Comparison of Clinical and Radiological Outcomes Between Transosseous Tunnel and Suture Anchor Patellar Fixation for Medial Patellofemoral Ligament Reconstruction: A Cohort Study With 2-Year Follow-up

Abstract

Background: Several surgical methods have been developed for medial patellofemoral ligament reconstruction (MPFLR). However, the question of which patellar fixation method, suture anchor (SA) or transosseous tunnel (TO) fixation, achieves better overall outcomes remains to be answered. Hypothesis: SA patellar fixation will present comparable clinical outcomes and a lower complication rate compared with TO patellar fixation for MPFLR. Study Design: Cohort study; Level of evidence, 3. Methods: We retrospectively reviewed the outcomes of 46 patients who underwent MPFLR with either TO fixation (n = 21; mean age, 24.4 ± 6.1 years) or SA fixation (n = 25; mean age, 24.1 ± 12.1 years) for the treatment of recurrent patellar dislocation. Clinical findings (International Knee Documentation Committee [IKDC] subjective score, Lysholm score, and Tegner activity score), radiological findings (congruence angle and patellar tilt angle), and complications (redislocation, patellar fracture, patellofemoral osteoarthritis progression, infection, and stiffness) were compared between the TO and SA groups at the 2-year follow-up visit. Results: The mean postoperative IKDC subjective and Lysholm scores did not differ significantly between groups. However, postoperative Tegner activity scores were significantly higher in the TO group than in the SA group (TO, 5.8 ± 1.4; SA, 4.9 ± 1.2; P = .012). Congruence angle did not differ significantly between the groups (TO, −3.2 ± 22.8; SA, −7.6 ± 17.8; P = .464). Patellar tilt angle was lower in the TO group than in the SA group (TO, 10.5 ± 5.4; SA, 13.7 ± 2.8; P = .015). During the follow-up period, the TO group had 1 redislocation and 2 patellar fractures, whereas the SA group had no redislocations or fractures. Patellofemoral osteoarthritis progression was significantly higher in the TO group than in the SA group at the 2-year follow-up visit (TO, 9/21; SA, 2/25; P = .006). Conclusion: Both TO and SA patellar fixation methods for MPFLR showed improved clinical outcomes. When compared with TO fixation, SA fixation presented comparable clinical outcomes and a lower complication rate.

Arthroscopy‐controlled medial reefing and lateral release for recurrent patellar dislocation: clinical, radiologic outcomes and complications

“…Postoperative complications such as redislocation, patellar fracture, patellofemoral osteoarthritis (PFOA) progression, infection, and stiffness were compared between the groups. PFOA progression was defined as an arthritic change that is more progressive than the preoperative state of the patellofemoral joint on skyline radiography at the final follow-up [ 8 ]. Arthritic changes of the patellofemoral joint were qualitatively evaluated using the Kellgren-Lawrence (K-L) classification [ 14 ].…”

“…Historically, patients with recurrent patellar dislocation have been treated with various surgical techniques such as medial patellofemoral ligament (MPFL) reconstruction and medial soft tissue realignment surgery [ 8 – 10 ]. A previous systematic review reported that medial soft tissue realignment surgery is associated with less favorable clinical outcomes than MPFL reconstruction [ 11 ].…”

Concomitant anterior medializing osteotomy and MPFL reconstruction improves patellar tilt when compared to MPFL reconstruction alone

“…Merchant view radiographs at the pre-operative visit and the irst post-operative visit were used to determine tilt at each timepoint, using a previously validated method, as shown in Fig. 1 [33]. The tilt diference was calculated as pre-operative tilt minus post-operative tilt.…”

Engineered Cell Based Therapeutics

“…Since CD28 stimulation and activeness, it is critical for the T Cell activation as there is greater interest in CDD8 as a target for immunotherapy approaches. Acellular biomaterials are capable of stimulating the local environment for repairing tissues without any scienti ic or regulatory challenges for T cell-based therapies on a large scale (Yoon et al, 2020). There has been a great understanding of the mechanism of the internal tissue repair, which takes a step further in designing the application of biomaterials present.…”