scholarly journals Tibial Tubercle Osteotomy and Medial Patellofemoral Ligament Imbrication for Patellar Instability Due to Trochlear Dysplasia

2019 ◽  
Vol 7 (8) ◽  
pp. 232596711986517
Author(s):  
Jonathan D. Hodax ◽  
Michael P. Leathers ◽  
David Y. Ding ◽  
Brian T. Feeley ◽  
Christina R. Allen ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Patellar Instability ◽  
Medial Patellofemoral Ligament ◽  
Trochlear Dysplasia ◽  
Patellofemoral Instability ◽  
Recurrent Dislocation ◽  
Tibial Tubercle ◽  
Tibial Tubercle Osteotomy ◽  
The Mean

Background: The treatment of patellar instability in the setting of trochlear dysplasia is challenging. Purpose/Hypothesis: The purpose of this study was to evaluate outcomes for the treatment of recurrent patellar dislocations due to trochlear dysplasia using anteromedialization tibial tubercle osteotomy combined with medial patellofemoral ligament (MPFL) imbrication. We hypothesized that the treatment of patellar instability with tibial tubercle osteotomy and MPFL imbrication would result in improved patient satisfaction and decrease patellar instability events in patients with prior instability and trochlear dysplasia. Study Design: Case series; Level of evidence, 4. Methods: We performed a retrospective analysis of patients who underwent MPFL imbrication and concomitant anteromedialization tibial tubercle osteotomy for recurrent patellofemoral instability at a single institution. The minimum follow-up was 1 year. Patient demographic information including age at the time of surgery, sex, body mass index (BMI), tibial tubercle–trochlear groove (TT-TG) distance, and grade of trochlear dysplasia was collected along with relevant operative data. Postoperatively, recurrent dislocation events as well as Knee injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster Universities Osteoarthritis Index, and Kujala scores were collected, and satisfaction was ascertained by asking patients whether they would undergo the procedure again. Results: A total of 37 knees from 31 patients (23 female) with a mean follow-up of 3.8 years (range, 1-8.9 years) were included. The mean patient age was 28.8 years (range, 14-45 years), the mean BMI was 24 kg/m2 (range, 20-38 kg/m2), and the mean preoperative TT-TG distance was 18.9 mm (range, 8.4-32.4 mm). Two knees were classified as low-grade trochlear dysplasia (Dejour A) and 35 as high-grade trochlear dysplasia (Dejour B-D). At final follow-up, patients reported mean KOOS subscale scores of 86.5 (Pain), 79.8 (Symptoms), 93.9 (Activities of Daily Living), 74.3 (Sports/Recreation), and 61.9 (Quality of Life), as well as a mean Kujala score of 81.3. Mean patient satisfaction was 8.3 of 10. The majority of knees (86.5%; 32/37) remained stable without recurrent instability after this procedure, while 13.5% (5 knees) suffered a recurrent dislocation, with 2 requiring revision surgery. Eight knees (21.6%) underwent subsequent hardware removal. Conclusion: Anteromedialization tibial tubercle osteotomy with MPFL imbrication can improve recurrent patellofemoral instability and provide significant clinical benefit to patients with trochlear dysplasia.

scholarly journals Treatment of the Objective Patellofemoral Instability

2017 ◽  
Vol 5 (1_suppl) ◽  
pp. 2325967117S0001
Author(s):  
Federico Alfano ◽  
Walter Spreafico
Keyword(s):  
Surgical Procedures ◽  
Patellar Instability ◽  
Medial Patellofemoral Ligament ◽  
Preoperative Planning ◽  
Patellofemoral Instability ◽  
Patellar Height ◽  
Tibial Tubercle ◽  
Tibial Tubercle Osteotomy ◽  
Axial View ◽  
Associated Abnormalities

Objectives: The aim of this study is to show the different surgical procedures for treating the objective patellar instability, including the different tibial tubercle osteotomies and the sulcus deepening trochleoplasty. Methods: This study analyzed the Caton-Deschamps index used for assessment of patellar height, the distance from the tibial tubercle to the troclear groove (TT-TG) on CT Scan in the axial view, and the different trochlear and patellar morphotypes. This study included 19 knees (19 patients) treated in an objective and documented patellofemoral instability. Results: We have had good results with both the transfer of the tibial tuberosity as the trochleoplasty. A reconstruction of the medial patellofemoral ligament was performed in both procedures. Recurrence of instability is very rare after these procedures and this is more likely to result from missed associated abnormalities. Conslusion: Accurate preoperative planning of the patellar height and determining the location of the tibial tubercle and the trochlear and patellar morphotypes for satisfactory results are required. However, as with any surgical procedure, both tibial tubercle osteotomy and the sulcus deepening trochleoplasty are susceptible of complications.

Radiographic and Clinical Outcomes After Tibial Tubercle Osteotomy for the Treatment of Patella Alta: A Systematic Review and Meta-analysis

2021 ◽  
pp. 036354652110123
Author(s):  
Derrick M. Knapik ◽  
Kyle N. Kunze ◽  
Eric Azua ◽  
Amar Vadhera ◽  
Adam B. Yanke ◽  
...  
Keyword(s):  
Systematic Review ◽  
Random Effects ◽  
Patellar Instability ◽  
Meta Analysis ◽  
Patellar Height ◽  
Patella Alta ◽  
Tibial Tubercle ◽  
Tibial Tubercle Osteotomy ◽  
The Mean

Background: Patella alta is a known risk factor for patellar instability and, in the setting of recurrent patellar instability with significant patella alta, correction of patellar height with a tibial tubercle osteotomy (TTO) may help decrease the failure of soft tissue–based stabilization. Purpose: To perform a systematic review and meta-analysis of radiographic and clinical outcomes after TTO for patella alta. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: PubMed, OVID/Medline, and Cochrane databases were queried in June 2020 for studies reporting outcomes of TTO for patella alta. Data pertaining to study characteristics and design, radiographic and clinical outcome values, and incidence of complications and reoperations were extracted. DerSimonian-Laird continuous and binary random-effects models were constructed to (1) perform subgroup-based analysis of mean changes in radiographic indices after TTO and (2) quantify the pooled incidence of complications and reoperations. Results: Eight studies including 340 patients (420 knees) with a mean age of 24.7 ± 8.4 years were included. The mean follow-up was 53.1 months (range, 3-120 months), with 1 study reporting a mean follow-up of less than 2 years. The pooled mean anterior transfer was 5.6 mm; the mean medial transfer was 8.7 ± 1.3 mm; and the pooled mean distalization of the tibial tubercle was 12.2 ± 4.5 mm. Continuous random-effects meta-analysis determined that significant reductions in the mean Insall-Salvati ratio (1.40 vs 0.98, P < .001), Caton-Deschamps index (1.26 vs 0.97, P < .001), and tibial tubercle to trochlear groove ratio (18.27 vs 10.69, P < .001) were observed after TTO. The overall incidence of complications was 7.6% (95% CI, 4.8%-10.5%), while the overall incidence of reoperations was 14.3% (95% CI 6.2%-22.4%). Conclusion: TTO for patellar instability in the setting of patella alta results in a significant decrease in patellar height with varying degrees of medialization depending on the utilized technique. A mean postoperative complication rate of 7.6% was reported with a reoperation incidence of 14.3%, related primarily to hardware removal.

Clinical Outcomes After Isolated Medial Patellofemoral Ligament Reconstruction for Patellar Instability Among Patients With Trochlear Dysplasia

2018 ◽  
Vol 46 (4) ◽  
pp. 883-889 ◽  
Author(s):  
Joseph N. Liu ◽  
Jacqueline M. Brady ◽  
Irene L. Kalbian ◽  
Sabrina M. Strickland ◽  
Claire Berdelle Ryan ◽  
...  
Keyword(s):  
Patellar Instability ◽  
Ligament Reconstruction ◽  
Medial Patellofemoral Ligament ◽  
Trochlear Dysplasia ◽  
Patellofemoral Instability ◽  
Mpfl Reconstruction ◽  
Trochlear Groove ◽  
Return To Sports ◽  
Medial Patellofemoral Ligament Reconstruction

Background: Medial patellofemoral ligament (MPFL) reconstruction has become one of the most common and widely used procedures to regain stability among patients with recurrent lateral patellar dislocation. While recent studies demonstrated low recurrence rates, improved patient-reported outcome measures, and a high rate of return to sports, limited literature explored its effectiveness as an isolated intervention in the context of trochlear dysplasia. Purpose: To determine the efficacy of isolated MPFL reconstruction in treating patellar instability in the setting of trochlear dysplasia. Study Design: Case series; Level of evidence, 4. Methods: This was a retrospective review of consecutive patients who underwent uni- or bilateral medial patellofemoral ligament reconstruction for patellofemoral instability with a minimum 2-year follow-up. No osteotomies were included. Pre- and postoperative assessment included ligamentous laxity, patellar crepitus, tilt, translation, apprehension, and radiographic features, including tibial tubercle-trochlear groove (TT-TG) distance, Dejour classification, and Caton-Deschamps index. Results: A total of 121 MPFL reconstructions were included. Mean age at surgery was 23.8 years, and 4.4 dislocation events occurred before surgery. Mean follow-up was 44 months; 76% of patients were female. Mean preoperative TT-TG ratio was 13.5, and mean Caton-Deschamps ratio was 1.2; 92% of patients had Dejour B, C, or D trochlear dysplasia. Kujala score improved from 55.0 preoperatively to 90.0 ( P < .001). Almost all patients (94.5%) were able to return to sports at 1 year, with 74% returning to the same or higher level of play. Only 3 patients reported a postoperative dislocation or subluxation event. Discussion: For patients without significantly elevated TT-TG distances or significant patella alta, isolated MPFL reconstruction provides a safe and effective treatment for patellofemoral instability, despite the presence of trochlear dysplasia. Most patients are able to return to sports by 1 year postoperatively at the same or higher level of play.

scholarly journals Isolated Medial Patellofemoral Ligament Reconstruction for Patellar Instability Regardless of the Tibial Tubercle Trochlear Groove Distance: Outcomes at 1 and 2 Years

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0007
Author(s):  
Brandon J. Erickson ◽  
Joseph Nguyen ◽  
Katelyn Gasik ◽  
Jacqueline Brady ◽  
Beth E. Shubin Stein
Keyword(s):  
Patellar Instability ◽  
Medial Patellofemoral Ligament ◽  
Trochlear Dysplasia ◽  
Patellar Height ◽  
Mpfl Reconstruction ◽  
Tibial Tubercle ◽  
Trochlear Groove ◽  
One Year ◽  
Recurrent Patellar Instability

Background: Several surgical options exist for treatment of recurrent patellar instability. The treatments can be divided into ligamentous and bony procedures. It is currently unclear which patients require a bony procedure in addition to a soft tissue reconstruction. Purpose: To report the one and two-year outcomes of patients following medial patellofemoral ligament (MPFL) reconstruction performed in isolation regardless of the patellar height, tibial tubercle trochlear groove distance (TT-TG) or trochlear dysplasia. Hypothesis:: Patients will have <5% re-dislocation rate and significant improvements in patient reported outcome measures (PROMs) following isolated MPFL reconstruction. Methods: All patients with recurrent patellar instability and without significant unloadable chondral defects, failed previous surgery or pain greater than or equal to 50% as their chief complaint, were prospectively enrolled beginning March of 2014. All patients underwent a primary, unilateral, isolated MPFL reconstruction regardless of concomitant bony pathology for treatment of recurrent patellar instability. Patients were followed at standard intervals. PROMs were collected at one year and two year follow up visits. Information on recurrent subjective instability, dislocations, and ability to return to sport (RTS) was recorded. TT-TG and patellar height (using the Caton-Deschamps index) were measured on magnetic resonance images. Results: Overall, 90 patients (77% female; average age 19.4 +/- 5.6 years) underwent a MPFL reconstruction from March 2014 to August 2017; 63 (70%) of whom reached one year follow up, and 35 of these patients (39%) reached 2-year follow-up. No patient experienced a redislocation; 96% of patients at one year and 100% of patients at two years had no subjective patellofemoral instability. RTS rates at one and two years were 59% and 75% respectively. No patient experienced a complication at one year. All patients had a clinically and statistically significant improvement from baseline to 1-year follow-up in the following PROMs: Knee injury and Osteoarthritis Outcome Score Quality of Life (KOOS QOL) (32.7 to 72.0; p<0.001), International Knee Documentation Committee (IKDC) (51.4 to 82.6; p<0.001) Kujala (62.2 to 89.5; p<0.001), and all general health PROM. No clinically and statistically significant change was seen between 1- and 2-year follow-ups in all outcome scores (all p>0.05). A non-statistically significant increase was seen in sporting activity of the Pediatric Functional Activity Brief Scale (Pedi-FABS) (13.9 to 16.7 p=0.292) at 2 years. Average patient satisfaction was 9.3 of 10 (10 being most satisfied) at 1- and 2-year follow-up. Average TT-TG was 15.1 +/- 4.0. Average patellar height was 1.25 +/- 0.17. Conclusion: Isolated MPFL reconstruction is an effective treatment for patellar instability and provides significant improvements in PROMs with a low redislocation/instability rate at early 1 and 2 year follow up, regardless of bony pathologies including TT-TG, Caton-Deschamps Index and trochlear dysplasia. The goal of this ongoing prospective study is to follow these patients out for 5 to 10 years to assess what radiologic and physical examination factors predict failure of isolated MPFL reconstruction.

Clinical Outcomes and Predictive Factors for Failure With Isolated MPFL Reconstruction for Recurrent Patellar Instability: A Series of 211 Reconstructions With a Minimum Follow-up of 3 Years

2019 ◽  
Vol 47 (6) ◽  
pp. 1323-1330 ◽  
Author(s):  
Elliot Sappey-Marinier ◽  
Bertrand Sonnery-Cottet ◽  
Padhraig O’Loughlin ◽  
Herve Ouanezar ◽  
Levi Reina Fernandes ◽  
...  
Keyword(s):  
Patellar Instability ◽  
Trochlear Dysplasia ◽  
Patella Alta ◽  
Mpfl Reconstruction ◽  
Tibial Tubercle ◽  
Trochlear Groove ◽  
Kujala Score ◽  
The Mean ◽  
Recurrent Patellar Instability

Background: Reconstruction of the medial patellofemoral ligament (MPFL) is widely acknowledged as an integral part of the current therapeutic armamentarium for recurrent patellar instability. The procedure is often performed with concomitant bony procedures, such as distalization of the tibial tuberosity or trochleoplasty in the case of patella alta or high-grade trochlear dysplasia, respectively. At the present time, few studies have evaluated the clinical effectiveness of MPFL reconstruction as an isolated intervention. Purpose: To report the clinical outcomes of isolated MPFL reconstruction in cases of patellar instability and to identify predictive factors for failure. Study Design: Case series; Level of evidence, 4. Methods: A retrospective analysis of prospectively collected data was performed, including all patients who had undergone isolated MPFL reconstruction between January 2008 and January 2014. Preoperative assessment included the Kujala score, assessment of patellar tracking (“J-sign”), and radiographic features, such as trochlear dysplasia according to Dejour classification, patellar height with the Caton-Deschamps index (CDI), tibial tubercle–trochlear groove distance, and patellar tilt. The Kujala score was assessed postoperatively. Failure was defined by a postoperative patellar dislocation or surgical revision for recurrent patellar instability. Results: A total of 239 MPFL reconstructions were included; 28 patients (11.7%) were uncontactable and considered lost to follow-up. Thus, 211 reconstructions were analyzed with a mean follow-up of 5.8 years (range, 3-9.3 years). The mean age at surgery was 20.6 years (range, 12-48 years), and 55% of patients were male. Twenty-seven percent of patients had a preoperative positive J-sign, and 93% of patients had trochlear dysplasia (A, 47%; B, 25%; C, 15%; D, 6%). The mean CDI was 1.2 (range, 1.0-1.7); mean tibial tubercle–trochlear groove distance, 15 mm (range, 5-30 mm); and mean patellar tilt, 23° (range, 9°-47°). The mean Kujala score improved from 56.1 preoperatively to 88.8 ( P < .001). Ten failures were reported that required surgical revision for recurrent patellar instability (4.7%). Uni- and multivariate analyses highlighted 2 preoperative risk factors for failure: patella alta (CDI ≥1.3; odds ratio, 4.9; P = .02) and preoperative positive J-sign (odds ratio, 3.9; P = .04). Conclusion: In cases of recurrent patellar instability, isolated MPFL reconstruction would appear to be a safe and efficient surgical procedure with a low failure rate. Preoperative failure risk factors identified in this study were patella alta with a CDI ≥1.3 and a preoperative positive J-sign.

Isolated Medial Patellofemoral Ligament Reconstruction for Patellar Instability Regardless of Tibial Tubercle–Trochlear Groove Distance and Patellar Height: Outcomes at 1 and 2 Years

2019 ◽  
Vol 47 (6) ◽  
pp. 1331-1337 ◽  
Author(s):  
Brandon J. Erickson ◽  
Joseph Nguyen ◽  
Katelyn Gasik ◽  
Simone Gruber ◽  
Jacqueline Brady ◽  
...  
Keyword(s):  
Patellar Instability ◽  
Medial Patellofemoral Ligament ◽  
Trochlear Dysplasia ◽  
Patellar Height ◽  
Mpfl Reconstruction ◽  
Tibial Tubercle ◽  
Trochlear Groove ◽  
Outcome Scores ◽  
Recurrent Patellar Instability

Background: It is unclear which patients with recurrent patellar instability require a bony procedure in addition to medial patellofemoral ligament (MPFL) reconstruction. Purpose: To report 1- and 2-year outcomes of patients after isolated MPFL reconstruction performed for patellar instability regardless of patellar height, tibial tubercle–trochlear groove (TT-TG) distance, or trochlear dysplasia. Study Design: Case series; Level of evidence, 4. Methods: All patients with recurrent patellar instability and without significant unloadable chondral defects (Outerbridge grade IV), cartilage defects (especially inferior/lateral patella), previous failed surgery, or pain >50% as their chief complaint were prospectively enrolled beginning March 2014. All patients underwent primary, unilateral, isolated MPFL reconstruction regardless of concomitant bony pathology for treatment of recurrent patellar instability. Information on recurrent subjective instability, dislocations, ability to return to sport (RTS), and outcome scores was recorded at 1 and 2 years. TT-TG distance, patellar height (with the Caton-Deschamps index), and trochlear depth were measured. Results: Ninety patients (77% female; mean ± SD age, 19.4 ± 5.6 years) underwent MPFL reconstruction between March 2014 and August 2017: 72 (80%) reached 1-year follow-up, and 47 (52.2%) reached 2-year follow-up (mean follow-up, 2.2 years). Mean TT-TG distance was 14.7 ± 5.4 mm (range, –2.2 to 26.8 mm); mean patellar height, 1.2 ± 0.11 mm (range, 0.89-1.45 mm); and mean trochlear depth, 1.8 ± 1.4 mm (range, 0.05-6.85 mm). Ninety-six percent of patients at 1 year and 100% at 2 years had no self-reported patellofemoral instability; 1 patient experienced a redislocation at 3.5 years. RTS rates at 1 and 2 years were 90% and 88%, respectively. Mean time to RTS was 8.8 months. All patients had clinically and statistically significant improvement in mean Knee injury and Osteoarthritis Outcome Score–Quality of Life (32.7 to 72.0, P < .001), mean International Knee Documentation Committee subjective form (51.4 to 82.6, P < .001), and mean Kujala score (62.2 to 89.5, P < .001). No difference existed between 1- and 2-year outcome scores (all P > .05). Conclusion: At early follow-up of 1 and 2 years, isolated MPFL reconstruction is an effective treatment for patellar instability and provides significant improvements in outcome scores with a low redislocation/instability rate regardless of bony pathologies, including TT-TG distance, Caton-Deschamps index, and trochlear dysplasia. Future data from this cohort will be used to assess long-term outcomes.

Effect of Isolated Medial Patellofemoral Ligament Reconstruction in Patellofemoral Instability Regardless of Predisposing Factors

2020 ◽  
Author(s):  
Jae Ik Lee ◽  
Mohd Shahrul Azuan Jaffar ◽  
Han Gyeol Choi ◽  
Tae Woo Kim ◽  
Yong Seuk Lee
Keyword(s):  
Medial Patellofemoral Ligament ◽  
Trochlear Dysplasia ◽  
Case Series ◽  
Patellofemoral Instability ◽  
International Knee Documentation Committee ◽  
Predisposing Factors ◽  
Mpfl Reconstruction ◽  
Patellar Tilt ◽  
Case Series Study

AbstractThe purpose of this study was to evaluate the outcomes of isolated medial patellofemoral ligament (MPFL) reconstruction, regardless of the presence of predisposing factors. A total of 21 knees that underwent isolated MPFL reconstruction from March 2014 to August 2017 were included in this retrospective series. Radiographs of the series of the knee at flexion angles of 20, 40, and 60 degrees were acquired. The patellar position was evaluated using the patellar tilt angle, sulcus angle, congruence angle (CA), and Caton-Deschamps and Blackburne-Peel ratios. To evaluate the clinical outcome, the preoperative and postoperative International Knee Documentation Committee (IKDC) and Lysholm knee scoring scales were analyzed. To evaluate the postoperative outcomes based on the predisposing factors, the results were separately analyzed for each group. Regarding radiologic outcomes, 20-degree CA was significantly reduced from 10.37 ± 5.96° preoperatively to −0.94 ± 4.11° postoperatively (p = 0.001). In addition, regardless of the predisposing factors, delta values of pre- and postoperation of 20-degree CA were not significantly different in both groups. The IKDC score improved from 53.71 (range: 18–74) preoperatively to 94.71 (range: 86–100) at the last follow-up (p = 0.004), and the Lysholm score improved from 54.28 (range: 10–81) preoperatively to 94.14 (range: 86–100) at the last follow-up (p = 0.010). Isolated MPFL reconstruction provides a safe and effective treatment for patellofemoral instability, even in the presence of mild predisposing factors, such as trochlear dysplasia, increased patella height, increased TT–TG distance, or valgus alignment. This is a Level 4, case series study.

scholarly journals Sulcus-Deepening Trochleoplasty for Trochlear Dysplasia

2021 ◽  
Vol 1 (3) ◽  
pp. 263502542110111
Author(s):  
Anthony J. Ignozzi ◽  
Zane Hyde ◽  
Scott E. Dart ◽  
David R. Diduch
Keyword(s):  
Patient Satisfaction ◽  
Trochlear Dysplasia ◽  
Recurrent Dislocation ◽  
Trochlear Groove ◽  
Thick Shell ◽  
Absorbable Sutures ◽  
Postoperative Dislocation ◽  
A Prospective Study ◽  
Patellar Stability

Background: Patients who are refractory to initial management of trochlear dysplasia, which consists of bracing and physical therapy, may be candidates for trochleoplasty. Indications: Indications for trochleoplasty include Dejour classification type B or D trochlear dysplasia, supratrochlear spur height ≥7 mm, and a positive J sign on examination. Technique Description: The thick shell sulcus-deepening trochleoplasty technique involves removing the supratrochlear spur by creating a 5-mm–thick osteochondral shell with underlying cavity, dividing the thick shell into medial and lateral leaflets, and securing the leaflets with absorbable sutures. This establishes a new trochlear groove that is flush with the anterior cortex of the femur. Results: A review of 21 studies with length of follow-up from 8.8 months to 15 years found postoperative dislocation was present in 0% to 15% of patients and the patient satisfaction ranged from 81.0% to 94.4%. A prospective study with a minimum 2-year follow-up found no cases of recurrent dislocation, no progression of radiographic arthritis, 84.8% of patients returned to sport, and the patient satisfaction was a 9.1/10. Discussion/Conclusion: Sulcus-deepening trochleoplasty for trochlear dysplasia provides patellar stability and excellent patient satisfaction.

scholarly journals Comparable outcome for autografts and allografts in primary medial patellofemoral ligament reconstruction for patellofemoral instability: systematic review and meta-analysis

2021 ◽  
Author(s):  
Filippo Migliorini ◽  
Andromahi Trivellas ◽  
Jörg Eschweiler ◽  
Matthias Knobe ◽  
Markus Tingart ◽  
...  
Keyword(s):  
Medial Patellofemoral Ligament ◽  
Meta Analysis ◽  
Patellofemoral Instability ◽  
Mpfl Reconstruction ◽  
Current Evidence ◽  
Level Of Evidence ◽  
Feasible Alternative ◽  
The Mean ◽  
Persistent Instability

Abstract Purpose This study updates the current evidence on the role of allografts versus autografts for medial patellofemoral ligament (MPFL) reconstruction in patients with patellofemoral instability. Methods The study was performed according to the PRISMA guidelines. In March 2021, a literature search in the main online databases was performed. Studies reporting quantitative data concerning primary MPFL reconstruction using an allograft were considered for inclusion. The Coleman Methodology Score was used to assess the methodological quality of the selected articles. Results Data from 12 studies (474 procedures) were retrieved. The mean follow-up was 42.2 (15–78.5) months. The mean age was 21.1 ± 6.2 years. 64.9% (285 of 439) of patients were female. At the last follow-up, the Tegner (p < 0.0001), Kujala (p = 0.002) and the Lysholm (p < 0.0001) scores were minimally greater in the autografts. The similarity was found in the rate of persistent instability sensation and revision. The allograft group evidenced a lower rate of re-dislocations (p = 0.003). Conclusion Allografts may represent a feasible alternative to traditional autograft for MPFL reconstruction in selected patients with patellofemoral instability. Allograft tendons yielded similar PROMs, rates of persistent instability, and revision. Allograft reconstructions tended to have modestly lower re-dislocation rates. Level of evidence IV.

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]

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