, p = 0.000) and of the Lysholm score (71.3 to 88.4, p = 0.000). Range of motion at follow-up was 149.0° (115–165). 77.5% of the knees had patella alta and 52.9% trochlear dysplasia types B, C, or D. Patellar cartilage legions were present in 54.2%. Redislocations occurred in knees with trochlear dysplasia type C in combination with patella alta. Conclusion MPFL reconstruction with soft tissue patellar fixation leads to significant improvement of knee function and low midterm redislocation rate. Patients with high-grade trochlear dysplasia should be considered for additional osseous correction.

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Section: Resultsmentioning

confidence: 99%

“…Lateral patella dislocation occurs in 5.8 to 77.8 of 100,000 patients per year [ 1 , 2 ]. Without surgical treatment redislocation occurs in up to 40–70% [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

Why compromise the patella? Five-year follow-up results of medial patellofemoral ligament reconstruction with soft tissue patellar fixation

Boelch

Gurok

Gilbert

et al. 2021

International Orthopaedics (SICOT)

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“…Therefore, the combination of MPFL reconstruction and ATT transposition in patients with trochlear dysplasia produce good clinical results and low degrees of re-dislocation, in agreement with the literature [ 18 ]. In our study, the pre-operative TT-TG distance did not affect the clinical results at the final and intermediate follow-ups, considering the disagreement in the literature regarding the measure being seen as pathological [ 1 ]. According to Matsushita et al [ 23 ] no statistically significant difference in clinical scores was obtained between patients with a TT-TG distance > 20 mm and those with a TT-TG distance < 20 mm who underwent surgery for patellar instability.…”

Section: Discussionmentioning

confidence: 79%

“…Trochlear dysplasia is one of the most important predisposing factors, having been confirmed as a radiological finding in 85% of patients with a history of recurrent lateral patella dislocations [ 2 ]. Other important bony abnormalities that contribute to patellar instability are high tibial tubercle to trochlear groove (TT-TG) distance, patellar height, pathological patellar tilt and sulcus angle [ 1 , 8 ]. Moreover, medial patellofemoral ligament (MPFL) rupture, which contributes from 50 to 60% of the total medial restraining force against lateral patellar dislocation at 0° to 30° degrees of knee flexion [ 7 ], represents the main risk factor among all soft-tissue abnormalities that cause patellar instability.…”

Section: Introductionmentioning

confidence: 99%

MPFL reconstruction and tibial tuberosity transposition in patients with patellar instability: May it troubleshots also trochlear dysplasia?

et al. 2021

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Purpose This study aimed to highlight short- and medium-term outcomes of combined medial patello-femoral ligament (MPFL) reconstruction and anterior tibial tuberosity (ATT) transposition surgery in patients with recurrent patellar instability and different degrees of trochlear dysplasia. Methods Between January 2014 and May 2019, 25 patients with patellar instability underwent a surgical procedure combining the lowering/transposition of the ATT and the MPFL reconstruction. Each patient were preoperative assessed by Kujala score, International Knee Documentation Committee (IKDC), Tegner activity level scale. The assessment of instability predisposing factors was carried out with patellar height, tibial tuberosity-trochlear groove (TT-TG) distance, trochlear dysplasia, sulcus angle, patellar tilt and MPFL injuries. Functional outcomes were evaluated with Kujala, IKDC and Tegner scores at 3, 6 and 12 months after surgery. Results The average age of the patients was 20 years (range 13–43 years). Pre- operative Caton–Deschamps index was pathological in 10 (40%). Sulcus angle was elevated in 13 patients (52%) and TT-TG distance was irregular in 17 patients (68%). Trochlear dysplasia was present in 13 patients (9 type A, 3 type B, 1 type C according to Dejour’s Classification). No re-dislocation occurred during the follow-up. There was a significant increase in the Kujala, IKDC and Lysholm scores after 3, 6 and 12 months, and the results were compared for the different follow-up times and patient’s trochlear dysplasia degree. Conclusion This prospective observational longitudinal study identified good clinical outcomes in patients who underwent MPFL reconstruction and ATT transposition for patellar instability. Finally, the different risk factors for patellar instability examined, particularly the presence of trochlear dysplasia, did not significantly influence the final functional results, which range from good to excellent without re-dislocation episodes.

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“…A recent systematic review by Vivekanantha et al [28] reported a pooled rate (four relevant studies) of return to sport among patients undergoing MPFLR with TTO to be 92%, compared to 82% among iMPFLRs. On the other hand, numerous case series have reported return to sport rates following TTO and MPFLR with TTO, ranging from 57% to 100% [14,[29][30][31][32][33]. In a systematic review by Platt et al [17], they concluded that additional osteotomy does not affect the rate or time to return to sport.…”

Section: Discussionmentioning

confidence: 99%

Patients who undergo tibial tubercle anteromedialization with medial patellofemoral ligament reconstruction demonstrate similar rates of return to sport compared to isolated MPFL reconstruction

Li,

Garra,

Eskenazi

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeTo investigate the rate of return to sports and sport psychological readiness between patients who underwent isolated MPFLR (iMPFLR) compared to a matched cohort of patients who underwent MPFLR with anteromedializing tibial tubercle osteotomy (MPFLR/TTO).MethodsPatients who underwent primary MPFLR with or without TTO for recurrent patellar instability were retrospectively reviewed from 2012 to 2020 at a single institution. Preinjury sport and work information, Kujala, Tegner, Visual Analogue Score for pain, satisfaction and MPFL‐Return to Sport after Injury (MPFL‐RSI) score were collected. Two readers independently measured the tibial tuberosity‐trochlear groove distance, Caton–Deschamps index and Dejour classification for trochlear dysplasia. Patients in iMPFLR and MPFLR/TTO groups were matched 1:1 on age, sex, body mass index and follow‐up length. Multivariate regression analysis was performed to determine whether the MPFL‐RSI was associated with a return to sport.ResultsThis study included 74 patients at mean follow‐up of 52.5 months (range: 24–117). These groups returned to sport at similar rates (iMPFLR: 67.6%, MPFLR/TTO: 73.0%, not significant [ns]), though iMPFLR patients returned more quickly (8.4 vs. 12.8 months, p = 0.019). Rates of return to preinjury sport level were also similar (45.9% vs. 40.5%, ns). Patients with Dejour B/C took more time to return to sport compared to patients with mild/no trochlear pathology (13.8 vs. 7.9 months, p = 0.003). Increasing MPFL‐RSI score was significantly predictive of the overall return to sport (odds ratio [OR]: 1.08, 95% confidence interval [CI] [1.03, 1.13], p < 0.001) and return to preinjury level (OR: 1.07, 95% CI [1.04, 1.13], p < 0.001). Most patients in iMPFLR and MPFLR/TTO groups resumed work (95.7% vs. 88.5%, ns), though iMPFLR patients who returned to preinjury work levels did so more quickly (1.7 vs. 4.6 months, p = 0.005).ConclusionPatients who underwent MPFLR with anteromedializing TTO demonstrated similar rates of return to sport and psychological readiness compared to an isolated MPFLR matched comparison group, though iMPFLRs returned more quickly. Patients with more severe trochlear pathology required more time to return to sports.Level of Evidence: Level III.

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Combined Medial Patellofemoral Ligament Reconstruction and Tibial Tubercle Transfer Results at a Follow-Up of 2 years

Cited by 13 publications

References 22 publications

Why compromise the patella? Five-year follow-up results of medial patellofemoral ligament reconstruction with soft tissue patellar fixation

Why compromise the patella? Five-year follow-up results of medial patellofemoral ligament reconstruction with soft tissue patellar fixation

MPFL reconstruction and tibial tuberosity transposition in patients with patellar instability: May it troubleshots also trochlear dysplasia?

Patients who undergo tibial tubercle anteromedialization with medial patellofemoral ligament reconstruction demonstrate similar rates of return to sport compared to isolated MPFL reconstruction

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