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

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

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

Methods

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

Results

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

Conclusion

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

Level of evidence

IV.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Service de Chirurgie orthopédique, Centre Hospitalo Universitaire de Saint-Étienne, University Hospital of Saint Etienne, Hôpital Nord, 42055, Saint-Étienne Cedex 2, France

    Thomas Neri, Clara Gensac, Bertrand Boyer, Frederic Farizon & Remi Philippot

  2. EA 7424, Inter-University Laboratory of Human Movement Science, University Lyon, University Jean Monnet Saint Etienne, Saint-Étienne, France

    Thomas Neri, Frederic Farizon & Remi Philippot

  3. Sydney Orthopaedic Research Institute, Sydney, Australia

    Thomas Neri, David Anthony Parker & Aaron Beach

Authors
  1. Thomas Neri
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  2. David Anthony Parker
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  3. Aaron Beach
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  4. Clara Gensac
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  5. Bertrand Boyer
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  6. Frederic Farizon
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  7. Remi Philippot
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Correspondence to Thomas Neri.

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The authors declare that they have no competing interests. No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of our institutional research committee and with the 1964 Helsinki declaration and its later amends or comparable standard.

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Neri, T., Parker, D.A., Beach, A. et al. Medial patellofemoral ligament reconstruction with or without tibial tubercle transfer is an effective treatment for patellofemoral instability. Knee Surg Sports Traumatol Arthrosc 27, 805–813 (2019). https://doi.org/10.1007/s00167-018-5102-4

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