MPFL reconstruction for patellar instability after TKA may yield satisfactory results
Published results showed appropriately selected patients with patellofemoral instability after total knee arthroplasty may experience satisfactory results when treated with medial patellofemoral ligament reconstruction.
“Patella instability after total knee arthroplasty in appropriately selected patients is treatable with a medial patellofemoral ligament reconstruction and additional tibial tubercle-osteotomy when indicated,” Jobe Shatrov, MBBS(Hons), BSc, told Healio. “The results of this study provide a treatment algorithm for surgeons faced with this difficult problem.”
Shatrov and colleagues retrospectively studied the results of MPFL reconstruction using a quadriceps tendon autograft in 22 patients with patellofemoral instability after TKA. Surgeons fixed the graft with either an interference screw or additional suspensory fixation and performed a tibial tubercle osteotomy for select indications. Researchers assessed patients with Kujala and IKDC scores at a minimum 12-month follow-up and studied patients’ plain radiographs.
Results showed patients had an average preoperative femoral component rotation on CT of 0.10° external rotation. Researchers found improved postoperative clinical and radiographic outcomes in all patients, with a mean IKDC knee score of approximately 77.6, mean IKDC function score of approximately 75.2 and a mean Kujala score of approximately 60.2. Researchers noted one mechanical failure that occurred after MPFL reconstruction with interference fixation and six complications postoperatively. Although patients had higher clinical and radiographic scores with double fixation of the MPFL reconstruction graft, results showed the difference was not statistically significant. Researchers found MPFL reconstruction had a patella lowering effect from 0.97 preoperatively to 0.74 postoperatively.
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