Anteromedial Tibial Tubercle Osteotomy Improves Results of Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Instability in Patients With Tibial Tuberosity–Trochlear Groove Distance of 17 to 20 mm

• Published in: Arthroscopy Vol. 35; no. 2; pp. 566 - 574
• Main Authors: Franciozi, Carlos Eduardo, Ambra, Luiz Felipe, Albertoni, Leonardo José Bernardes, Debieux, Pedro, Granata, Geraldo Sergio de Mello, Kubota, Marcelo Seiji, Carneiro, Mario, Abdalla, Rene Jorge, Luzo, Marcus Vinícius Malheiros, Cohen, Moisés
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2019
• Subjects: Adolescent; Adult; Female; Femur - surgery; Humans; Joint Instability - pathology; Joint Instability - surgery; Knee Joint - physiopathology; Knee Joint - surgery; Male; Osteotomy - methods; Patella - physiopathology; Patellar Dislocation - pathology; Patellar Dislocation - surgery; Patellar Ligament - surgery; Patellofemoral Joint - surgery; Postoperative Period; Prospective Studies; Recovery of Function; Recurrence; Tibia - pathology; Tibia - surgery; Young Adult
• ISSN: 0749-8063; 1526-3231; 1526-3231
• DOI: 10.1016/j.arthro.2018.10.109

To compare the midterm clinical outcomes of anteromedialization tibial tubercle osteotomy combined with medial patellofemoral ligament reconstruction (TTO+MPFLR) with MPFLR alone (MPFLRa) for the treatment of recurrent patellar instability (RPI) in patients with a tibial tuberosity–trochlear groove (TT-TG) of 17 to 20 mm. From January 2008 to August 2013, patients with RPI and a TT-TG of 17 to 20 mm were divided into 2 groups: TTO+MPFLR or MPFLRa. Subjects were evaluated for J sign classification (1-4+); patellar glide (1-4+); the apprehension test; increased femoral anteversion; the Caton index; trochlear dysplasia; TT-TG; and Kujala, Lysholm, International Knee Documentation Committee (IKDC), and Tegner scores. Kujala improvement was the primary outcome. Forty-two subjects were evaluated, 18 in the TTO+MPFLR group and 24 in the MPFLRa group. Mean follow-up time was 40.86 months (range, 24-60 months). Demographics between the groups were not different. Preoperatively, there was no statistically significant difference between groups regarding J sign classification; patellar glide; the apprehension test; increased femoral anteversion; the Caton index; trochlear dysplasia; TT-TG; and Kujala, Lysholm, IKDC, and Tegner scores. Postoperative J sign classification mean results comparing TTO+MPFLR and MPFLRa, respectively, were 1 and 1.33 (P = .006). Improvement was significantly higher in the TTO+MPFLR group in all scores except for Tegner. Kujala improvement, 30.27 and 23.95, respectively (P = .003), was also clinically significant, favoring TTO+MPFLR. Lysholm improvement was 40.5 and 36.2, respectively (P = .02), and IKDC improvement was 38.59 and 31.6, respectively (P = .002). There were no reported recurrent subluxations or dislocations in either group. TTO+MPFLR resulted in better functional outcome scores and patellar kinematics compared with MPFLRa in the surgical treatment of RPI in patients with a TT-TG distance of 17 to 20 mm. Level II, prospective comparative study.