Isolated Medial Patellofemoral Ligament Reconstruction in Patellar Instability: Does the Distance Between Tibial Tuberosity-Trochlear Groove Make a Difference?

Diego Edwards; Juan Pablo Casas-Cordero; Daniel Cerda; Julián Alonso; Francisco Cornejo; Rafael Calvo; Gerardo Zelaya

doi:10.1007/s43465-023-00906-6

Isolated Medial Patellofemoral Ligament Reconstruction in Patellar Instability: Does the Distance Between Tibial Tuberosity-Trochlear Groove Make a Difference?

Indian J Orthop. 2023 May 27;57(8):1203-1208. doi: 10.1007/s43465-023-00906-6. eCollection 2023 Aug.

Authors

Diego Edwards^{1

2}, Juan Pablo Casas-Cordero³, Daniel Cerda¹, Julián Alonso¹, Francisco Cornejo⁴, Rafael Calvo², Gerardo Zelaya^{1

5}

Affiliations

¹ Knee Team, La Florida Hospital, Froilán Roa 6542, La Florida, Santiago, Chile.
² Department of Traumatology, Alemana Clinic, Santiago, Chile.
³ Traumatology Resident, Finis Terrae University, Santiago, Chile.
⁴ Child Trauma Resident, Santiago University, Santiago, Chile.
⁵ Head of Unit Knee Team, La Florida Hospital, Santiago, Chile.

Abstract

Introduction: Medial patellofemoral ligament reconstruction (MPFLR) is used in most patellar instability surgeries, there is controversy on adding a tibial tuberosity osteotomy (TTO).

Objective: To describe the results of isolated MPFLR in patellar instability according to the Tibial Tuberosity-Trochlear Groove distance (TT-TG).

Methods: Retrospective study of patients with patellar instability with a mature skeleton in one center between 2016 and 2021, using isolated MPFLR. Patients with incomplete clinical and/or radiological records and less than one year follow-up were excluded. Pre-surgical demographic and radiological data (TT-TG, Caton-Deschamps (CD) index, patellar tilt, trochlear dysplasia) were recorded. Patients were divided into three groups according to TT-TG distance (Group 1: < 17 mm, Group 2: 17-19, Group 3: ≥ 20 mm). A pre and post-surgical Kujala score was performed. Local complications, satisfaction, recurrence and/or reintervention were recorded. Pre-surgical variables between groups, intra and inter-group Kujala differences were compared using Bartlett's test. Consent from the patients and approval from the local ethics committee were obtained.

Results: 67 patients met the selection criteria, mean age of 23 years, 70% were women. There were no pre surgical, radiological nor follow-up differences between the groups (average 27 months). Pre and post-surgical Kujala score, respectively: Group 1: 37-78, Group 2: 37-78, Group 3: 39-79. All groups had a significant improvement (p < 0.05), there were no significant differences in improvement between groups (p > 0.05). There were three patients with a redislocation episode, all in group 1. One patient had a mobilization under anesthesia due to an arthrofibrosis (Group 2). 97% of all cases reported being satisfied.

Conclusion: Isolated MPFLR in patellar instability presents a functional improvement, with a low rate of complications and failure, regardless of the pre surgical TT-TG.

Supplementary information: The online version contains supplementary material available at 10.1007/s43465-023-00906-6.

Keywords: Joint instability; Patellofemoral ligament; Tibial tuberosity osteotomy.

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