Osteotomy may yield better outcomes vs. tibial tubercle transfer for MPFL reconstruction
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Key takeaways:
- De-rotational osteotomy may be preferred vs. tibial tubercle transfer for medial patellofemoral ligament reconstruction.
- Osteotomy was associated with better outcomes vs. tibial tubercle transfer.
Published results showed de-rotational osteotomy with medial patellofemoral ligament reconstruction was associated with better outcomes vs. tibial tubercle transfer with MPFL reconstruction for patellar instability and torsion deformity.
Researchers performed a retrospective study of data from 36 patients with recurrent patellar instability and torsion deformity who underwent surgery. Mean follow-up was 30 months. Among the cohort, 18 patients underwent double-level knee de-rotational osteotomy combined with MPFL reconstruction and 18 patients underwent tibial tubercle transfer combined with MPFL reconstruction.
Outcomes included Kujala, VAS, Lysholm, IKDC, Tegner and KOOS scores, as well as radiographic parameters.
Compared with the tubercle transfer cohort, patients in the osteotomy cohort had better scores for all postoperative functional outcomes except for the KOOS daily living activities subscore and the KOOS sports and recreation subscore.
In addition, researchers found all postoperative radiographic parameters were within normal ranges except for patellar height in both cohorts and femoral torsion and tibial torsion in the tibial tubercle transfer cohort.
They found patients in the osteotomy cohort had a lower patellar tilt angle compared with the tubercle transfer cohort (2.3° vs. 8.4°). They noted one patient (6%) in the osteotomy cohort and eight patients (44%) in the tubercle transfer cohort had postoperative anterior knee pain, while no patients from either cohort had a patellar dislocation.
Overall, researchers found more patients in the osteotomy cohort achieved the minimal clinically important difference for patient-reported outcomes vs. patients in the tubercle transfer cohort.
“[Knee de-rotational osteotomy] might be a better option for patients with torsional malformation without causing severe complications,” the researchers wrote in the study.
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