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Su P, Yao D, Zhang L, Li G. Results of medial patellofemoral ligament reconstruction with and without tibial tubercle osteotomy in patellar instability: a systematic review and single-arm meta-analysis. BMC Musculoskelet Disord 2024; 25:642. [PMID: 39143601 PMCID: PMC11323645 DOI: 10.1186/s12891-024-07722-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 07/21/2024] [Indexed: 08/16/2024] Open
Abstract
PURPOSE To confirm which method provides lower rate of recurrent instability and superior clinical outcomes. METHOD We searched PubMed, Embase and Web of Science for the trials involving one intervention or both for patellar instability: medial patellofemoral ligament reconstruction (MPFLR) with and without tibial tubercle osteotomy (TTO). The postoperative Kujala score, Lysholm score, Tegner scores and the rate of recurrent instability (dislocation or subluxation) were analyzed as the primary clinical outcome parameters in a random or fixed effects meta-analysis. RESULTS In total, 43 articles met inclusion criteria after full-text review. A total of 2046 patients were analyzed. The overall mean age was 20.3 years (range, 9.5-60.0 years), with a mean follow-up time of 3.2 years (range, 1-8 years). The mean Kujala scores in MPFLR and MPFLR + TTO were 89.04 and 84.44, respectively. There was significant difference in Kujala scores between MPFLR and MPFLR + TTO (MD = 4.60, 95%CI: 1.07-8.13; P = 0.01). The mean Lysholm scores in MPFLR and MPFLR + TTO were 90.59 and 88.14, respectively. There was no significant difference in Lysholm scores between MPFLR and MPFLR + TTO (MD = 2.45, 95%CI: -3.20-8.10; P = 0.40). The mean Tegner scores in MPFLR and MPFLR + TTO were 5.30 and 4.88, respectively. There was no significant difference in Tegner scores between MPFLR and MPFLR + TTO (MD = 0.42, 95%CI: -0.39-1.23; P = 0.31). At final follow-up, the rates of recurrent instability in MPFLR and MPFLR + TTO were 3% and 4%, respectively. There was no significant difference in the rates between MPFLR and MPFLR + TTO (OR = 0.99, 95%CI: 0.96-1.02; P = 0.4848). CONCLUSION MPFLR and MPFLR + TTO are effective and reliable treatments in the setting of patellofemoral instability. MPFLR seems to show a better performance in functional outcomes than MPFLR + TTO. Moreover, their rates of recurrent instability are very low, and no significant difference exists.
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Affiliation(s)
- Peng Su
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
- Department of Hand and Foot Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Dongying Yao
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lu Zhang
- School of Finance, Department of Economics and Management, Qilu University of Technology (Shandong Academy of Sciences), Jinan, Shandong, China
| | - Gang Li
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China.
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Guevel B, Njai A, Raboff A, Hillman A, Barton M, Kocher MS. 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. Orthop J Sports Med 2023; 11:23259671231195905. [PMID: 38107841 PMCID: PMC10722933 DOI: 10.1177/23259671231195905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 05/19/2023] [Indexed: 12/19/2023] Open
Abstract
Background There has been recent debate regarding the optimal surgical management strategy for recurrent patellofemoral instability in the presence of an increased tibial tuberosity-trochlear groove (TT-TG) distance. In particular, performing a combined tibial tuberosity osteotomy (TTO) and medial patellofemoral ligament reconstruction (MPFLR) for patients with a TT-TG >20 mm has been questioned, with the hypothesis that an isolated MPFLR (iMPFLR) would be just as effective. Purpose To pool and compare outcomes after MPFLR+TTO versus iMPFLR in patients with a TT-TG >20 mm. Study Design Systematic review; Level of evidence, 4. Methods PubMed-MEDLINE, Embase, Web of Science, and Cochrane Central were searched, and a systematic review was performed. Included were studies that reported postoperative redislocation rates and/or functional outcome scores for patients with recurrent patellar instability and a TT-TG >20 mm who underwent either MPFLR+TTO or iMPFLR and had minimum 2-year follow-up data. Methodologic quality was assessed using the modified Coleman Methodology Score (mCMS). A proportional meta-analysis comparing redislocation, subjective instability, and total complication rates was performed, and mean postoperative functional outcome scores were pooled using a random-effects model with a restricted maximum likelihood estimator. Results In total, 1548 studies were screened, from which 13 were included for analysis. Of the 386 included patients (406 knees), 276 underwent MPFLR+TTO and 110 underwent iMPFLR. The mean mCMS was 61.3 ± 10.5 (range, 48-77). The pooled postoperative redislocation rate was 1.22% (95% CI, 0.22%-7%), with no significant difference between the study groups (P = .9995). The pooled complication rate was 10.17% (95% CI, 6.2%-16.3%) with no difference between groups (P = .9275), although the MPFLR+TTO group had higher heterogeneity in complication rates (I2 = 79.4%) compared with iMPFLR (I2 = 0%). There was no group difference in the pooled postoperative Lysholm scores (P = .5177), but patients who underwent iMPFLR had significantly higher postoperative Kujala scores compared with those who underwent MPFLR+TTO (P = .0283). Conclusion Even in the presence of previously indicative anatomic factors (TT-TG >20 mm), TTO combined with MPFLR does not seem to confer additional benefit compared with iMPFLR. This finding could be advantageous in minimizing the burden of additional surgery with its associated risks. The study findings should, however, be interpreted with caution given the heterogeneity of the studies.
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Affiliation(s)
- Borna Guevel
- Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Abdoulie Njai
- Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Aly Raboff
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Andrew Hillman
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Michael Barton
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Mininder S. Kocher
- Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Xu T, Zhu Y, Zhang L, Xie H, Fu W. Results of Medial Patellofemoral Ligament Reconstruction with and without Tibial Tubercle Transfer in Patellar Instability: A Systematic Review and Meta-Analysis. Orthop Surg 2023; 15:2766-2776. [PMID: 37688429 PMCID: PMC10622283 DOI: 10.1111/os.13870] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 07/24/2023] [Accepted: 07/29/2023] [Indexed: 09/10/2023] Open
Abstract
The optimal surgical intervention for lateral patellar instability remains a topic of controversy despite satisfactory clinical outcomes and low re-dislocation rates reported in numerous studies following medial patellofemoral ligament reconstruction (MPFLR) with and without tibial tubercle transfer (TTT). The purpose of this systematic review and meta-analysis is to investigate the hypothesis that combining MPFLR with TTT provides reduced complication rates and improved clinical outcomes to isolated MPFLR in patients with lateral patellar instability. We conducted a comprehensive systematic review and meta-analysis of comparative trials involving MPFLR with and without TTT, sourcing data from PubMed, the Cochrane Library, Embase, and Web of Science. The primary clinical outcomes analyzed included the Kujala score, the Lysholm score, complication rates, and the Caton-Deschamps index (CDI). Random or fixed effects were used for the meta-analysis. Postoperatively, there were no significant differences observed in the Kujala and Lysholm scores between MPFLR and MPFLR + TTT (p = 0.053). At the final follow-up, the CDI had decreased 0.015 (95% CI -0.044, 0.013; p = 0.289) points in the MPFLR group, with no statistical significance. In contrast, the MPFLR + TTT group demonstrated a significant decrease of 0.207 (95% CI -0.240, -0.174; p = 0.000) points in CDI. Notably, the complication rate was higher in the MPFLR + TTT group compared to the MPFLR-only group (RR = 2.472; 95% CI 1.638, 3.731; p = 0.000). Both MPFLR and MPFLR + TTT procedures yield significant improvements in the Kujala and Lysholm scores. However, the MPFLR + TTT approach results in an apparent improvement in CDI and corrects patellar maltracking, particularly in cases involving high tibial tuberosity-trochlear groove (TT-TG) (>20 mm) or patella alta (CDI > 1.2), while MPFLR alone cannot. It is essential to consider the higher complication rate of MPFLR + TTT, which suggests that MPFLR alone may be sufficient for patients without high TT-TG or patella alta.
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Affiliation(s)
- Tianhao Xu
- Sports Medicine Center, Department of Orthopaedic Surgery/Orthopaedic Research InstituteWest China Hospital, Sichuan UniversitySichuanChina
| | - Yanlin Zhu
- Sports Medicine Center, Department of Orthopaedic Surgery/Orthopaedic Research InstituteWest China Hospital, Sichuan UniversitySichuanChina
| | - Lei Zhang
- Sports Medicine Center, Department of Orthopaedic Surgery/Orthopaedic Research InstituteWest China Hospital, Sichuan UniversitySichuanChina
| | - Hui‐Qi Xie
- Laboratory of Stem Cell and Tissue Engineering, Orthopaedic Research Institute, Med‐X Center for Materials, State Key Laboratory of BiotherapyWest China Hospital, Sichuan UniversitySichuanChina
| | - Weili Fu
- Sports Medicine Center, Department of Orthopaedic Surgery/Orthopaedic Research InstituteWest China Hospital, Sichuan UniversitySichuanChina
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Castagno C, Kneedler S, Fares A, Maier M, Gontre G, Weiss WM. Isolated medial patellofemoral reconstruction outcomes: A systematic review and meta-analysis. Knee 2023; 44:59-71. [PMID: 37531844 DOI: 10.1016/j.knee.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 06/03/2023] [Accepted: 07/16/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Treatment of patellar instability remains up for debate, and a combination of tibial tubercle osteotomy and medial patellofemoral ligament reconstruction (MPFLr) of the medial patellofemoral ligament (MPFL) has become the mainstay treatment for recurrent lateral patellar dislocation. Due to limited small studies, there remains a variety of surgical techniques still being practiced. The use of MPFL reconstruction, in isolation, has demonstrated promise. PURPOSE The purpose of this systematic review and meta-analysis is to investigate if isolated medial patellofemoral ligament reconstruction (iMPFLr) can safely and efficaciously restore knee stability and to present the patient demographics, surgical techniques, graft choices, clinical outcomes, and complications after iMPFLr for recurrent patellar dislocation (RPD). METHODS A review of the current literature according to Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, yielded 299 abstracts. Twenty-seven articles met the inclusion/exclusion criteria accounting for 1200 patients. Data was pooled and analyzed focusing on patient demographics, graft type used, Kujala, International Knee Documentation Committee (IKDC), Lysholm, Tegner, and complications. RESULTS Across all studies the weighted mean age was found to be an average of 24.5 years, BMI was 24.9 kg/m2, follow-up was 47.3 months, as 67% were female, TT-TG distance was 15.3 mm, and Caton Deschamps index 1.11. The pooled effect size difference of pre versus post assessment of Kujala was -2.8, IKDC was -4.5, Lysholm was -6.4, and Tegner was -0.74. The pooled complication rate was found to be 8% across all included studies. A subgroup analysis was also performed, specifically looking at how single bundle, double bundle, gracilis, semitendinosus and knee angle during fixation effect outcome data. CONCLUSION This systematic review and meta-analysis demonstrates that isolated MPFL reconstruction is a safe and effective treatment for recurrent patellar dislocations. Given the efficacy of isolated MPFL reconstruction, future investigations should aim to uncover the exact TT-TG distance, trochlear dysplasia, and patella alta grade for selecting patients to undergo this procedure. Furthermore, more primary research needs to be conducted on this topic due to the overall lack of published data from randomized controlled studies and no broad standardization of outcome measurements. LEVEL OF EVIDENCE (4) Systematic Review and Meta-Analysis.
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Affiliation(s)
- Christopher Castagno
- Texas Tech University Health Science Center, Paul Foster School of Medicine, El Paso, TX, USA.
| | - Sterling Kneedler
- Department of Orthopedic Surgery & Rehabilitation, The University of Texas Medical Branch, Galveston, TX, USA
| | - Austin Fares
- Orthopedic Surgery and Sports Medicine, William Beaumont Army Medical Center, Fort Bliss, TX, USA
| | - Michael Maier
- Orthopedics and Sports Medicine, Baylor College of Medicine and St. Luke's Medical, Sugar Land, TX, USA
| | - Gil Gontre
- Texas Tech University Health Science Center, Paul Foster School of Medicine, El Paso, TX, USA; Texas Tech University Health Science Center, Department of Orthopedics & Rehabilitation, El Paso, TX, USA
| | - William M Weiss
- Orthopedic Sports Medicine, Arthroscopy, & Extremity Reconstruction; Department of Orthopedic Surgery & Rehabilitation, The University of Texas Medical Branch, Galveston, TX, USA
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Almeida J, Senra AR, Leite MJ, Oliveira P, Sousa A, Torres J. Is combined MPFL reconstruction and tubercule tibial osteotomy superior to isolated reconstruction? A systematic review and meta-analysis. J Clin Orthop Trauma 2023; 45:102277. [PMID: 38044955 PMCID: PMC10689258 DOI: 10.1016/j.jcot.2023.102277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/18/2023] [Accepted: 11/03/2023] [Indexed: 12/05/2023] Open
Abstract
Purpose There is no consensus for management of patellar instability, even in the case of malalignment. The purpose of the review is to evaluate outcomes in the literature of MPFL reconstruction with and without tibial tubercle osteotomy. Methods Two databases PubMed and Scopus were searched for studies comparing MPFL reconstruction with and without concomitant tibial tuberosity osteotomy. PRISMA guidelines were followed. Data on functional outcomes via Kujala score, redislocation rates and return to sport rates were reported. Results 9 studies included data from 806 knees: 463 submitted to isolated MPFL reconstruction, and 343 submitted to the combined surgery. Patients submitted to the combined procedure had all TT-TG values superior to 18, while the ones with isolated reconstruction had more heterogeneous values, varying between 13 and 20 mm. 77.78% of the studies reported on postoperative Kujala scores, with a mean value of 83.53 in patients who underwent MPFL reconstruction alone and 83.72 in those who underwent the combined procedure. The mean difference between the two groups was -0.83, with the improvement of the score statistically significant in 22.22% of the studies, regardless of the surgery. Concerning redislocation rate, odds ratio comparing both procedures was 0.84 (p = 0.67). Conclusion The principal finding is that the MPFL reconstruction with or without TTO resulted in similar functional outcomes, assessed by the Kujala score, and low complications concerning recurrent patellar dislocation. More robust literature is needed in the setting of a high TT-TG distance. Level of evidence IV.
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Affiliation(s)
- Joana Almeida
- Department of Orthopedics and Traumatology, São João University Hospital, Porto, Portugal
| | - Ana Rita Senra
- Department of Orthopedics and Traumatology, São João University Hospital, Porto, Portugal
| | - Maria João Leite
- Department of Orthopedics and Traumatology, São João University Hospital, Porto, Portugal
- Porto Medical School, Porto University, Portugal
- Hospital CUF Porto, Portugal
| | - Paulo Oliveira
- Department of Orthopedics and Traumatology, São João University Hospital, Porto, Portugal
- Porto Medical School, Porto University, Portugal
- Hospital CUF Porto, Portugal
- Head of the Portuguese Society for the Study of Knee Pathology, Portugal
| | - António Sousa
- Department of Orthopedics and Traumatology, São João University Hospital, Porto, Portugal
- Porto Medical School, Porto University, Portugal
- Hospital CUF Porto, Portugal
| | - João Torres
- Department of Orthopedics and Traumatology, São João University Hospital, Porto, Portugal
- Porto Medical School, Porto University, Portugal
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Hao K, Niu Y, Feng A, Wang F. Outcomes After Derotational Distal Femoral Osteotomy for Recurrent Patellar Dislocations With Increased Femoral Anteversion: A Systematic Review and Meta-analysis. Orthop J Sports Med 2023; 11:23259671231181601. [PMID: 37465210 PMCID: PMC10350774 DOI: 10.1177/23259671231181601] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 03/31/2023] [Indexed: 07/20/2023] Open
Abstract
Background An increased femoral anteversion angle (FAA) is a predisposing factor for recurrent patellar dislocations (RPDs), and combined procedures including derotational distal femoral osteotomy (DDFO) have been shown to be good options. Purpose To investigate the safety and effectiveness of combined DDFO on clinical and radiological outcomes to treat RPDs with an increased FAA. Study Design Systematic review; Level of evidence, 4. Methods This review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. We searched 7 databases for articles from inception to March 10, 2023, that reported outcomes after combined DDFO in patients with an RPD and increased FAA. Two reviewers independently extracted data and assessed study quality. Outcomes evaluated were functional scores, redislocation rates, complications, satisfaction, and radiological parameters. A meta-analysis was performed to pool functional scores, with data reported as mean differences (MDs) and 95% confidence intervals (CIs). Results Included were 8 studies of 189 knees from 183 patients, with a mean patient age of 22.4 years and a mean follow-up of 33.4 months. The mean preoperative FAA ranged from 31° to 42.70°, and the mean postoperative FAA ranged from 10° to 19.08°. Significant improvements were found in the Kujala score (MD, 26.96 [95% CI, 23.54 to 30.37]), Lysholm score (MD, 26.17 [95% CI, 22.13 to 30.22]), visual analog scale score for pain (MD, -2.61 [95% CI, -3.12 to -2.10]), and Tegner activity score (MD, 1.33 [95% CI, 0.86 to 1.79]). No subluxation or redislocation occurred. The overall complication rate was 10.6%, and most of the complications were pain (60%) and limited knee activity (20%). The overall satisfaction rate was 83.3%. The patellar tilt angle significantly decreased from 40.7° ± 11.9° to 20.5° ± 8.7° and from 26.35° ± 6.86° to 11.65° ± 2.85° in 2 studies. Conclusion Combined DDFO was found to be safe and effective for the treatment of RPDs and an increased FAA by addressing both patellar dislocations and torsional malalignment. However, because of the lack of comparisons, it remains to be investigated when DDFO should be combined in such patients.
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Affiliation(s)
- Kuo Hao
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yingzhen Niu
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ao Feng
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Fei Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
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The remaining parameters of patellar instability could be affected for osteoarthritic change after medial patellofemoral ligament reconstruction with or without anteromedialization of the tibial tubercle osteotomy for patellar instability: a retrospective cohort study. BMC Musculoskelet Disord 2023; 24:56. [PMID: 36683021 PMCID: PMC9869604 DOI: 10.1186/s12891-022-06100-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 12/19/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND In literature, studies evaluating the factors associated the postoperative progression of patellofemoral (PF) osteoarthritis (OA) following patellar stabilization surgery are limited. This study aimed to compare the clinical outcomes after medial patellofemoral ligament reconstruction (MPFLR) as an isolated procedure (iMPFLR) and in combination with anteromedialization (AMZ) of the tibial tubercle osteotomy (TTO) and investigate the factors related to the postoperative progression of PFOA after patellar stabilization surgery. METHODS Between 2009 and 2020, 30 knees of 23 consecutive patients underwent MPFLR with or without AMZ, using an autologous semitendinosus tendon graft; they were followed up for more than 2 years in the retrospective nature of the study. iMPFLR was performed in cases of recurrent patellar dislocation with normal tibial tubercle-trochlear groove (TT-TG) distance and no PFOA, and MPFLR+AMZ was performed for cases of excessive TT-TG distance, preoperative PFOA of recurrent patellar dislocation, or habitual patellar dislocation. Clinical findings and radiographs of the PF joint were evaluated pre- and postoperatively with PF alignment parameters and PFOA and were compared between surgical procedures. Factors for the postoperative progression of PFOA were compared between the OA progression and non-progression groups. RESULTS Postoperative clinical score, radiographic parameters except for sulcus angle, TT-TG distance, and progression of PFOA were not significantly different between the iMPFLR and MPFLR+AMZ groups. Postoperative lateral patellar displacement (p = 0.001) and congruence angle (p = 0.017) were significantly different between the OA progression and non-progression groups. CONCLUSION Similar to MPFLR for recurrent cases, MPFLR with AMZ can improve the clinical and radiographic outcomes in severe cases. The remaining parameters of patellar instability could be affected in the postoperative progression of PFOA after MPFL reconstruction with or without AMZ of TTO for patellar instability.
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Ewald F, Klasan A, Putnis S, Farizon F, Philippot R, Neri T. After MPFL reconstruction, femoral tunnel widening and migration increase with poor tunnel positioning and are related to poor clinical outcomes. Knee Surg Sports Traumatol Arthrosc 2022; 31:2315-2322. [PMID: 36564507 DOI: 10.1007/s00167-022-07277-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 12/07/2022] [Indexed: 12/25/2022]
Abstract
PURPOSE Isolated MPFL reconstruction (iMPFLR) is increasingly used for the surgical treatment of treatment for recurrent patella dislocation. The purpose of this study was to evaluate the influence of tunnel widening and migration on clinical outcomes after iMPFL using a CT-scannographic analysis at 6 months postoperatively. METHODS One hundred and sixty patients (91 females for 69 males) with an average age of 23 years [14-54] who underwent iMPFLR and had an evaluation scan at 6 months postoperatively were evaluated with a mean follow-up of 97 ± 89 months [12 to 166]. Functional International Knee Documentation Committee (IKDC) Score, Kujala score, and joint mobility were assessed preoperatively, at 6 months and at the latest follow-up. The IKDC and Kujala scores were expressed as the difference between pre- and postoperative scores (dIKDC and dKujala). The position of the femoral tunnel was assessed according to the Schöttle criteria on post-operative radiographic profiles. Tunnel widening (at three levels of measurement) and the migration of the center of the tunnel were studied on a CT-scan analysis at 6 months. Any correlation and regression between the evolution of the clinical scores and the measured scannographic parameters were investigated. The relationships between tunnel position and tunnel changes were also studied. RESULTS Between pre- and post-op, the IKDC (45 ± 13 to 80 ± 15, p < 0.001) and Kujala (55 ± 11 to 87 ± 12, p < 0.001) scores were significantly improved. Patients with tunnel changes had decreased clinical and functional results at 6 months post-op of an iMPFLR (p < 0.001). These changes in the femoral tunnel, evidenced by a tunnel entrance widening and migration of the tunnel center, were related to an initial malposition of the tunnel (p < 0.001). CONCLUSION In iMPFLR, changes in the femoral tunnel, corresponding to dilatation and migration of the tunnel center, may occur. These changes are increased by the initial malpositioning of the femoral tunnel and are correlated with less good clinical and functional outcomes. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Fabien Ewald
- Department of Orthopaedic Surgery, University Hospital of Saint Étienne, CEDEX 2 42055, Saint Étienne, France.
| | | | - Sven Putnis
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Frédéric Farizon
- Department of Orthopaedic Surgery, University Hospital of Saint Étienne, CEDEX 2 42055, Saint Étienne, France
- EA 7424-Interuniversity Laboratory of Human Movement Science, University Lyon-University Jean Monnet, Saint Étienne, France
| | - Rémi Philippot
- Department of Orthopaedic Surgery, University Hospital of Saint Étienne, CEDEX 2 42055, Saint Étienne, France
- EA 7424-Interuniversity Laboratory of Human Movement Science, University Lyon-University Jean Monnet, Saint Étienne, France
| | - Thomas Neri
- Department of Orthopaedic Surgery, University Hospital of Saint Étienne, CEDEX 2 42055, Saint Étienne, France
- EA 7424-Interuniversity Laboratory of Human Movement Science, University Lyon-University Jean Monnet, Saint Étienne, France
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Change of the cross-sectional area of vastus medialis oblique in patients with recurrent patellar dislocation treated by tibial tubercle transfer combined with medial patellofemoral ligament reconstruction on axial CT. J Orthop Surg Res 2022; 17:469. [PMID: 36307822 PMCID: PMC9617303 DOI: 10.1186/s13018-022-03367-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 10/18/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To investigate the change of the cross-sectional area (CSA) of vastus medialis oblique (VMO) in patients with recurrent patellar dislocation (RPD) treated by tibial tubercle transfer combined with medial patellofemoral ligament (MPFL) reconstruction by imaging methods, and to guide clinical treatment and rehabilitation. METHODS From October 2015 to March 2022, 23 patients with RPD who underwent tibial tubercle transfer combined with MPFL reconstruction were retrospectively enrolled. All patients were assessed by CT in the supine position with the knee fully extended and the quadriceps relaxed. The CSA of VMO and the ratio of CSA of VMO to body weight (CSA/BW) were measured at the upper pole of the patella, 5 mm above the upper pole of the patella and 5 mm below the upper pole of patella. The differences of measured parameters were compared before surgery and at follow-up, including CSA of VMO and CSA/BW. Test level α = 0.05. RESULTS The tibial tubercle-trochlear groove (TT-TG) distance was significantly reduced at follow-up compared with that before surgery (27.91 ± 1.95 mm vs 12.33 ± 1.07 mm, P < 0.001). The CSA of VMO was significantly increased at follow-up compared with that before surgery at 5 mm below the upper pole of the patella (473.06 ± 106.32 mm2 vs 562.97 ± 157.90 mm2, P < 0.001), at the upper pole of the patella (641.23 ± 188.45 mm2 vs 700.23 ± 177.55 mm2, P = 0.029), and at 5 mm above the upper pole of the patella (788.25 ± 238.62 mm2 vs 849.79 ± 180.84 mm2, P = 0.018). The CSA/BW was significantly increased at follow-up compared with that before surgery at 5 mm below the upper pole of the patella (7.83 ± 2.52 mm2/kg vs 9.22 ± 3.54 mm2/kg, P < 0.001), at the upper pole of the patella (10.48 ± 3.62 mm2/kg vs 11.42 ± 4.14 mm2/kg, P = 0.020), and at 5 mm above the upper pole of the patella (12.86 ± 4.65 mm2/kg vs 13.68 ± 3.86 mm2/kg, P = 0.017). CONCLUSION After tibial tubercle transfer combined with MPFL reconstruction, CSA of VMO increased in patients with RPD, which will help to enhance patellar stability and reduce recurrence.
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Hao K, Feng A, Kong L, Wang F. Quality of life following medial patellofemoral ligament reconstruction combined with medial tibial tubercle transfer in patients with recurrent patellar dislocation: a retrospective comparative study. J Orthop Surg Res 2022; 17:416. [PMID: 36104806 PMCID: PMC9476691 DOI: 10.1186/s13018-022-03310-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/03/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Because the patients undergoing medial patellofemoral ligament reconstruction (MPFLr) combined with medial tibial tubercle transfer (TTT) procedure are usually young and active, the quality of life (QoL) is also an important prognostic factor for patients with recurrent patellar dislocation. Assessing QoL can provide more useful and accurate evidence for the effects of this procedure. This study aimed to evaluate QoL following MPFLr combined with TTT, compared with isolated MPFLr (iMPFLr).
Methods
Fifty-one patients who underwent iMPFLr + TTT and 48 patients who underwent iMPFLr were included. Clinical evaluation included QoL (EQ-5D-5L and EQ-5D VAS), functional outcomes (Kujala, Lysholm and Tegner activity scores), physical examinations (patellar apprehension test and range of motion) and redislocation rates. Radiological evaluation included patellar tilt angle and bisect offset. These preoperative and postoperative results were compared between groups at baseline and the final follow-up. The paired and independent t tests were used for the data following a normal distribution. Otherwise, the Wilcoxon and Mann–Whitney U tests were used to analyze the differences. Categorical variables were compared by chi-square or Fisher’s exact test.
Results
All of the QoL (EQ-5D-5L and EQ-5D VAS), clinical results and radiological outcomes significantly improved in both groups at the final follow-up, with no significant differences between groups. There was no significant difference in five dimensions of EQ-5D at the final follow-up, although percentages of people with problems of mobility and pain/discomfort were higher in the MPFLr + TTT group. Female patients had lower EQ-5D index and EQ-5D VAS compared with male patients in both groups at the final follow-up, but there was only a significant difference in the EQ-5D VAS.
Conclusions
Both MPFLr + TTT and iMPFLr groups obtained similar and satisfactory improvements in the QoL, clinical results and radiological outcomes, indicating that MPFLr combined with TTT is a safe and effective procedure, which can significantly improve the QoL for patients with recurrent patellar dislocation in cases of pathologically lateralized TT. However, female patients obtained lower QoL than males.
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Zhou K, Bai P, Sun Z, Jia Y, Wang F, Wang X, Niu Y. Distalization of tibial tubercle osteotomy is not necessary for patients with recurrent patellar dislocation accompanied by patella alta and increased TT-TG distance. BMC Musculoskelet Disord 2022; 23:838. [PMID: 36057569 PMCID: PMC9440549 DOI: 10.1186/s12891-022-05779-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 08/24/2022] [Indexed: 11/10/2022] Open
Abstract
Background The aim of this study is to determine whether distalization of the tibial tubercle is necessary for patients with recurrent patellar dislocation accompanied by patella alta and increased TT-TG. Methods In this retrospective study, all 70 patients (70 knees) with recurrent patellar dislocation accompanied by TT–TG distance ≥20 mm and patella alta (CD-I ≥ 1.4) were surgically treated using MPFLR combined with medialization of the tibial tubercle or medialization and distalization of the tibial tubercle in the Third Hospital of Hebei Medical University between 2017 and 2019. 33 patients(33 knees) received MPFLR combined with medialization of the tibial tubercle (MPFLR + TTm group), 37 patients(37 knees) received MPFLR combined with medialization and distalization of the tibial tubercle (MPFLR + TTm-d group). Evaluation indicators included knee injury and osteoarthritis prognostic score (KOOS) and Kujala score evaluation, congruence angle (CA), patellar tilt angle (PTA), TT-TG distance, Blackburne-Peel index (BP-I), Caton-Deschamps index (CD-I). Results A total of 70 knees (70 patients) with a mean follow-up time of 32 ± 6 months were evaluated in the present study. The postoperative, the PTA, CA, CD-I, BP-I, and TT-TG distance significantly improved in the two groups (P < 0.05), and there was no statistical difference between the two groups (>0.05). The KOOS and Kujala scores of the two groups at the last follow-up were significantly higher than the preoperative scores (P < 0.05), and there was no statistical difference between the two groups (P>0.05). No complications were noted in either group. Conclusion For patients with recurrent patellar dislocation accompanied by increased TT-TG distance and patella alta, distalization is not needed and medialization is sufficient even in the presence of patella alta.
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Affiliation(s)
- Kezhen Zhou
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Pengchen Bai
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Zhiwen Sun
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Yanfeng Jia
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Fei Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Xiaofeng Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China.
| | - Yingzhen Niu
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China.
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Outcomes and reoperation rates after tibial tubercle transfer and medial patellofemoral ligament reconstruction: higher revision stabilization in patients with trochlear dysplasia and patella alta. Knee Surg Sports Traumatol Arthrosc 2022; 30:2227-2234. [PMID: 34743233 DOI: 10.1007/s00167-021-06784-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 10/25/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To determine the reoperation rate, risk factors for reoperation, and patient-reported outcomes after isolated or combined tibial tubercle transfer and medial patellofemoral ligament reconstruction, for patellofemoral instability surgery. METHODS Patient's records who underwent medial patellofemoral ligament reconstruction and/or tibial tubercle transfer for patellar instability by 35 surgeons from 2002 to 2018 at a single academic institution were retrospectively reviewed using CPT codes. Four-hundred-and-eighty-six patients were identified. 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. RESULTS The overall rate of reoperation was 120/486 (24.7%). The most common cause for reoperation was removal of hardware 42/486 (8.6%). The rate of reoperation for isolated medial patellofemoral ligament reconstruction 43/226 (19%) was lower than that of isolated tibial tubercle transfer 45/133 (33.8%) or a combined procedure 32/127 (25.2%) (P = 0.007). Woman had a higher rate of reoperation (29.4%) compared to men (15.9%) (P = 0.002). Patients at risk for a revision stabilization procedure included those with severe trochlear morphology (C or D) (6.1%) and those with Caton-Deschamps index > 1.3 (7.3%). Patients who underwent reoperation of any kind had poorer patient-reported outcomes. CONCLUSION The overall reoperation rate after patellofemoral instability surgery remains high, and any reoperation portends worse patient-reported outcomes. Re-operations for instability are more likely in patients with trochlear dysplasia and patella alta and may benefit from more aggressive initial treatment, such as medial patellofemoral ligament reconstruction and tibial tubercle transfer in combination. Using the results of this study, surgeons will be able to engage in meaningful discussion with patients to counsel patients on expectations postoperatively. LEVEL OF EVIDENCE IV.
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Derotational distal femoral osteotomy yields satisfactory clinical outcomes in pathological femoral rotation with failed medial patellofemoral ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2022; 30:1809-1817. [PMID: 34596695 DOI: 10.1007/s00167-021-06739-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 09/02/2021] [Indexed: 01/27/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the clinical outcomes of de-rotational distal femoral osteotomy (DDFO) in patients who underwent primary medial patellofemoral ligament reconstruction (MPFLR) failure with increased femoral anteversion along with high-grade J sign. METHODS Between 2011 and 2019, 14 patients underwent DDFO revision surgery due to failed MPFLR. The pre- and postoperative J sign grade, Caton-Deschamps index (CDI), tibial tuberosity-trochlear groove (TT-TG) distance, femoral anteversion angle (FAA), patellar lateral tilt angle (PLTA), MPFL graft laxity, and patient-reported outcomes (Kujala, Lysholm, Tegner, and International Knee Documentation Committee (IKDC) subjective scores) were collected. The anterior-posterior and proximal-distal distances between the actual point and the Schöttle point were also calculated. RESULTS Fourteen patients underwent MPFLR revision by DDFO combined with MPFLR. The mean PLTA improved from 40.7° ± 11.9° to 20.5° ± 8.7° (P < 0.001). The mean FAA significantly decreased from 42.7° ± 12.0° to 14.1° ± 5.2° (P < 0.001). The mean patellar laxity index (PLI) decreased from 82.4% preoperatively to 15.1% postoperatively (P < 0.001). None of these patients experienced subluxation or re-dislocation during follow-up of 29.7 ± 5.0 months after revision surgery. Meanwhile, the Tegner score at the last follow-up ranged from 3 to 6, with a median of 5. The Kujala, Lysholm, and IKDC subjective scores showed significant improvements, from a mean of 51.0 ± 6.8 preoperatively to 75.4 ± 5.1 postoperatively (P < 0.001), 49.2 ± 7.9 to 75.2 ± 7.2 (P < 0.001), and 42.9 ± 6.2 to 76.8 ± 6.0 (P < 0.001), respectively. The proportion of patients with a high-grade J sign was significantly lower postoperatively than preoperatively (100% vs. 14%). Four out of 14 patients (29%) showed femoral tunnel mal-positioning. CONCLUSION MPFLR revision by DDFO combined with MPFLR achieved favorable clinical outcomes in patients with increased femoral anteversion along with high-grade J sign. LEVEL OF EVIDENCE IV.
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Schmiesing A, Engelking M, Agel J, Arendt EA. Distalization of the Tibial Tubercle for Patellar Stabilization Combined With Medial Patellofemoral Ligament Reconstruction: Length of Distalization or Residual Patella Alta and its Affect on Outcome. Am J Sports Med 2022; 50:1627-1634. [PMID: 35438591 DOI: 10.1177/03635465221089979] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Previous research supports that distal translation of the tibial tubercle osteotomy (dTTO) for patients with recurrent lateral patellar dislocation (R-LPD) and patella alta is effective for surgical patellar stabilization. HYPOTHESIS/PURPOSE The main purpose of this article is to evaluate (1) the results of modifying the surgical threshold and postoperative goal of patellar height measurements for surgical stabilization originated in the "menu à la carte" approach to patellar surgical stabilization and (2) the relationship between the distance distalized in millimeters and postoperative complications. Our hypothesis was that dTTO with medial patellofemoral ligament reconstruction (MPFL-R) will successfully stabilize the patella with improvement in outcome scores and few complications, using a modification of the original menu à la carte as our surgical algorithm. STUDY DESIGN Case series; Level of evidence, 4. METHODS A total of 68 consecutive patients with R-LPD underwent dTTO and MPFL-R for surgical patellar stabilization by a single surgeon between May 2009 and September 2015. Surgical indications were R-LPD combined with patella alta. The surgical threshold for dTTO was Caton-Deschamps index (CDI) or Insall-Salvati ratio ≥1.4 and/or a patellar trochlear index <0.15. The postoperative surgical goal for patellar height was a CDI of 1.1 to 1.2. Length of the distalization was computed by using the CDI measurement as the primary intraoperative guide and measured intraoperatively with a ruler. Clinical, radiographic, and patient outcome measures were reviewed. RESULTS The mean CDI preoperatively was 1.40 and postoperatively it was 1.09. The mean distalization was 9.9 mm (range, 4-15 mm). Three patients (4.4%) had frank R-LPD postoperatively. Ten patients had residual patella alta (CDI >1.2), with 1 redislocation. Mean postoperative CDI in the recurrent dislocation group was 1.13 (range, 1.06-1.25) as compared with 1.09 (range, 0.92-1.35) in the nonrecurrent group (P = 0.65). Complications included 3 tibial fractures (4.4%) and postoperative knee arthrofibrosis in 6 patients (8.8%), with mean distalization greater in the arthrofibrosis group (P = .04). Knee injury and Osteoarthritis Outcome Score (KOOS) values improved in all domains, including a 31-point increase in Quality of Life. CONCLUSION dTTO with MPFL-R for patients with patella alta leads to a high rate of normalization of patellar height measurements (87%) and patellar stabilization (95.6%). Residual patella alta is not associated with an increased risk of recurrence. The length of dTTO up to 15 mm is not associated with an increase in postoperative complications, except for an increased prevalence of arthrofibrosis (8.8%).
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Affiliation(s)
- Andrew Schmiesing
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Marta Engelking
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Julie Agel
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Elizabeth A Arendt
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
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Markus DH, Hurley ET, Gipsman A, Campbell KA, Jazrawi LM, Alaia MJ, Strauss EJ. Adding a tibial tubercle osteotomy with anteromedialisation to medial patellofemoral ligament reconstruction does not impact patient-reported outcomes in the treatment of patellar instability. J ISAKOS 2022; 7:3-6. [DOI: 10.1016/j.jisako.2021.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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16
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Imerci A, McDonald TC, Rogers KJ, Thacker MM, Atanda A. Outcomes of medial patellofemoral ligament reconstruction and tibial tubercle osteotomy in syndromic adolescents with patellar dislocation. J Clin Orthop Trauma 2022; 25:101770. [PMID: 35127438 PMCID: PMC8803613 DOI: 10.1016/j.jcot.2022.101770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 12/16/2021] [Accepted: 01/12/2022] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Treatment of congenital and habitual dislocation of the patella in syndromic adolescents can be difficult due to accompanying soft-tissue and/or osseous abnormalities often present in the knee. The aim of this study was to report the results of surgical treatment of congenital and habitual patellar dislocation with medial patellofemoral ligament (MPFL) reconstruction and tibial tubercle osteotomy (TTO) in adolescents with an underlying syndrome. METHODS Syndromic adolescent patients with congenital or habitual patellar dislocation treated with MPFL reconstruction and TTO between 2005 and 2019 with a minimum of one year of follow-up were identified. Demographic, clinical, radiographic, and surgical data were recorded, and any complications were noted. Kujala and Lysholm scores were used to quantitate knee function. RESULTS Seventeen knees in 11 patients met the criteria for inclusion. The mean age at operation was 14.8 years (range, 13.3-18.3 years). Patients were identified as having Ehlers-Danlos (four), Down (two), trichorhinophalangeal (one), McCune-Albright (one), Klippel-Feil (one), and generalized joint hypermobility (two) syndromes. The mean follow-up was 2.2 years for each individual knee (range, 1-5.9 years). The mean Kujala score increased from 56 ± 10 preoperatively to 86 ± 6 at the most recent postoperative visit (p < 0.001). The mean Lysholm score increased from 53 ± 10 preoperatively to 85 ± 7 at the most recent postoperative visit (p < 0.001). Knee flexion increased significantly from 117° ± 15° preoperatively to 154° ± 13° postoperatively (p < 0.001). However, knee extension was no different pre- and postoperatively (4° ± 8° vs. 1° ± 4°, respectively, p = 0.2). CONCLUSIONS Congenital and habitual patellar dislocation in adolescent-aged patients with an underlying syndromic diagnosis can be successfully treated with MPFL reconstruction combined with TTO.
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Affiliation(s)
- Ahmet Imerci
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Mugla Sitki Kocman University, Kötekli Mahallesi, 48000, Menteşe, Mŭgla, Turkey
| | - Tyler C. McDonald
- Department of Orthopaedic Surgery, Nemours/Alfred I. DuPont Hospital for Children, 1600 Rockland Rd., Wilmington, DE, 19803, USA
| | - Kenneth J. Rogers
- Department of Orthopaedic Surgery, Nemours/Alfred I. DuPont Hospital for Children, 1600 Rockland Rd., Wilmington, DE, 19803, USA
| | - Mihir M. Thacker
- Department of Orthopaedic Surgery, Nemours/Alfred I. DuPont Hospital for Children, 1600 Rockland Rd., Wilmington, DE, 19803, USA
| | - Alfred Atanda
- Department of Orthopaedic Surgery, Nemours/Alfred I. DuPont Hospital for Children, 1600 Rockland Rd., Wilmington, DE, 19803, USA
- Corresponding author.
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Gondolfo Junior R, Emanuele HS, Guerreiro JPF, Queiroz ADO, Danieli MV. CLINICAL RESULTS OF MEDIAL PATELLOFEMORAL LIGAMENT RECONSTRUCTION. ACTA ORTOPEDICA BRASILEIRA 2022; 30:e241172. [PMID: 35694023 PMCID: PMC9150868 DOI: 10.1590/1413-785220223003e241172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 03/03/2021] [Indexed: 11/22/2022]
Abstract
Objective To assess clinical results of patients who underwent medial patellofemoral ligament (MPFL) reconstruction after a minimum of two years of follow-up. Methods Patients' medical records were assessed for residual instability, patient satisfaction, and post-operative functional outcomes. Results Fifty-one patients were analyzed, out of which 56.87% were women. Patients' mean age was 30.8 years (16 to 57 years). The mean follow-up time was 68.7 months (37 to 120 months). Length between first dislocation and surgery was less than 1 year for 58.82% of patients, between 1 and 5 years for 37.25%, and over 5 years for 3.93%. Patients showed a high degree of satisfaction (96.08% would undergo surgery again), with recurrence rate of 11.76%. Twenty-two patients reported knee symptoms, including pain from movements (72.72%), weakness (18.18%), constant pain (13.63%), and crepitus (4.54%). Considering dissatisfied patients, patients with dislocation recurrence, and patients with symptoms, five cannot practice physical activity, out of which only three blame their knee. Conclusion MPFL reconstruction showed a recurrence rate of 11.7%, with high patient satisfaction, good functional results, and high rate of return to sports, after a minimum of two years of follow-up. Level of Evidence IV, Case Series.
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Zhang Z, Cao Y, Song G, Li Y, Zheng T, Zhang H. Derotational Femoral Osteotomy for Treating Recurrent Patellar Dislocation in the Presence of Increased Femoral Anteversion: A Systematic Review. Orthop J Sports Med 2021; 9:23259671211057126. [PMID: 34881342 PMCID: PMC8647269 DOI: 10.1177/23259671211057126] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 08/25/2021] [Indexed: 01/27/2023] Open
Abstract
Background: Studies on the clinical outcomes of derotational femoral osteotomy to treat recurrent patellar dislocation in the presence of increased femoral anteversion are limited. Purpose: To investigate the role of derotational femoral osteotomy in the treatment of recurrent patellar dislocation in the presence of increased femoral anteversion. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was performed according to the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-analyses) by searching the Medline, Embase, Web of Science, and Cochrane Library databases through February 10, 2021. Included were studies of skeletally mature patients presenting with recurrent patellar dislocation and exhibiting increased femoral anteversion who subsequently underwent derotational femoral osteotomy. Methodological quality was assessed using the MINORS (Methodological Index for Nonrandomized Studies) score. The basic characteristics of each study were recorded and analyzed: characteristic information, radiological parameters, surgical techniques, patient-reported outcomes, and complications. Results: A total of 6 studies with 163 patients (170 knees) were included. Sample sizes ranged from 7 to 66 patients, and the patients were predominantly women (range, 79%-100%). The mean age and follow-up ranges were 18 to 28 years and 16 to 44 months, respectively. The mean femoral anteversion decreased significantly from 34° preoperatively to 12° postoperatively. In studies reporting pre- and postoperative outcomes, significant improvements were found in the Lysholm score (from 24.8 to 44.1), Kujala score (from 15.8 to 41.9), International Knee Documentation Committee score (from 11.0 to 28.0), and visual analog scale for pain (from 2.0 to 3.7). All studies reported postoperative complications, giving an overall reported complication rate of 4.7%, but no redislocations occurred during the follow-up period. Conclusion: For recurrent patellar dislocation in the presence of increased femoral anteversion, combination treatment with derotational femoral osteotomy led to favorable clinical outcomes with a low redislocation rate. However, there was no consensus among researchers on the indications for derotational femoral osteotomy in the treatment of recurrent patellar dislocation.
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Affiliation(s)
- ZhiJun Zhang
- Sports Medicine Service, Beijing Jishuitan Hospital, Beijing, China
| | - Yanwei Cao
- Sports Medicine Service, Beijing Jishuitan Hospital, Beijing, China
| | - Guanyang Song
- Sports Medicine Service, Beijing Jishuitan Hospital, Beijing, China
| | - Yue Li
- Sports Medicine Service, Beijing Jishuitan Hospital, Beijing, China
| | - Tong Zheng
- Sports Medicine Service, Beijing Jishuitan Hospital, Beijing, China
| | - Hui Zhang
- Sports Medicine Service, Beijing Jishuitan Hospital, Beijing, China
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Jing L, Wang X, Qu X, Liu K, Wang X, Jiang L, Wu D, Zhang Z, Li Z, Yu L, Wang S, Yang J. Closing-wedge distal femoral osteotomy combined with medial patellofemoral ligament reconstruction for recurrent patellar dislocation with genu valgum. BMC Musculoskelet Disord 2021; 22:668. [PMID: 34372805 PMCID: PMC8351451 DOI: 10.1186/s12891-021-04554-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 07/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Medial patellofemoral ligament reconstruction (MPFLR) is a well-established procedure for addressing recurrent patellar dislocation (RPD) in young patients. However, despite being a promising procedure for RPD with genu valgum, there is a scarcity of reports on simultaneous MPFLR and closing-wedge distal femoral osteotomy (CWDFO). The purpose of the present study was to observe and analyse the clinical and imaging findings of CWDFO combined with MPFLR for RPD with genu valgum. METHODS From May 2015 to April 2018, 25 patients with RPD and genu valgum were surgically treated in our department. Anteroposterior long-leg, weight-bearing, lower-extremity radiographs, lateral radiographs and computed tomography (CT) scans of the patellofemoral joint were obtained, and the anatomical femorotibial angle (aFTA), mechanical lateral distal femoral angle (mLDFA), weight-bearing line rate (WBLR), patellar height, patellar lateral shift (PLS) and tibial tubercle-trochlear groove (TT-TG) distance were analysed. Validated knee scores, such as the Kujala, Lysholm, visual analogue scale (VAS) scores and Tegner socres, were evaluated preoperatively and 2 years postoperatively. RESULTS 25 patients, with an average age of 19.8 years (14-27), were evaluated. During the 2-year follow-up period, all patients were able to achieve a better sports level without any problems, with no recurrence of patellar instability. Compared with preoperation, the aFTA, mLDFA, WBLR and PLS showed statistically significant improvement following the procedure (p < 0.001). Meanwhile, no significant differences in the Insall index and TT-TG distance were found. The mean Kujala score, average Lysholm score, VAS score and Tegner socres showed significant postoperative improvement. CONCLUSIONS CWDFO combined with MPFLR is a suitable treatment for RPD with genu valgum, and can lead to significant improvement in the clinical and imaging findings of the knee in the short term.
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Affiliation(s)
- Lizhong Jing
- Department of Orthopedics, Affiliated Hospital to Shandong University of Traditional Chinese Medicine, Jinan, 250011, China
| | - Xiaole Wang
- Department of Orthopedics, Affiliated Hospital to Shandong University of Traditional Chinese Medicine, Jinan, 250011, China
| | - Xiaoliang Qu
- Department of Orthopedics, Dongying Hospital of Traditional Chinese Medicine, Dongying, 257000, China
| | - Kun Liu
- Department of Orthopedics, Penglai Traditional Chinese Medicine Hospital, Yantai, 265600, China
| | - Xiaotan Wang
- Shandong University of Traditional Chinese Medicine, Jinan, 250000, China
| | - Lu Jiang
- Shandong University of Traditional Chinese Medicine, Jinan, 250000, China
| | - Di Wu
- Shandong University of Traditional Chinese Medicine, Jinan, 250000, China
| | - Zhiwei Zhang
- Shandong University of Traditional Chinese Medicine, Jinan, 250000, China
| | - Zhuang Li
- Shandong University of Traditional Chinese Medicine, Jinan, 250000, China
| | - Le Yu
- Department of Orthopedics, Affiliated Hospital to Shandong University of Traditional Chinese Medicine, Jinan, 250011, China
| | - Shaoshan Wang
- Department of Orthopedics, Affiliated Hospital to Shandong University of Traditional Chinese Medicine, Jinan, 250011, China
| | - Jiushan Yang
- Department of Orthopedics, Affiliated Hospital to Shandong University of Traditional Chinese Medicine, Jinan, 250011, China.
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Sos C, Schmitt A, Berhouet J. Percutaneous Reconstruction of the Medial Patello-Femoral Ligament Using Dynamic Gracilis Tendon Transfer. Orthop Traumatol Surg Res 2021; 107:102910. [PMID: 33812094 DOI: 10.1016/j.otsr.2021.102910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 09/17/2020] [Accepted: 09/21/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Many techniques have been described for reconstructing the medial patello-femoral ligament (MPFL), using a variety of transplants and fixation methods to treat patello-femoral dislocation. The main challenge with static transfers is to position the femoral fixation point at the site that best restores MPFL anisometry. The objective of this cadaveric study was to propose a version of the initially described dynamic gracilis transfer technique that can be performed percutaneously. HYPOTHESIS Our working hypothesis was that using a minimally invasive approach would provide better cosmesis without altering the biomechanical efficacy of the procedure. METHODS 20 cadaveric knees were used to evaluate the feasibility and reliability of our percutaneous technique. We analysed femoral pulley location and scar length. RESULTS After dissection, the position of the femoral pulley allowed superimposition of the transplant along the trajectory of the native MPFL in all 20 knees. Cumulative scar length was 6.5cm (range, 6-7.5cm). DISCUSSION Percutaneous dynamic gracilis transfer is easy to perform, reproducible, and capable of creating a pulley that anatomically replicates the femoral insertion point of the native MPFL. LEVEL OF EVIDENCE IV; retrospective study.
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Affiliation(s)
- Clara Sos
- Service de chirurgie orthopédique et traumatologique, Centre Hospitalo-Universitaire Tours - Université de Médecine de Tours François Rabelais, 37000 Tours, France.
| | - Antoine Schmitt
- Service de chirurgie orthopédique et traumatologique, Pôle santé Léonard De Vinci, 37170 Chambray-lès-Tours, France
| | - Julien Berhouet
- Service de chirurgie orthopédique et traumatologique, Centre Hospitalo-Universitaire Tours - Université de Médecine de Tours François Rabelais, 37000 Tours, France
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Nha KW, Kim HS, Cho ST, Bae JH, Jang KM, Kim SG. Arthroscopy-controlled medial reefing and lateral release for recurrent patellar dislocation: clinical, radiologic outcomes and complications. BMC Musculoskelet Disord 2021; 22:430. [PMID: 33971864 PMCID: PMC8111772 DOI: 10.1186/s12891-021-04300-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 04/27/2021] [Indexed: 12/16/2022] Open
Abstract
Background Few studies have reported the clinical outcomes of the medial reefing procedure and lateral release with arthroscopic control of medial retinacular tension in patients with recurrent patellar dislocation. The purpose of this study was to investigate the clinical, radiologic outcomes and complications of arthroscopy-controlled medial reefing and lateral release. Methods Patients who underwent arthroscopy-controlled medial reefing and lateral release for recurrent patellar dislocation between November 2007 and June 2017 were retrospectively evaluated. The clinical outcome (Kujala score), radiologic outcome (congruence and patellar tilt angles), and complications were evaluated at final follow-up. The results were also compared with literature-reported outcomes of other surgical procedures for patellar dislocation. Results Twenty-five patients (mean age, 18.3 ± 4.8 years) were included in the study. The mean clinical follow-up period was 7.0 ± 2.5 (range, 3.8–12.2) years. The mean Kujala score was significantly improved from 54.7 ± 14.0 (range, 37–86) preoperatively to 91.0 ± 7.6 (range, 63–99) at a mean follow-up period of 7 years (P < 0.001). The radiologic results also significantly improved from 17.8° ± 5.9° to 6.8° ± 2.4° (P < 0.001) in the congruence angle and from 17.5° ± 8.2° to 5.6° ± 3.1° (P < 0.001) in the patella tilt angle at a mean follow-up period of 3.6 years. One patient developed a redislocation after a traumatic event, and two patients showed patellofemoral osteoarthritis progression. Conclusions Arthroscopy-controlled medial reefing and lateral release significantly improved the clinical and radiologic outcomes of the patients with recurrent patellar dislocation at a mean follow-up period of 7 years. The results of this study are comparable with the literature-reported outcomes of other surgical procedures for patellar dislocation. Level of evidence Level IV, retrospective therapeutic case series.
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Affiliation(s)
- Kyung Wook Nha
- Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, 170, Juhwa-ro, Ilsanseo-gu, Gyeonggi-do, Goyang-si, 10380, Republic of Korea
| | - Hyung Suh Kim
- Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, 170, Juhwa-ro, Ilsanseo-gu, Gyeonggi-do, Goyang-si, 10380, Republic of Korea
| | - Sung Tan Cho
- Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, 170, Juhwa-ro, Ilsanseo-gu, Gyeonggi-do, Goyang-si, 10380, Republic of Korea
| | - Ji Hoon Bae
- Department of Orthopaedic Surgery, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Ki-Mo Jang
- Department of Orthopaedic Surgery, Korea University Anam Hospital, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Sang-Gyun Kim
- Department of Orthopaedic Surgery, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-Gu, Gyeongki-do, Ansan-si, 15355, Republic of Korea.
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Song YF, Wang HJ, Yan X, Yuan FZ, Xu BB, Chen YR, Ye J, Fan BS, Yu JK. Tibial Tubercle Osteotomy May Not Provide Additional Benefit in Treating Patellar Dislocation With Increased Tibial Tuberosity-Trochlear Groove Distance: A Systematic Review. Arthroscopy 2021; 37:1670-1679.e1. [PMID: 33359817 DOI: 10.1016/j.arthro.2020.12.210] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 12/11/2020] [Accepted: 12/14/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To examine the indications and outcomes of medial patellofemoral ligament reconstruction (MPFLR) with or without tibial tubercle osteotomy (TTO) in treating recurrent or habitual patellar dislocation with an increased tibial tuberosity-trochlear groove (TT-TG) distance. METHODS We performed a literature search of the established medical databases Cochrane Central, PubMed-MEDLINE, EMBASE, and Web of Science. The inclusion criteria were as follows: skeletally mature patients with recurrent or habitual patellar dislocation and an increased TT-TG distance, treatment with MPFLR combined with a TTO procedure or isolated MPFLR, and reporting of clinical outcomes and complications. Each study was assessed for quality and the level of evidence. The general characteristics, indications, surgical techniques, TT-TG distance, clinical results, imaging evaluation findings, and complications of each study were recorded. RESULTS Nine studies consisting of 288 knees met the inclusion criteria. The average Coleman score was 71.56 (range, 55-83). The threshold for an increased TT-TG distance ranged from 16 to 20 mm in the included studies. Similar good postoperative outcomes were reported in patients with an increased TT-TG distance treated with MPFLR with versus without a TTO procedure. The mean postoperative Lysholm score ranged from 75.0 to 94.7 (I2 = 87.6%) in the isolated MPFLR group and from 85.0 to 87.6 (I2 = 16.3%) in the TTO-with-MPFLR group. Similar postoperative congruence angles were reported in both groups. The postoperative redislocation rate ranged from 0% to 4.2% in the TTO-with-MPFLR group, and no redislocation was found in the isolated MPFLR group. The postoperative apprehension sign was only reported in isolated MPFLR patients. CONCLUSIONS The outcomes of MPFLR with or without TTO to treat recurrent or habitual patellar dislocation with an increased TT-TG distance appeared similar. However, this study was limited by the considerable heterogeneity, variety of techniques, variety of TT-TG distances, and variability in patella alta and trochlear dysplasia among the included studies. LEVEL OF EVIDENCE Level IV, systematic review of Level II to IV studies.
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Affiliation(s)
- Yi-Fan Song
- Knee Surgery Department, Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
| | - Hai-Jun Wang
- Knee Surgery Department, Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
| | - Xin Yan
- Knee Surgery Department, Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
| | - Fu-Zhen Yuan
- Knee Surgery Department, Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
| | - Bing-Bing Xu
- Knee Surgery Department, Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
| | - You-Rong Chen
- Knee Surgery Department, Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
| | - Jing Ye
- Knee Surgery Department, Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
| | - Bao-Shi Fan
- Knee Surgery Department, Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
| | - Jia-Kuo Yu
- Knee Surgery Department, Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China.
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Zhao Z, Wang Y, Li J, Wang H, Bai X, Wang Q, Li Z. Clinical Outcomes and Prognostic Factors in Patients With Recurrent Patellar Lateral Dislocation Treated With Isolated Medial Patellofemoral Ligament Reconstruction: A Retrospective Single-Center Analysis. Orthop J Sports Med 2021; 9:2325967121995803. [PMID: 33954219 PMCID: PMC8044575 DOI: 10.1177/2325967121995803] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 11/29/2020] [Indexed: 12/19/2022] Open
Abstract
Background Medial patellofemoral ligament reconstruction (MPFLR) is widely used to treat patellofemoral instability. However, it is still unclear when a concomitant bony procedure is needed. Purpose To evaluate the therapeutic efficacy of isolated MPFLR for recurrent patellar lateral dislocation and to identify the prognostic factors for clinical outcomes. Study Design Case series; Level of evidence, 4. Methods A total of 237 patients who had undergone unilateral isolated MPFLR between January 2011 and December 2016 were included. Patellar tracking (J sign) and radiologic information including patellar height, trochlear dysplasia, tibial tubercle-trochlear groove distance, and patellar tilt was collected preoperatively, and the Kujala and International Knee Documentation Committee (IKDC) functional scores were used to assess postoperative recovery. Failure was defined as redislocation or patient-reported and clinically confirmed patellar instability. The influence of radiologic features and the J sign on knee functional scores was explored via subgroup analysis. Potential prognostic factors were explored using univariate and multivariate regression analyses, and risk factors for a positive J sign were evaluated using Spearman coefficient correlation analysis. Results The mean ± SD follow-up period was 70.67 ± 18.05 months (range, 36-108 months). From preoperatively to final follow-up, all patients had statistically and clinically significant improvements in the Kujala score (from 51.43 ± 6.87 to 88.52 ± 4.83; P < .001) and IKDC score (from 49.78 ± 6.05 to 81.16 ± 4.20; P < .001). Subgroup analysis indicated no significant difference in functional score improvements based on radiologic features or the J sign. Overall, 20 knees (8.4%) experienced postoperative failure: 11 with redislocation and 9 with patellar instability. A preoperative positive J sign was shown to be an independent prognostic factor for postoperative failure via logistic regression analyses: univariate (odds ratio, 3.340; 95% CI, 1.316-8.480; P = .011) and multivariate (odds ratio, 3.038; 95% CI, 1.179-7.827; P = .021). In addition, the J sign was closely associated with patellar height (r S, 0.159; P = .014) and trochlear dysplasia (r S, 0.235; P < .001). Conclusion Isolated MPFLR appears to be an effective strategy for recurrent patellar lateral dislocation, with significant functional improvement and a low failure rate. A preoperative positive J sign was identified as a potential prognostic risk factor for postoperative failure.
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Affiliation(s)
- Zhidong Zhao
- Medical School of Chinese PLA, Beijing, China.,Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yuxing Wang
- Medical School of Chinese PLA, Beijing, China.,Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Ji Li
- Medical School of Chinese PLA, Beijing, China.,Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Haoran Wang
- Medical School of Chinese PLA, Beijing, China.,Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Xiaowei Bai
- Medical School of Chinese PLA, Beijing, China.,Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Qi Wang
- Medical School of Chinese PLA, Beijing, China.,Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Zhongli Li
- Medical School of Chinese PLA, Beijing, China.,Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, China
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Li Y, Liu J, Lei L, Zhou P, Deng F, Li Z. [Short-term effectiveness of derotational distal femoral osteotomy combined with medial patellofemoral ligament reconstruction for recurrent patellar dislocation]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:343-348. [PMID: 33719244 DOI: 10.7507/1002-1892.202009111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the short-term effectiveness of derotational distal femoral osteotomy (DDFO) combined with medial patellofemoral ligament (MPFL) reconstruction in treatment of recurrent patellar dislocation with excessive femoral anteversion angle (FAA≥30°). Methods Between June 2017 and August 2019, 17 patients with recurrent patellar dislocation with FAA≥30° were treated with DDFO and MPFL reconstruction. There were 5 males and 12 females, aged 14-22 years, with an average of 17.7 years. The patella dislocated for 2 to 8 times (mean, 3.6 times). The disease duration was 2-7 years (mean, 4.6 years). The patellar apprehension tests were positive. Preoperative pain visual analogue scale (VAS) score, Lysholm score, Tegner score, and Kujala score were 4.2±1.1, 47.8±8.1, 3.6±1.1, and 56.8±5.7, respectively. FAA, mechanical lateral distal femoral angle (mLDFA), lateral patella displacement (LPD), tibial tuberosity-trochlear groove distance (TT-TG) were (34.9±3.4)°, (85.8±3.0)°, (13.7±3.8) mm, and (23.1±2.1) mm, respectively. Results All incisions healed by first intention, and there was no complications such as knee stiffness, infection, and re-dislocation of the patella. All patients were followed up 13-25 months, with an average of 17.7 months. The imaging review showed that 1 case of osteotomy did not union, and achieved satisfactory results after the secondary revision and strengthening fixation; the osteotomies of other patients healed completely after 3 to 4 months of operation. The patellar apprehension tests were negative. At last follow-up, the FAA, mLDFA, LPD, and TT-TG were (15.6±2.7)°, (83.0±2.1)°, (5.0±2.6) mm, and (20.5±2.5) mm, respectively; the VAS score, Lysholm score, Tegner score, and Kujala score were 2.4±1.4, 93.4±7.8, 6.8±1.5, and 89.0±8.0, respectively. There were significant differences in the above indicators between pre- and post-operation ( P<0.05). Conclusion DDFO combined with MPFL reconstruction for the recurrent patellar dislocation with excessive FAA (≥30°) can achieve good short-term effectiveness, significantly reduce knee pain, and improve function.
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Affiliation(s)
- Yuan Li
- Department of Orthopaedics, the Affiliated Hospital of Southwest Medical University & Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou Sichuan, 646000, P.R.China
| | - Juncai Liu
- Department of Orthopaedics, the Affiliated Hospital of Southwest Medical University & Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou Sichuan, 646000, P.R.China
| | - Lei Lei
- Department of Rehabilitation Medicine, the Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China
| | - Peng Zhou
- Department of Orthopaedics, the Affiliated Hospital of Southwest Medical University & Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou Sichuan, 646000, P.R.China
| | - Fuyuan Deng
- Department of Orthopaedics, the Affiliated Hospital of Southwest Medical University & Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou Sichuan, 646000, P.R.China
| | - Zhong Li
- Department of Orthopaedics, the Affiliated Hospital of Southwest Medical University & Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou Sichuan, 646000, P.R.China
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Feng X, Wang F. Clinical outcomes of medial retinaculum plasty versus MPFL reconstruction with concomitant tibial tubercle transfer: a retrospective study. Arch Orthop Trauma Surg 2020; 140:1759-1766. [PMID: 32710341 DOI: 10.1007/s00402-020-03556-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 07/20/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To elucidate the clinical outcomes of medial retinaculum plasty versus MPFL reconstruction with concomitant tibial tubercle transfer. METHODS From January 2014 to July 2018, 57 patients who underwent tibial tubercle transfer combined with medial retinaculum plasty or MPFL reconstruction were enrolled in the present study. The 57 patients were divided into two comparison groups according to the therapeutic protocol. The 25 patients in group I underwent the medial retinaculum plasty and tibial tubercle transfer. The 32 patients in group II underwent the MPFL reconstruction and tibial tubercle transfer. Clinical outcomes were assessed using the knee injury and osteoarthritis outcome score, Kujala score, congruence angle, patellar tilt angle, patellar lateral shift, tibial tuberosity-trochlear groove distance and Caton-Deschamps Index. The clinical outcomes were compared between the two groups preoperatively and at the time of the last follow-up. RESULTS Significant improvement was seen in both groups postoperatively (P < 0.05). There were no significant differences in the knee injury and osteoarthritis outcome score, Kujala score, congruence angle, patellar tilt angle, patellar lateral shift, tibial tuberosity-trochlear groove distance and Caton-Deschamps Index between the two groups (P > 0.05). CONCLUSION The combined medial retinaculum plasty and tibial tubercle transfer achieved similar clinical outcomes versus the MPFL reconstruction with concomitant TTT. This therapeutic protocol was a good option in treatment of patellar dislocation with increased TT-TG distance or patella alta.
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Affiliation(s)
- Xunkai Feng
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Fei Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China.
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Hinckel BB, Baumann CA, Ejnisman L, Cavinatto LM, Martusiewicz A, Tanaka MJ, Tompkins M, Sherman SL, Chahla JA, Frank R, Yamamoto GL, Bicos J, Arendt L, Fithian D, Farr J. Evidence-based Risk Stratification for Sport Medicine Procedures During the COVID-19 Pandemic. J Am Acad Orthop Surg Glob Res Rev 2020; 4:e20.00083. [PMID: 33986224 PMCID: PMC7537824 DOI: 10.5435/jaaosglobal-d-20-00083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/16/2020] [Indexed: 01/08/2023]
Abstract
Orthopaedic practices have been markedly affected by the emergence of the COVID-19 pandemic. Despite the ban on elective procedures, it is impossible to define the medical urgency of a case solely on whether a case is on an elective surgery schedule. Orthopaedic surgical procedures should consider COVID-19-associated risks and an assimilation of all available disease dependent, disease independent, and logistical information that is tailored to each patient, institution, and region. Using an evidence-based risk stratification of clinical urgency, we provide a framework for prioritization of orthopaedic sport medicine procedures that encompasses such factors. This can be used to facilitate the risk-benefit assessment of the timing and setting of a procedure during the COVID-19 pandemic.
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Affiliation(s)
- Betina B Hinckel
- From the Oakland University, Rochester (Dr. Hinckel, and Dr. Cavinatto); Department of Orthopaedic Surgery, William Beaumont Hospital, Royal Oak (Dr. Hinckel, Dr. Cavinatto), MI; the University of Missouri-School of Medicine, Columbia, MO (Mr. Baumann); the Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, SP, BR (Dr. Ejnisman); the Shoulder and Elbow Surgery, Beaumont Orthopaedic Associates, Beaumont Health (Dr. Martusiewicz); the Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA (Dr. Tanaka); the Department of Orthopedic Surgery, TRIA Orthopedic Center, University of Minnesota, Gillette Children's Specialty Healthcare, MN (Dr. Tompkins); the Department of Orthopedic Surgery, Stanford University, CA (Dr. Sherman); the Rush University Medical Center, Chicago, IL (Dr. Chahla); the Division of Sports Medicine and Shoulder Surgery, Department of Orthopedics, Aurora, CO (Dr. Frank); the Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA (Dr. Yamamoto); CEGH-CEL, Instituto de Biociências, Universidade de São Paulo (Dr. Yamamoto); DASA Laboratories, Sao Paulo, Brazil (Dr. Yamamoto); the Michigan Orthopedic Surgeons, Fellowship Director William Beaumont Sports Medicine Fellowship, Assistant Professor Oakland University William Beaumont School of Medicine, MI (Dr. Bicos); the Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN (Dr. Arendt); the Southern California Permanente Medical Group and Torrey Pines Orthopaedic Medical Group, San Diego, CA (Dr. Fithian); and the Knee Preservation, Cartilage Regeneration and OrthoBiologics, Department of Orthopedic Surgery, Indiana University School of Medicine, OrthoIndy and OrthoIndy Hospital, Greenwood and Indianapolis, IN (Dr. Farr)
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Zhang Z, Zhang H, Song G, Zheng T, Ni Q, Feng H. Increased femoral anteversion is associated with inferior clinical outcomes after MPFL reconstruction and combined tibial tubercle osteotomy for the treatment of recurrent patellar instability. Knee Surg Sports Traumatol Arthrosc 2020; 28:2261-2269. [PMID: 31797022 DOI: 10.1007/s00167-019-05818-3] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 11/27/2019] [Indexed: 01/27/2023]
Abstract
PURPOSE This study aimed at investigating the influence of an increased femoral anteversion angle on clinical outcomes after medial patellofemoral ligament reconstruction and combined tibial tubercle osteotomy for the treatment of recurrent patellar instability. It was hypothesized that an increased femoral anteversion is associated with inferior clinical outcomes. METHODS From 2014 to 2016, a total of 144 consecutive patients with recurrent patellar instability were treated with medial patellofemoral ligament reconstruction and combined tibial tubercle osteotomy. The femoral anteversion angle was measured using three-dimensional computed tomography scans. Patients were allocated into group A (femoral anteversion < 20°), group B (femoral anteversion 20°-30°) and group C (femoral anteversion > 30°) based on the value of the femoral anteversion angle. Routine radiography and CT examinations were performed to evaluate the patellar height, trochlear dysplasia, genu valgum, and tibial tuberosity-trochlear groove (TT-TG) distance. The patellar lateral shift distance assessed with stress radiography was used pre- and postoperatively to quantify medial patellofemoral ligament residual laxity under anaesthesia. Patient-reported outcomes (Kujala, IKDC, and Lysholm scores) and patellar maltracking ("J-sign") were evaluated pre- and postoperatively. Finally, subgroup analysis was performed to investigate the influence of an increased femoral anteversion angle on the clinical and radiological outcomes. RESULTS A total of 66 patients (70 knees) were included with a median follow-up time of 28 months (range 24-32). After a minimum of 2 years of follow-up, all patient-reported outcomes (Kujala, Lysholm, and IKDC scores) improved significantly, and subgroup analysis showed that group C had significantly lower Kujala scores (75 ± 8 vs. 84 ± 8, P13 = 0.003; 75 ± 8 vs. 82 ± 8, P23 = 0.030), Lysholm scores (81 ± 9 vs. 87 ± 7, P13 = 0.021) and IKDC scores (78 ± 6 vs. 85 ± 7, P13 = 0.001; 78 ± 6 vs. 84 ± 6, P23 = 0.005) than group A and group B. Twelve patients had a postoperative residual J-sign (17.1%), and significant differences were found between group C and group A regarding the rate of residual J-sign (32.1% vs. 4.8%, P13 = 0.003). Postoperatively, group C had a greater patellar lateral shift distance than group A (10 ± 4 vs. 6 ± 4 mm, P13 = 0.006) and group B (10 ± 4 vs. 6 ± 3 mm, P23 = 0.008). Additionally, patients with a residual J-sign demonstrated greater medial patellofemoral ligament laxity than patients without a residual J-sign (12 ± 4 vs. 9 ± 3 mm, P = 0.009). CONCLUSION Patients with an increased femoral anteversion angle (> 30°) had inferior postoperative clinical outcomes, including greater patellar laxity, a higher rate of residual J-sign and lower patient-reported outcomes after medial patellofemoral ligament reconstruction and combined tibial tubercle osteotomy for the treatment of recurrent patellar instability. LEVEL OF EVIDENCE III, retrospective cohort study.
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Affiliation(s)
- ZhiJun Zhang
- Sports Medicine Service, Beijing Jishuitan Hospital, No. 31, Xin Jie Kou East Street, Xi Cheng District, Beijing, China
| | - Hui Zhang
- Sports Medicine Service, Beijing Jishuitan Hospital, No. 31, Xin Jie Kou East Street, Xi Cheng District, Beijing, China
| | - GuanYang Song
- Sports Medicine Service, Beijing Jishuitan Hospital, No. 31, Xin Jie Kou East Street, Xi Cheng District, Beijing, China
| | - Tong Zheng
- Sports Medicine Service, Beijing Jishuitan Hospital, No. 31, Xin Jie Kou East Street, Xi Cheng District, Beijing, China
| | - QianKun Ni
- Sports Medicine Service, Beijing Jishuitan Hospital, No. 31, Xin Jie Kou East Street, Xi Cheng District, Beijing, China
| | - Hua Feng
- Sports Medicine Service, Beijing Jishuitan Hospital, No. 31, Xin Jie Kou East Street, Xi Cheng District, Beijing, China.
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Zhang Z, Zhang H, Song G, Zheng T, Feng H. A pre-operative grade 3 J-sign adversely affects short-term clinical outcome and is more likely to yield MPFL residual graft laxity in recurrent patellar dislocation. Knee Surg Sports Traumatol Arthrosc 2020; 28:2147-2156. [PMID: 31612265 DOI: 10.1007/s00167-019-05736-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 09/26/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE The purposes of this study were to investigate the anatomical risk factors of grade 3 J-sign and analyse the influence of J-sign grades on the short-term clinical outcomes of patients with recurrent patellar dislocation. METHODS From 2016 to 2018, a total of 168 patients with recurrent patellar dislocation (187 knees) underwent medial patellofemoral ligament reconstruction with or without tibial tuberosity medialization. Pre-operative J-sign severity was graded according to a previously described classification (grades 1-3). Potential anatomical risk factors of J-sign were explored. Comparisons were assessed between patients with different grades of J-sign using univariate and binary logistic regression analyses. The Kujala score was assessed and compared with pre-operative values, and stress fluoroscopy was performed to assess medial patellofemoral ligament residual graft laxity. Among the 130 included cases, 104 knees with at least 1-year follow-up were included in the clinical outcome analyses to explore the influence of several anatomical factors and J-sign grade on short-term clinical outcomes. RESULTS A total of 118 patients (130 knees) were included in the present study. The median age at surgery was 21 years (range 13-38), and 111 affected knees belonged to female patients (85%). Univariate and multivariate logistic regressions between the grade 3 group and the grade 1-2 groups showed that increased femoral anteversion, excessive external tibial torsion, and patella alta were three independent risk factors of grade 3 J-sign in patients with recurrent patellar dislocation. A total of 104 knees with at least a 1-year follow-up were included in the clinical outcome analyses. The median Kujala score improved from 54 (range, 38-72) pre-operatively to 86 (range, 70-100) post-operatively. Although no re-dislocation was reported during the follow-up, 6 out of 32 patients in the grade 3 group demonstrated "MPFL residual graft laxity" based on post-operative stress radiography (18.8%), which was significantly higher than in the grade 1-2 groups (0%, p < 0.001). Subgroup analysis showed that patients with grade 3 J-sign had significantly lower post-operative Kujala scores than those with grade 1-2 J-sign (p < 0.001). Moreover, increased femoral anteversion (≥ 30°) was correlated with an inferior post-operative Kujala score (p = 0.023). CONCLUSION The three independent anatomic risk factors of grade 3 J-sign in patients with recurrent patellar dislocation were increased femoral anteversion, excessive external tibial torsion, and patella alta. A pre-operative grade 3 J-sign was correlated with a lower post-operative Kujala score and more "MPFL residual graft laxity" in patients with recurrent patellar dislocation treated with MPFL reconstruction with or without tibial tuberosity medialization at a minimum 1-year follow-up. LEVEL OF EVIDENCE III.
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Affiliation(s)
- ZhiJun Zhang
- Sports Medicine Service, Peking University Fourth School of Clinical Medicine, No. 31, Xin Jie Kou East Street, Xi Cheng District, Beijing, China
| | - Hui Zhang
- Sports Medicine Service, Peking University Fourth School of Clinical Medicine, No. 31, Xin Jie Kou East Street, Xi Cheng District, Beijing, China
| | - GuanYang Song
- Sports Medicine Service, Peking University Fourth School of Clinical Medicine, No. 31, Xin Jie Kou East Street, Xi Cheng District, Beijing, China
| | - Tong Zheng
- Sports Medicine Service, Peking University Fourth School of Clinical Medicine, No. 31, Xin Jie Kou East Street, Xi Cheng District, Beijing, China
| | - Hua Feng
- Sports Medicine Service, Peking University Fourth School of Clinical Medicine, No. 31, Xin Jie Kou East Street, Xi Cheng District, Beijing, China.
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Abstract
PURPOSE OF REVIEW The patellofemoral joint is a complicated articulation of the patella and femur that is prone to pathologies. The purpose of this review is to report on the current methods of investigating patellofemoral mechanics, factors that affect joint function, and future directions in patellofemoral joint research with emerging technologies and techniques. RECENT FINDINGS While previous hypotheses have suggested that the patella is only a moment arm extender, recent literature has suggested that the patella influences the control of knee moments and forces acting on the tibia as well as contributes to various aspects of patellar function with minimal neural input. With advancements in simulating a six-degrees-of-freedom patellofemoral joint, we have gained a better understanding of patella motion and have shown that geometry and muscle activations impact patella mechanics. Research into influences on patella mechanics from other joints such as the hip and foot has become more prevalent. In this review, we report current in vivo, in vitro, and in silico approaches to studying the patellofemoral joint. Kinematic and anatomical factors that affect patellofemoral joint function such as patella alta and tilt or bone morphology and ligaments are discussed. Moving forward, we suggest that advanced in vivo dynamic imaging methods coupled to musculoskeletal simulation will provide further understanding of patellofemoral pathomechanics and allow engineers and clinicians to design interventions to mitigate or prevent patellofemoral pathologies.
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Chahla J, Smigielski R, LaPrade RF, Fulkerson JP. An Updated Overview of the Anatomy and Function of the Proximal Medial Patellar Restraints (Medial Patellofemoral Ligament and the Medial Quadriceps Tendon Femoral Ligament). Sports Med Arthrosc Rev 2019; 27:136-142. [PMID: 31688531 DOI: 10.1097/jsa.0000000000000252] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The medial patellofemoral ligament (MPFL) has been widely accepted to function as "the primary static restraint to lateral patellar displacement." However, current growing evidence suggests that there is a complex of medial patellofemoral/tibial ligaments, both proximal [MPFL, and medial quadriceps tendon femoral ligament (MQTFL)], and distal (medial patellotibial ligament and the medial patellomeniscal ligament) which restrain lateral patellar translation at different degrees of knee flexion. Specifically, the MQTFL has gained popularity over the last decade because of pure soft tissue attachments into the extensor mechanism that allow for avoidance of drilling tunnels into the patella during reconstruction. The purpose of this article was to report on the current knowledge (anatomy, biomechanics, diagnosis, indications for surgery, and techniques) on the proximal medial patellar restraints, namely the MPFL and the MQTFL, collectively referred to as the proximal medial patellar restraints.
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Affiliation(s)
| | - Robert Smigielski
- "Mirai" Institute: Trauma, Orthopaedics and Physical Therapy.,"ARS Medicinalis" Foundation, Warsaw, Poland
| | | | - John P Fulkerson
- Orthopedic Associates of Hartford, University of Connecticut School of Medicine, Farmington, CT
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Isolated medial patellofemoral ligament reconstruction significantly improved quality of life in patients with recurrent patella dislocation. Knee Surg Sports Traumatol Arthrosc 2019; 27:3513-3517. [PMID: 30820603 DOI: 10.1007/s00167-019-05447-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 02/25/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE The purpose of this study was to measure the improvement in quality of life (QoL) following isolated anatomical double-bundle medial patellofemoral ligament reconstruction. METHODS This is a single-centre, prospective study of 56 consecutive patients (57 knees) who underwent isolated MPFL reconstruction between 2014 and 2017. Functional outcome and QoL were assessed with the Kujala score and the EQ-5D-3L questionnaire, respectively. Objective outcomes were obtained through clinical examination at the latest follow-up assessing redislocation rate, patella apprehension test, patellar tilt, pain and range of motion. RESULTS The median Kujala score increased from 60 (range 31-96) to 92 (range 34-100) at latest follow-up (p < 0.001). The median EQ-5D index also increased, from 0.69 (range 0.10-1) at baseline to 1 (range 0.16-1) at latest follow-up (p < 0.001), as well as the median EQ-5D VAS from 75 (range 20-95) to 92 (range 40-100) (p < 0.001). Four dimensions of the EQ-5D were significantly improved except for the anxiety/depression scores. Female patients reported lower scores at baseline and at latest follow-up, for all three outcomes (Kujala, EQ-5D index, EQ-5D VAS), however there was no evidence that gender negatively impacted on the benefit of surgery. The re-dislocation rate was 0%. Apprehension and patellar tilt test were negative in all patients and no flexion deficit was identified at latest follow-up. Two patients had tenderness along the reconstruction requiring femoral screw removal in one of them. CONCLUSIONS Isolated anatomical double-bundle aperture MPFL reconstruction, offered significantly improved short-term QoL along with excellent functional outcome. Female patients scored lower, but this did not affect the overall outcome. Including QoL tools in the assessment of ligament reconstruction operations, such as the MPFL, can provide more accurate understanding of the overall patient benefit. LEVEL OF EVIDENCE II.
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Zhao Y, Huang J, Li D, Hu W. [Arthroscopic medial patellofemoral ligament reconstruction combined with tibial tuberosity transfer for recurrent patellar dislocation]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:960-964. [PMID: 31407553 PMCID: PMC8337898 DOI: 10.7507/1002-1892.201811111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 06/20/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate the effectiveness of arthroscopic medial patellofemoral ligament (MPFL) reconstruction combined with tibial tuberosity transfer for recurrent patellar dislocation. METHODS Between February 2012 and December 2013, 24 patients (24 knees) with recurrent patellar dislocation were treated with arthroscopic MPFL reconstruction combined with tibial tuberosity transfer. There were 7 males and 17 females, with a mean age of 23.2 years (range, 18-37 years). One patient had recurrence dislocation after operation in the other hospital, and the others were the first operation. The disease duration ranged from 6 months to 20 years (mean, 5.6 years). The patellar apprehension tests were positive. The preoperative Lysholm score was 49.79±11.67 and the Kujala score was 49.63±6.28. X-ray films showed that 13 patients had dysplasia of the patella and femoral trochlea; 8 patients had high tibia (Caton-Deschamps index>1.2); the congruence angle was (23.96±5.54)°. CT examination showed that the tibial tuberosity-trochlear groove distance (TT-TG) value was (23.71±2.35) mm. RESULTS All incisions healed by first intention. Twenty-two patients were followed up 59-81 months, with an average of 66.8 months. No dislocation occurred during the follow-up period. The patellar apprehension tests were negative. At 1 week after operation, the results of X-ray films and CT showed that the congruence angle angle was (-1.96±4.65)°, and the TT-TG value was (13.75±1.89) mm, which were significantly lower than those before operation ( P<0.05). At 6 months, 1 year, and last follow-up, Lysholm scores were 81.13±17.76, 91.35±3.60, and 92.23±2.71, respectively; and Kujala scores were 84.04±3.98, 91.48±3.64, and 91.45±3.29, respectively. The Lysholm and Kujala scores were significantly increased after operation when compared with the preoperative scores ( P<0.05). At last follow-up, the effectiveness was excellent in 11 cases, good in 8 cases, and fair in 3 cases, with an excellent and good rate of 86%. CONCLUSION Arthroscopic MPFL reconstruction combined with tibial tuberosity transfer for recurrent patellar dislocation can effectively improve the patellofemoral joint matching relationship and has a satisfactory short- and medium-term effectiveness.
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Affiliation(s)
- Yun Zhao
- Department of Orthopedics, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin, 300131, P.R.China
| | - Jingmin Huang
- The Second Department of Sport Injury and Arthroscopy, Tianjin Hospital, Tianjin, 300211,
| | - Dongchao Li
- Department of Orthopedics, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin, 300131, P.R.China
| | - Wenjin Hu
- Department of Orthopedics, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin, 300131, P.R.China
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Hiemstra LA, Page JL, Kerslake S. Patient-Reported Outcome Measures for Patellofemoral Instability: a Critical Review. Curr Rev Musculoskelet Med 2019; 12:124-137. [PMID: 30835079 PMCID: PMC6542883 DOI: 10.1007/s12178-019-09537-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE OF REVIEW The purpose of this paper was to review the current psychometric properties of patient-reported outcome measures that are commonly used for patients with patellofemoral instability. This review provides evidence to guide the selection of subjective outcome measures for assessing outcomes in clinical care and research studies. RECENT FINDINGS At the present time, there are two patient-reported outcome measures that have been designed for, and tested on, large cohorts of patellofemoral instability patients, the Banff Patella Instability Instrument (BPII) and the Norwich Patellar Instability Score (NPI). The BPII is a wholistic quality of life outcome measure and the NPI is a symptom score. The use of disease-specific outcome measures such as the BPII and NPI, in combination with generic knee, functional activity, and/or psychological outcome measures that have been proven to be valid and reliable for the patellofemoral instability population, is most likely to provide a well-rounded evaluation of treatment outcomes.
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Affiliation(s)
- Laurie Anne Hiemstra
- Banff Sport Medicine, PO Box 1300, Banff, Alberta, T1L 1B3, Canada.
- Department of Surgery, University of Calgary, Calgary, Canada.
| | - Jessica L Page
- Banff Sport Medicine, PO Box 1300, Banff, Alberta, T1L 1B3, Canada
| | - Sarah Kerslake
- Banff Sport Medicine, PO Box 1300, Banff, Alberta, T1L 1B3, Canada
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Agarwalla A, Gowd AK, Liu JN, Puzzitiello RN, Yanke AB, Verma NN, Forsythe B. Concomitant Medial Patellofemoral Ligament Reconstruction and Tibial Tubercle Osteotomy Do Not Increase the Incidence of 30-Day Complications: An Analysis of the NSQIP Database. Orthop J Sports Med 2019; 7:2325967119837639. [PMID: 31019984 PMCID: PMC6463332 DOI: 10.1177/2325967119837639] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background: Lateral patellar dislocations account for 2% to 3% of total knee injuries, especially in adolescents. Depending on the anatomic abnormality contributing to lateral patellar instability, medial patellofemoral ligament reconstruction (MPFLR) and/or tibial tubercle osteotomy (TTO) may be indicated. Purpose: To assess the risk of adverse events (AEs) after TTO, MPFLR, and concomitant MPFLR and TTO. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent MPFLR, TTO, and concomitant MPFLR and TTO between 2005 and 2016 were identified through the American College of Surgeons–National Surgical Quality Improvement Program (ACS-NSQIP) database. Medical complications (eg, surgical site infection and deep vein thrombosis), readmission rates, and extended hospital stay within 30 days of the procedure were recorded. Outcomes were compared with bivariate and multivariate Poisson regression. Results: Out of 882 patients, 617 (70.0%) underwent isolated MPFLR, 170 (19.3%) underwent TTO, and 95 (10.8%) underwent concomitant MPFLR and TTO. The operative time for concomitant MPFLR and TTO was significantly longer (122 ± 45 minutes) compared with isolated MPFLR (97 ± 55 minutes; P < .001) and isolated TTO (89 ± 51 minutes; P < .001). There were 32 AEs (3.6%), with 10 AEs in the isolated TTO group (5.9%), 18 AEs in the isolated MPFLR group (2.9%), and 4 AEs in the MPFLR + TTO group (4.2%). There was no significant difference in the rate of AEs between the isolated MPFLR and isolated TTO groups (P = .1), isolated MPFLR and MPFLR + TTO groups (P = .5), and isolated TTO and MPFLR + TTO groups (P = .8). Diabetes mellitus was associated with an increased risk of developing an AE (odds ratio, 4.0; P = .003), and hypertension resulted in an increased risk of an extended hospital stay (odds ratio, 4.0; P = .010). Conclusion: While concomitant MPFLR and TTO significantly increased operative time, there was no difference in the rate of AEs, extended hospital stay, and readmissions within 30 days after isolated MPFLR, isolated TTO, and concomitant MPFLR and TTO.
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Affiliation(s)
- Avinesh Agarwalla
- Department of Orthopaedic Surgery, Westchester Medical Center, Valhalla, New York, USA
| | - Anirudh K Gowd
- Department of Orthopaedic Surgery, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Joseph N Liu
- Department of Orthopedic Surgery, Loma Linda University Medical Center, Loma Linda, California, USA
| | - Richard N Puzzitiello
- Department of Orthopaedic Surgery, Tufts University Medical Center, Boston, Massachusetts, USA
| | - Adam B Yanke
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Nikhil N Verma
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Brian Forsythe
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
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