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Long-term clinical and radiographic outcome of patello-femoral realignment procedures: a minimum of 15-year follow-up

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

A retrospective single-centre study was focused on the long-term outcome after different patello-femoral (PF) realignment procedures.

Methods

Thirty-nine patients treated for recurrent PF instability were examined after a mean post-operative time of 22.5 years. Their 78 knees were divided into: non-operated knees (NON-OPERATED)—N = 24, isolated proximal procedures (PROXIMAL)—N = 22, isolated distal procedures (DISTAL)—N = 10, and combined procedures (COMBINED)—N = 22. PF-related medical history together with clinical, subjective (KOOS and Kujala scores), and radiographic (Caton–Deschamps PF height index, Kellgren–Lawrence scale for tibio-femoral OA, and Iwano classification for PF OA) evaluation was conducted.

Results

PF re-dislocation rate was comparable between PROXIMAL (36 %), DISTAL (20 %), and COMBINED (32 %). Isolated proximal procedures revealed less central patella positions (PROXIMAL 64 %; DISTAL 90 %; COMBINED 95 %) and more frequent PF apprehension test (PROXIMAL 82 %; DISTAL 40 %, COMBINED 50 %). KOOS and Kujala scores were similar in all three surgical subgroups, but significantly lower than in NON-OPERATED. Patellas were positioned lower after DISTAL, 0.8 (0.5–1.0) or COMBINED, 0.9 (0.4–1.3). Kellgren–Lawrence scores ≥2 were found in 42 % NON-OPERATED, 37 % PROXIMAL, 70 % DISTAL, and 59 % COMBINED, whereas Iwano classification ≥2 was confirmed in 46 % NON-OPERATED, 64 % PROXIMAL, 80 % DISTAL, and 86 % COMBINED.

Conclusions

High PF re-dislocation rates together with a very high incidence of PF OA indicate that PF realignment strategies used traditionally had failed to reach their long-term expectations. The transfer of tibial tuberosity resulted in more constrained PF joints than isolated proximal procedures which allowed for more residual PF instability. Distal procedures additionally increased the likelihood for tibio-femoral OA.

Level of evidence

III.

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Authors and Affiliations

  1. Medical Faculty, University of Ljubljana, Ljubljana, Slovenia

    Gregor Vivod

  2. Faculty of Physiotherapy and Orthopedic Surgery, Ghent University, Ghent, Belgium

    Peter Verdonk

  3. Department of Orthopedic Surgery, Monica Hospitals, Antwerp, Belgium

    Peter Verdonk

  4. Department of Orthopedic Surgery, University Medical Centre Ljubljana, Zaloška 9, 1000, Ljubljana, Slovenia

    Matej Drobnič

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  1. Gregor Vivod
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Correspondence to Matej Drobnič.

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Vivod, G., Verdonk, P. & Drobnič, M. Long-term clinical and radiographic outcome of patello-femoral realignment procedures: a minimum of 15-year follow-up. Knee Surg Sports Traumatol Arthrosc 22, 2747–2755 (2014). https://doi.org/10.1007/s00167-013-2637-2

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