Does severity of femoral trochlear dysplasia affect outcome in patellofemoral instability treated by medial patellofemoral ligament reconstruction and anterior tibial tuberosity transfer?

Moitrel, G; Roumazeille, Thibaut; Arnould, A.; Migaud, Henri; Putman, Sophie; Ramdane, Nassima; Pasquier, Gilles

doi:10.1016/j.otsr.2015.06.020

Cited by 21 publications

(9 citation statements)

References 13 publications

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“…Theoretically, an ideal graft should have very similar material properties to the native structure. 53,61 Here, although most studies have confirmed a nonlinear force-displacement relationship of the MPFL during axial loading, reported values for failure load, ultimate elongation, and stiffness are inconsistent. From this systematic review, it has now become clear that the mean ultimate load ranges from 72 N to 208 N. 6,14,32,33,35,45,55 The variability in structural properties is likely partially because of differences in experimental conditions under which the tissues were tested.…”

Section: Mechanical Properties Of the Mpflmentioning

confidence: 87%

Properties and Function of the Medial Patellofemoral Ligament: A Systematic Review

et al. 2019

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Background: As the main passive structure preventing patellar lateral subluxation, accurate knowledge of the anatomy, material properties, and functional behavior of the medial patellofemoral ligament (MPFL) is critical for improving its reconstruction. Purpose: To provide a state-of-the-art understanding of the properties and function of the MPFL by undertaking a systematic review and statistical analysis of the literature. Study Design: Systematic review. Methods: On June 26, 2018, data for this systematic review were obtained by searching PubMed and Scopus. Articles containing numerical information regarding the anatomy, mechanical properties, and/or functional behavior of the MPFL that met the inclusion criteria were reviewed, recorded, and statistically evaluated. Results: A total of 55 articles met the inclusion criteria for this review. The MPFL presented as a fanlike structure spanning from the medial femoral epicondyle to the medial border of the patella. The reported data indicated ultimate failure loads from 72 N to 208 N, ultimate failure elongation from 8.4 mm to 26 mm, and stiffness values from 8.0 N/mm to 42.5 N/mm. In both cadaveric and in vivo studies, the average elongation pattern demonstrated close to isometric behavior of the ligament in the first 50° to 60° of knee flexion, followed by progressive shortening into deep flexion. Kinematic data suggested clear lateralization of the patella in the MPFL-deficient knee during early knee flexion under simulated muscle forces. Conclusion: A lack of knowledge regarding the morphology and attachment sites of the MPFL remains. The reported mechanical properties also lack consistency, thus requiring further investigations. However, the results regarding patellar tracking confirm that the lack of an MPFL leads to lateralization of the patella, followed by delayed engagement of the trochlear groove, plausibly leading to an increased risk of patellar dislocations. The observed isometric behavior up to 60° of knee flexion plausibly suggests that reconstruction of the ligament can occur at flexion angles below 60°, including the 30° and 60° range as recommended in previous studies.

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Section: Mechanical Properties Of the Mpflmentioning

confidence: 87%

Properties and Function of the Medial Patellofemoral Ligament: A Systematic Review

et al. 2019

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“…There is evidence to support that trochlear dysplasia negatively affects patient-reported outcomes of MPFL-R with and without tibial tubercle osteotomy for patellar instability. 19,29,44 In our series, nearly all patients with recurrent instability had evidence of trochlear dysplasia, as judged a positive crossing sign (94%).…”

Section: Discussionmentioning

confidence: 60%

“…More recently, medial patellofemoral ligament reconstruction (MPFL-R) has been added to the surgical armamentarium, 41 leading some authors to question the surgical thresholds outlined in the menu guidelines. 20,27,29,41 The purposes of this study were as follows:…”

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confidence: 99%

Distalization of the Tibial Tubercle for Patellar Stabilization Combined With Medial Patellofemoral Ligament Reconstruction: Length of Distalization or Residual Patella Alta and its Affect on Outcome

et al. 2022

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Background: Previous research supports that distal translation of the tibial tubercle osteotomy (dTTO) for patients with recurrent lateral patellar dislocation (R-LPD) and patella alta is effective for surgical patellar stabilization. Hypothesis/Purpose: The main purpose of this article is to evaluate (1) the results of modifying the surgical threshold and postoperative goal of patellar height measurements for surgical stabilization originated in the “menu à la carte” approach to patellar surgical stabilization and (2) the relationship between the distance distalized in millimeters and postoperative complications. Our hypothesis was that dTTO with medial patellofemoral ligament reconstruction (MPFL-R) will successfully stabilize the patella with improvement in outcome scores and few complications, using a modification of the original menu à la carte as our surgical algorithm. Study Design: Case series; Level of evidence, 4. Methods: A total of 68 consecutive patients with R-LPD underwent dTTO and MPFL-R for surgical patellar stabilization by a single surgeon between May 2009 and September 2015. Surgical indications were R-LPD combined with patella alta. The surgical threshold for dTTO was Caton-Deschamps index (CDI) or Insall-Salvati ratio ≥1.4 and/or a patellar trochlear index <0.15. The postoperative surgical goal for patellar height was a CDI of 1.1 to 1.2. Length of the distalization was computed by using the CDI measurement as the primary intraoperative guide and measured intraoperatively with a ruler. Clinical, radiographic, and patient outcome measures were reviewed. Results: The mean CDI preoperatively was 1.40 and postoperatively it was 1.09. The mean distalization was 9.9 mm (range, 4-15 mm). Three patients (4.4%) had frank R-LPD postoperatively. Ten patients had residual patella alta (CDI >1.2), with 1 redislocation. Mean postoperative CDI in the recurrent dislocation group was 1.13 (range, 1.06-1.25) as compared with 1.09 (range, 0.92-1.35) in the nonrecurrent group ( P = 0.65). Complications included 3 tibial fractures (4.4%) and postoperative knee arthrofibrosis in 6 patients (8.8%), with mean distalization greater in the arthrofibrosis group ( P = .04). Knee injury and Osteoarthritis Outcome Score (KOOS) values improved in all domains, including a 31–point increase in Quality of Life. Conclusion: dTTO with MPFL-R for patients with patella alta leads to a high rate of normalization of patellar height measurements (87%) and patellar stabilization (95.6%). Residual patella alta is not associated with an increased risk of recurrence. The length of dTTO up to 15 mm is not associated with an increase in postoperative complications, except for an increased prevalence of arthrofibrosis (8.8%).

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“…Following abstract and full-text screening, 38 studies were kept which pertained to the inclusion and exclusion criteria. Of these, 31 studies addressed isolated MPFLR, 3,16 –18,26 –52 three addressed combined MPFLR, 53 –55 and four papers addressed both. 12,13,56,57 Of the papers investigating isolated MPFLR, three studies did not impose any exclusion for patients with an elevated TT-TG distance or Q-angle, while the other 28 did.…”

Section: Resultsmentioning

confidence: 99%

Isolated versus combined medial patellofemoral ligament reconstruction for lateral instability of the patella

Sivakumar

Phan

et al. 2019

J Orthop Surg (Hong Kong)

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Introduction: Medial patellofemoral ligament reconstruction (MPFLR) is regularly combined with a tibial tuberosity transfer (TTT) in cases of recurrent patellar instability with underlying structural deformity. However, these indications for a TTT have recently come into question. This study aimed to assess the traditional indications by comparing the outcomes of isolated and combined MPFLR for the treatment of recurrent lateral patellar dislocation. Methods: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Included studies were those which reported the outcomes of either isolated or combined or both MPFLR. Studies were required to report at least one of the following: redislocation rate, revision due to instability, or the Kujala score. Results: We found no difference between isolated and combined MPFLR in terms of redislocation (p ¼ 0.48), revisions due to instability (p ¼ 0.36), positive apprehension tests (p ¼ 0.25), or the Kujala score (p ¼ 0.58). Combined reconstruction presented more complications compared to isolated procedures (p ¼ 0.05). Subgroup analysis revealed no significant difference between studies investigating isolated medial patellofemoral ligament reconstruction MPFLR performed in patients with normal tibial tuberosity-trochlear groove (TT-TG) distances only or in patients with both normal and elevated TT-TG distances. Conclusions: According to the published data, there is no difference in outcomes between isolated and combined MPFLR. Underlying structural deformity did not demonstrate any significant effect on the success of the isolated MPFLR. Although there are definite indications for combined reconstruction, the current evidence suggests that our inclusion criteria may not be entirely correct. Further study is required to clarify and refine the true indications for combined MPFLR. Level of Evidence: III, meta-analysis of nonrandomized studies.

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Does severity of femoral trochlear dysplasia affect outcome in patellofemoral instability treated by medial patellofemoral ligament reconstruction and anterior tibial tuberosity transfer?

Abstract: III, retrospective case-control study.

Cited by 21 publications

References 13 publications

Properties and Function of the Medial Patellofemoral Ligament: A Systematic Review

Properties and Function of the Medial Patellofemoral Ligament: A Systematic Review

Distalization of the Tibial Tubercle for Patellar Stabilization Combined With Medial Patellofemoral Ligament Reconstruction: Length of Distalization or Residual Patella Alta and its Affect on Outcome

Isolated versus combined medial patellofemoral ligament reconstruction for lateral instability of the patella

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