Medial patellofemoral ligament reconstruction in skeletally immature patients without correction of bony risk factors leads to acceptable outcomes but higher failure rates

Leite, Chilan Bou Ghosson; Hinckel, Betina B.; Ribeiro, Gabriel Fernandes; Giglio, Pedro Nogueira; Santos, Tarsis Padula dos; Bonadio, Marcelo Batista; Arendt, Elizabeth A.; Gobbi, Riccardo Gomes

doi:10.1016/j.jisako.2023.02.003

Cited by 4 publications

(1 citation statement)

References 53 publications

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“…Zhang et al investigated the potential role of TFR as a marker for predicting surgical failure after MPFL‐R and found a TFR of 12.3° or more to be a reliable predictor for surgical failure [32]. Leite et al reported similar findings, namely that increased TFR was associated with a higher risk of recurrence after MPFL‐R [16]. In the present study, TFR was significantly higher in the nonlateralisation group than in the lateralisation group (15.4 vs. 9.4, P < 0.001), which may help to explain why patients in the nonlateralisation group had a significantly lower Kujala score and Lysholm score.…”

Section: Discussionmentioning

confidence: 99%

Increased TT–TG distance caused by excessive tibiofemoral rotation predicts poor clinical outcomes after tibial tubercle osteotomy in recurrent patellar dislocation

Zhang,

Feng,

et al. 2023

Knee surg. sports traumatol. arthrosc.

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Purpose To compare clinical outcome between recurrent patellar dislocation (RPD) with or without actual tibial tubercle lateralisation (TTL) after medial patellofemoral ligament reconstruction (MPFL-R) combined with tibial tubercle transfer. Methods From 2015 to 2018, a total of 172 knees with RPD and a tibial tubercle-trochlear groove (TT-TG) distance of > 20 mm were treated with MPFL-R combined with tibial tubercle transfer. Patients were divided into the lateralisation group (TT-PCL > 24 mm, n = 74) and the nonlateralisation group (TT-PCL ≤ 24 mm, n = 60) based on the presence or absence of actual TTL (TT-PCL > 24 mm). Clinical outcomes were assessed postoperatively at a minimum of 2 years. Second-look arthroscopic evaluations were available for 84 knees to assess cartilage damage. Results A total of 134 knees with a median follow-up time of 32 months were included. Tibiofemoral rotation (TFR) was signiicantly higher in the nonlateralisation group than in the lateralisation group (15.4° vs. 9.4°, P < 0.001). At the inal follow-up, the nonlateralisation group had signiicantly lower Kujala (78.2 vs. 86.4, P = 0.001) and Lysholm (80.3 vs. 88.2, P = 0.003) scores than the lateralisation group. At the time of the second-look arthroscopic assessment, 38.9% of the patients in the nonlateralisation group showed cartilage worsening in the medial patellar facet that was signiicantly higher than that in the lateralisation group (38.9% vs. 12.5%, P = 0.015). Conclusion Patients with RPD and an increased TT-TG distance of > 20 mm but without actual tibial tubercle lateralisation beneit less from tibial tubercle transfer than patients with actual tibial tubercle lateralisation, which may be related to the signiicantly higher tibiofemoral rotation angle of the former. Level of evidence III.

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Section: Discussionmentioning

confidence: 99%

Increased TT–TG distance caused by excessive tibiofemoral rotation predicts poor clinical outcomes after tibial tubercle osteotomy in recurrent patellar dislocation

Zhang,

Feng,

et al. 2023

Knee surg. sports traumatol. arthrosc.

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Bony Procedures for surgical patellar stabilization

Hinckel,

Liebensteiner,

Smith

et al. 2024

Journal of ISAKOS

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Navigating medial patellotibial ligament reconstruction: Clinical perspectives and surgical strategies

Zicaro,

Garcia-Mansilla

2025

World J Clin Cases

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The surgical approach for patellar instability usually refers to reconstruction of the medial patellofemoral ligament associated with an osteotomy of the tibial tuberosity or a trochleoplasty when required. The medial patellotibial ligament and the medial patellomeniscal ligament are secondary stabilizers of the patella. Despite this, both the medial patellotibial and patellofemoral ligaments aid in patellar rotation and tilt when the knee is flexed beyond 45°. The medial patellotibial ligament plays a particularly important role in the final stages of stretching in extension and between 40 degrees to 90 degrees of flexion. The clinical relevance and surgical indications for medial patellotibial ligament reconstruction associated with medial patellofemoral ligament reconstruction are still controversial. This editorial explores the surgical indications and clinical results for medial patellotibial ligament reconstruction to improve readers’ understanding of this technique, especially because reported clinical outcomes have remained sparse.

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Medial patellofemoral ligament reconstruction in skeletally immature patients without correction of bony risk factors leads to acceptable outcomes but higher failure rates

Cited by 4 publications

References 53 publications

Increased TT–TG distance caused by excessive tibiofemoral rotation predicts poor clinical outcomes after tibial tubercle osteotomy in recurrent patellar dislocation

Increased TT–TG distance caused by excessive tibiofemoral rotation predicts poor clinical outcomes after tibial tubercle osteotomy in recurrent patellar dislocation

Bony Procedures for surgical patellar stabilization

Navigating medial patellotibial ligament reconstruction: Clinical perspectives and surgical strategies

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