Medial Patellofemoral Ligament Reconstruction with or Without Tibial Tubercle Transfer is an Effective Treatment for Patellofemoral Instability

Overview

Journal Knee Surg Sports Traumatol Arthrosc

Publisher Wiley

Specialties Emergency Medicine
General Surgery
Orthopedics

Date 2018 Sep 1

PMID 30167754

Citations 25

Authors

Thomas Neri

David Anthony Parker

Aaron Beach

Clara Gensac

Bertrand Boyer

Frederic Farizon

Remi Philippot

Affiliations

Soon will be listed here.

Abstract

Purpose: The hypotheses were that medial patellofemoral ligament reconstruction (MPFLr) would improve the long-term symptoms of patellofemoral Instability (PFI) and control patellar tilt, based on computed tomography (CT), and that the addition of a TT transfer, when it is necessary, would not deteriorate the outcome. The purpose of this study was to evaluate the long-term clinical and radiographic outcomes of a large series of MPFLr, either isolated or associated with a TT transfer.

Methods: From 133 MPFLr with a minimum of 4 years postoperatively, three groups were defined: isolated MPFLr, MPFLr with tibial tubercle (TT) medialisation or MPFLr with TT medialisation and distalisation. IKDC and Kujala scores were evaluated. Patellar tilt was evaluated on the patient's preoperative and the last available radiograph, and on CT scan measurements performed preoperatively and at 6-month postoperatively.

Results: The mean follow-up was 6.3 ± 1.7 years [4.1-10.3] and four patients reported recurrent patellar dislocation. Between pre and postoperative at last follow-up a significant improvement in IKDC and Kujala functional scores was observed (P < 0.01), with no difference between the three groups. Regarding patellar tilt, there were significant decreases in Laurin and Merchant angles and an improvement of the Maldague stage (P < 0.01). The CT analysis of patellar tilt also demonstrates a significant improvement of the patella tilt (P < 0.01). The control of the patella tilt was correlated with a good functional result (P < 0.01).

Conclusion: The MPFLr, whether isolated or associated with a TT transfer, provides good long-term clinical and radiological outcomes with a low rate of recurrence. The addition of a TT transfer, when necessary, results in the same good outcomes. This article provides a guide for surgeons evaluating PFI to choose the most appropriate procedure.

Level Of Evidence: IV.

Citing Articles

Combining tibial tubercle osteotomy with medial patellofemoral ligament reconstruction often yields better outcomes in treating patellofemoral instability: a systematic review and meta-analysis of case-control studies.

Meng X, Ji Z, Wu P, Fang H, Zhao P, Ding Y J Orthop Surg Res. 2024; 19(1):695.

PMID: 39465420 PMC: 11514948. DOI: 10.1186/s13018-024-05113-z.

Results of medial patellofemoral ligament reconstruction with and without tibial tubercle osteotomy in patellar instability: a systematic review and single-arm meta-analysis.

Su P, Yao D, Zhang L, Li G BMC Musculoskelet Disord. 2024; 25(1):642.

PMID: 39143601 PMC: 11323645. DOI: 10.1186/s12891-024-07722-5.

Does Tibial Tuberosity Osteotomy Improve Outcomes When Combined With Medial Patellofemoral Ligament Reconstruction in the Presence of Increased Tibial Tuberosity-Trochlear Groove Distance? A Systematic Review and Meta-analysis.

Guevel B, Njai A, Raboff A, Hillman A, Barton M, Kocher M Orthop J Sports Med. 2023; 11(12):23259671231195905.

PMID: 38107841 PMC: 10722933. DOI: 10.1177/23259671231195905.

Is combined MPFL reconstruction and tubercule tibial osteotomy superior to isolated reconstruction? A systematic review and meta-analysis.

Almeida J, Senra A, Leite M, Oliveira P, Sousa A, Torres J J Clin Orthop Trauma. 2023; 45:102277.

PMID: 38044955 PMC: 10689258. DOI: 10.1016/j.jcot.2023.102277.

Results of Medial Patellofemoral Ligament Reconstruction with and without Tibial Tubercle Transfer in Patellar Instability: A Systematic Review and Meta-Analysis.

Xu T, Zhu Y, Zhang L, Xie H, Fu W Orthop Surg. 2023; 15(11):2766-2776.

PMID: 37688429 PMC: 10622283. DOI: 10.1111/os.13870.

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