Medial patellofemoral ligament imbrication reduced instability
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Published results showed anteromedialization tibial tubercle osteotomy with medial patellofemoral ligament imbrication decreased the risk of recurrent patellofemoral instability among patients with trochlear dysplasia.
Alan L. Zhang, MD, and colleagues retrospectively collected recurrent dislocation events, KOOS score, WOMAC index, Kujala scores and satisfaction of 31 patients with trochlear dysplasia who underwent medial patellofemoral ligament imbrication and concomitant anteromedialization tibial tubercle osteotomy for recurrent patellofemoral instability. Researchers also collected patient demographic information, including age at the time of surgery, sex, BMI, tibial tubercle-trochlear groove distance and grade of trochlear dysplasia.
Researchers classified two knees as having low-grade trochlear dysplasia and 35 knees as having high-grade trochlear dysplasia. Results showed patients had mean KOOS subscale scores of 86.5 for pain, 79.8 for symptoms, 93.9 for activities of daily living, 74.3 for sports/recreation and 61.9 for quality of life at final follow-up. Researchers also found patients had a mean Kujala score of 81.3, as well as a mean patient satisfaction score of 8.3 of 10. Postoperatively, 86.5% of knees remained stabled without recurrent instability, according to results. Researchers noted 13.5% of knees had recurrent dislocation with two knees requiring revision surgery, while 21.6% of knees underwent subsequent hardware removal.
“The study shows that patellar instability due to high-grade trochlear dysplasia can be successfully treated with anteromedialization tibial tubercle osteotomy and [medial patellofemoral ligament] MPFL imbrication,” Zhang told Healio Orthopedics. “Although new techniques such as trochleoplasty have surfaced, we found that a classic approach to patellar instability was effective for treatment in the setting of trochlear dysplasia.”
Perspective
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James Bicos, MD
The article looked at whether medial patellofemoral ligament imbrication and tibial tubercle osteotomy could successfully treat recurrent patellar dislocations in patients with trochlear dysplasia. I commend the authors on trying to study the complexities of the patellofemoral compartment, but there are some inherent flaws with the study that cannot be overlooked. Unfortunately, the study being a retrospective review allows no direct comparison to a control group, making the outcomes difficult to assess. The authors specifically state that there were no preoperative outcome scores to compare to, so I am not quite sure how any valid statistical comparisons on outcomes could be made. One thing we need to understand more are the preoperative risk factors for failure of patellofemoral reconstructive procedures. Finally, they listed outcomes comparable to other published literature studies, but I think the study could have better validity if it was adequately powered.
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