Medial patellofemoral ligament reconstruction with or without tibial tubercle transfer is an effective treatment for patellofemoral instability

2018 ◽  
Vol 27 (3) ◽  
pp. 805-813 ◽  
Author(s):  
Thomas Neri ◽  
David Anthony Parker ◽  
Aaron Beach ◽  
Clara Gensac ◽  
Bertrand Boyer ◽  
...  
Keyword(s):  
Effective Treatment ◽  
Ligament Reconstruction ◽  
Medial Patellofemoral Ligament ◽  
Patellofemoral Instability ◽  
Tibial Tubercle ◽  
Medial Patellofemoral Ligament Reconstruction ◽  
Tibial Tubercle Transfer

scholarly journals Outcomes And Reoperation Rates After Tibial Tubercle Transfer And Medial Patellofemoral Ligament Reconstruction

2020 ◽  
Vol 8 (3_suppl2) ◽  
pp. 2325967120S0012
Author(s):  
Dax T. Varkey ◽  
Jacob Gorbaty ◽  
Susan Odum ◽  
Dana P. Piasecki ◽  
James E. Fleischli
Keyword(s):  
Knee Pain ◽  
Ligament Reconstruction ◽  
Medial Patellofemoral Ligament ◽  
Patellofemoral Instability ◽  
Reoperation Rate ◽  
Tibial Tubercle ◽  
Trochlear Groove ◽  
Medial Patellofemoral Ligament Reconstruction ◽  
Tibial Tubercle Transfer ◽  
Reoperation Rates

Objectives: Patellofemoral instability (PFI) is a painful condition affecting approximately 7 patients per 100,000 in the US. Unfortunately, as many as 50% of young patients with patellar dislocations can go on to recurrent instability and have debilitating symptoms. With a wide range of operative techniques, and subsequent reoperation and complication rate cited in the literature, it becomes challenging to create an appropriate algorithm with which to treat patients. The goal of our study was to determine the reoperation rate, risk factors for reoperation, and patient reported outcomes after Tibial Tubercle Transfer (TTT), Medial Patellofemoral Ligament Reconstruction (MPFLR), or a combination of the two, for patellofemoral instability surgery. Methods: We retrospectively identified patients who underwent MPFLR and TTT by querying the surgical database at our single institution from 2002-2018 for CPT codes associated with the procedures (CPT-27418, CPT-27427). Patients were included if they had an MPFLR and/or TTT performed for PFI whether recurrent or single dislocation. Patients were excluded if either additional ligamentous reconstruction was performed simultaneously, indications for the procedure was for a condition other than PFI or if records were incomplete. 497 patients were eligible to be included. Radiographic measurements, demographic parameters, and subsequent revision procedures and their indications were identified. A modified anterior knee pain survey was conducted by mail and with follow-up phone survey. Chi-Square Tests or Fishers Exact Test were used to compare differences for categorical data and Wilcoxon rank sum tests were used to compare the non-parametric pain scores. A multivariable logistic regression was used to determine the association between patient demographics, radiographic parameters and procedure type. Results: The overall rate of reoperation amongst all patients was 25.6%. The rate of reoperation for MPFL alone (19.9%) was lower than that of TTT alone (34.8%) or both procedures simultaneously (26.4%) (P = .007). There was a trend towards increased major reoperation rates and revision stabilization procedures in patients with isolated TTT (P = .16). There was no association with tibial tubercle to trochlear groove (TTTG) distance and the rate of reoperation (P = .99). A preoperative Dejour classification D was associated with a higher reoperation rate (28%) than those with Dejour A-C (P=.43). A Caton-Deschamp ratio >1.3 increased the odds of having a revision stabilization surgery (odds ratio 2.303). Patients who had a revision surgery for any reason were more likely to report pain while walking compared to those who did not (P = <.0001). Conclusion: The overall reoperation after PFI surgery is higher than previously reported. Patients who underwent further procedures were more likely to report continued knee pain when walking. Our results would suggest that patients with trochlear dysplasia and patella alta are more likely to undergo future procedures for instability, and may benefit from more aggressive initial treatment, such as MPFLR and TTT in combination.

scholarly journals SPONTANEOUS CORRECTION OF EXTERNAL TIBIOFEMORAL ROTATION AND TIBIAL TUBEROSITY-TROCHLEAR GROOVE DISTANCE OCCURS AFTER MEDIAL PATELLOFEMORAL LIGAMENT RECONSTRUCTION IN FIXED OR OBLIGATORY DISLOCATORS

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0013
Author(s):  
Alexandra H. Aitchison ◽  
Kenneth M. Lin ◽  
Daniel W. Green
Keyword(s):  
Patellar Instability ◽  
Ligament Reconstruction ◽  
Medial Patellofemoral Ligament ◽  
Extensor Mechanism ◽  
Tibial Tubercle ◽  
Trochlear Groove ◽  
Medial Patellofemoral Ligament Reconstruction ◽  
Force Vector ◽  
Tibiofemoral Rotation ◽  
The Mean

Background: Tibial tubercle to trochlear groove distance (TT-TG) and external tibiofemoral rotation (TFR) through the knee joint have been identified potential contributing factors to patellar instability. In patients with a fixed or obligatory lateral patella dislocation (FOD), the normal force vector of the extensor mechanism is altered, so instead of a direct axial pull to cause extension, it exerts a lateralizing and external rotatory force on the tibia via the tibial tubercle. Hypothesis/Purpose: The purpose of this study is to investigate postoperative changes in TT-TG and TFR after medial patellofemoral ligament reconstruction (MPFLR) in two clinical cohorts: standard traumatic patellar instability (SPI) patients and FOD patients. We hypothesized that by surgically relocating the patella in the trochlea, and re-establishing medial sided soft tissue tension, the increased medializing force vector on the patella may exert enough force to alter resting rotation of the tibia in relation to the femur in the FOD group. Methods: A retrospective study was performed from April 2009 to February 2019. FOD and SPI patients under 18 years with available magnetic resonance imaging (MRI) of the knee before and after MPFLR were eligible. All FOD patients in the time frame were analyzed and SPI patients were randomly selected. Exclusion criteria were outside institution MRI, concomitant alignment procedures done at the time of MPFLR, and prior MPFLR or tibial tubercle osteotomy. TT-TG and TFR (using the posterior femoral and tibial condylar lines) were measured blindly on initial axial MRI. Statistical analysis using a paired sample t-test was performed with significance set at p<0.05. Results: A total of 30 patients were included, 14 in the FOD group and 16 in the SPI group. The mean age at time of surgery was 13.9 years (range 10-17 years), 53% of the cohort was female, and the mean time from surgery to follow-up MRI was 2.0 years. Demographics by group are shown in Table 1. TT-TG and TFR were not significantly different preoperatively versus postoperatively in the SPI group (Table 2). In the FOD group, both TT-TG (17.7 vs 13.7, P=.019) and TFR (8.6 vs 3.1, P=.025) decreased significantly on postoperative MRI. Conclusion: The postoperative decrease in TT-TG and TFR in the FOD group suggests that MPFLR in fixed or obligatory dislocators can improve the external rotation deformity through the level of the joint, and thus may help normalize the forces acting through the extensor mechanism. Tables/ Figures [Table: see text][Table: see text]

scholarly journals Isolated medial patellofemoral ligament reconstruction for recurrent patellofemoral instability: analysis of outcomes and risk factors

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Filippo Migliorini ◽  
Francesco Oliva ◽  
Gayle D. Maffulli ◽  
Jörg Eschweiler ◽  
Matthias Knobe ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Outcomes ◽  
Ligament Reconstruction ◽  
Medial Patellofemoral Ligament ◽  
Patellofemoral Instability ◽  
Mpfl Reconstruction ◽  
Medial Patellofemoral Ligament Reconstruction ◽  
The Mean ◽  
Tegner Score

Abstract Background The medial patellofemoral ligament (MPFL) is always damaged after patellar dislocation. In selected patients, MPFL reconstruction is necessary to restore a correct patellar tracking. Despite the large number of different techniques reported to reconstruct the MPFL, there is no consensus concerning the optimal procedure, and debates is still ongoing. The present study analysed the results after isolated MPFL reconstruction in patients with patellofemoral instability. Furthermore, a subgroup analysis of patients presenting pathoanatomical risk factors was made. Methods In November 2020, the main electronic databases were accessed. All articles reporting the results of primary isolated MPFL reconstruction for recurrent patellofemoral instability were considered for inclusion. Only articles reporting a minimum 12-month follow-up were eligible. Results Data from a total of 1777 knees were collected. The mean age of the patients involved was 22.8 ± 3.4 years. The mean follow-up was 40.7 ± 25.8 months. Overall, the range of motion (+ 27.74; P < 0.0001) and all the other scores of interests improved at last follow-up: Kujala (+ 12.76; P = 0.0003), Lysholm (+ 15.69; P < 0.0001), Tegner score (+ 2.86; P = 0.006). Seventy-three of 1780 patients (4.1%) showed a positive apprehension test. Thirty of 1765 patients (1.7%) experienced re-dislocations, while 56 of 1778 patients (3.2%) showed persisting joint instability. Twenty-five of 1786 patients (1.4%) underwent revision surgeries. Conclusion Isolated MPFL reconstruction for recurrent patellofemoral instability provides reliable surgical outcomes. Patients with pathoanatomical predisposing factors reported worse surgical outcomes.

Medial Patellofemoral Ligament Reconstruction With or Without Derotational Distal Femoral Osteotomy in Treating Recurrent Patellar Dislocation With Increased Femoral Anteversion: A Retrospective Comparative Study

2020 ◽  
Vol 49 (1) ◽  
pp. 200-206
Author(s):  
ZhiJun Zhang ◽  
Guanyang Song ◽  
Yue Li ◽  
Tong Zheng ◽  
QianKun Ni ◽  
...  
Keyword(s):  
Ligament Reconstruction ◽  
Medial Patellofemoral Ligament ◽  
Femoral Anteversion ◽  
Tibial Tubercle ◽  
Control Group ◽  
High Grade ◽  
Recurrent Patellar Dislocation ◽  
Distal Femoral Osteotomy ◽  
Patellar Maltracking ◽  
Tibial Tubercle Transfer

Background: Controversy exists regarding the surgical treatment of recurrent patellar dislocation (RPD) with an increased femoral anteversion angle (FAA). Medial patellofemoral ligament reconstruction (MPFL-R) either alone or combined with derotational distal femoral osteotomy (DDFO) results in favorable clinical outcomes. Purpose: To compare the clinical outcomes of MPFL-R versus MPFL-R with DDFO in treating RPD with increased FAA (>30°). Study Design: Cohort study; Level of evidence, 3. Methods: Between January 2014 and December 2017, 126 patients (135 knees) with RPD and increased FAA (>30°) were surgically treated using MPFL-R with or without DDFO and eligible for this retrospective study. These patients were allocated into 2 groups based on whether an additional DDFO was performed: the DDFO group (MPFL-R + DDFO with or without tibial tubercle transfer; n = 66) and the control group (MPFL-R with or without tibial tubercle transfer; n = 69). Pre- and postoperative patellar stability was measured using stress radiography. Patellar maltracking (J-sign) and patient-reported outcomes (Kujala, International Knee Documentation Committee, Lysholm, and Tegner scores) were evaluated and compared between the 2 groups. Subgroup analysis was performed by stratifying the results in terms of the severity of preoperative patellar maltracking (low-grade vs high-grade J-sign). Results: A total of 135 knees (126 patients) with a mean follow-up time of 3.7 ± 1.2 years were evaluated in the present study. The rates of postoperative MPFL residual graft laxity and residual J-sign were significantly lower in the DDFO group than in the control group (6% vs 19%, P = .028; 33% vs 54%, P = .018). The DDFO group had significantly higher Kujala (82.3 vs 76.7; P = .001) and Lysholm (83.7 vs 77.7; P = .034) scores than the control group had postoperatively. For patients with a preoperative high-grade J-sign, further subgroup analysis demonstrated that the DDFO group had a significantly lower rate of MPFL residual graft laxity than the control group had (18% vs 57%; P = .029). Conclusion: In this retrospective study, treatment of RPD with increased femoral anteversion using MPFL-R with DDFO yielded more favorable subjective and objective outcomes than did MPFL-R without DDFO, and this circumstance was more remarkable when the patients had a preoperative high-grade J-sign.

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