Anatomic medial patellofemoral ligament (MPFL) reconstruction with and without tibial tuberosity osteotomy for objective patellar instability

Abstract

Purpose: The aim of this study was to evaluate the clinical outcomes of patients treated with anatomic medial patellofemoral ligament (MPFL) reconstruction with and without tibial tuberosity osteotomy (TTO). Correlations between patient's age, gender, pre-injury physical activity and the achieved results were investigated as secondary endpoints. Methods: An observational retrospective study with prospective collected data was performed. Inclusion criteria were: treatment with anatomic MPFL reconstruction with gracilis tendon according to Schӧttle’s technique performed between 2011 and 2017; associated TTO as unique accessory procedure; skeletal joint maturity; a minimum follow-up of 12 months after surgery. Clinical outcomes were assessed with the Kujala, Lysholm and Tegner scores. Results: Forty patients (42 knees) were included, 64% of them underwent TTO. The Kujala score significantly improved from 47.4 ± 17.6 preoperatively to 89.4 ± 13.6 postoperatively (p < 0.01). The average Lysholm score was 45.6 ± 20.5 preoperatively: it showed a significant increase to 89.8 ± 12.8 postoperatively (p < 0.01). Pre-injury mean Tegner was 5.9 ± 1.8, while it dropped to 3.0 ± 1.6 after injury. After surgery, Tegner resulted 4.9 ± 1.6. Forty-three percent of patients regained the pre-injury sport activity level. Redislocation rate was 2.4%. Conclusion: Anatomic MPFL reconstruction allows excellent patellar stability recovery, knee functionality improvement, return to Activities of Daily Living and a low redislocation rate. Better results were achieved in younger (under 30 years old) and higher sports activity-level subjects. The TTO association provided clinical results comparable to isolated MPFL reconstructions, suggesting that the two procedures can be safely accomplished together without affecting the positive outcomes. Level of evidence: Level IV.