top of page

Topic:

Patellar Instability

Issue:

Knee

Category:

Trauma

Title:

Medial Patellofemoral Ligament Reconstruction With or Without Tibial Tubercle Osteotomy in Carefully Selected Patients Results in a 5% Revision Rate: A Preliminary Analysis

Author:

Perkins, Crystal A. MD; Egger, Anthony C. MD; Busch, Michael T. MD; Murata, Asahi BS, MPH; Willimon, Samuel C. MD

Journal:

Journal of Pediatric Orthopaedics

Date:

February 2024

Reference:

44(2): p e144-e150, DOI: 10.1097/BPO.0000000000002582

Level Of Evidence:

III

# of Patients:

78 knees in 74 patients

Study Type:

Retrospective study

Location:

Single institution

Summary:

The study evaluates outcomes of medial patellofemoral ligament (MPFL) allograft reconstruction with or without tibial tubercle osteotomy (TTO) in adolescents for lateral patellar instability. The study focuses on revision rates, patient demographics, and imaging characteristics.

Methods:

Retrospective analysis of patients aged 12 to 19 years who underwent MPFL reconstruction with or without TTO. Demographic, clinical, surgical, and postoperative data were collected, and patient-reported outcomes were evaluated at a minimum of 2 years. X-ray and MRI measurements were performed independently by two surgeons. The primary outcome was recurrent instability requiring revision surgery.

Exclusions:

Patients older than 19 years Those who underwent revision surgery or had concomitant knee injuries at the time of the index procedure or within 12 months post-surgery Incomplete data for the primary outcome measure (revision surgery) or 2-year follow-up.

Results:

45 knees underwent isolated MPFL reconstruction, while 33 knees received combined MPFL + TTO. Knees in the MPFL + TTO group had greater tibial tubercle-trochlear groove (19.0 mm vs. 15.4 mm, P=0.015) and patellar tendon-lateral trochlear ridge distances (10.9 mm vs. 5.9 mm, P=0.018) compared to the isolated MPFL group. Revision Surgery: 4 knees (5.1%) required revision surgery, including 3 knees (6.7%) in the isolated MPFL group and 1 knee (3.0%) in the MPFL + TTO group. The failure rate between the two groups was not significantly different (P=0.634). No significant differences in age, sex, body mass index, number of dislocations, or imaging characteristics between patients who required revision surgery and those who did not. Patient-reported Outcomes: No significant differences in patient-reported outcomes between the two treatment groups (assessed at a median of 36 months post-surgery).

Conclusions:

The study found a 95% revision-free outcome for adolescents who underwent MPFL reconstruction, with or without TTO, for patellar instability. Despite differences in tibial tubercle and patellar tendon distances between the two groups, no predictive factors for revision surgery were identified. These findings suggest that both MPFL reconstruction alone and with TTO offer excellent outcomes when carefully selected.

Relevance:

Limitations:

Perspective:

bottom of page