Quality of life following medial patellofemoral ligament reconstruction combined with medial tibial tubercle transfer in patients with recurrent patellar dislocation: a retrospective comparative study

Abstract

Background Because the patients undergoing medial patellofemoral ligament reconstruction (MPFLr) combined with medial tibial tubercle transfer (TTT) procedure are usually young and active, the quality of life (QoL) is also an important prognostic factor for patients with recurrent patellar dislocation. Assessing QoL can provide more useful and accurate evidence for the effects of this procedure. This study aimed to evaluate QoL following MPFLr combined with TTT, compared with isolated MPFLr (iMPFLr). Methods Fifty-one patients who underwent iMPFLr + TTT and 48 patients who underwent iMPFLr were included. Clinical evaluation included QoL (EQ-5D-5L and EQ-5D VAS), functional outcomes (Kujala, Lysholm and Tegner activity scores), physical examinations (patellar apprehension test and range of motion) and redislocation rates. Radiological evaluation included patellar tilt angle and bisect offset. These preoperative and postoperative results were compared between groups at baseline and the final follow-up. The paired and independent t tests were used for the data following a normal distribution. Otherwise, the Wilcoxon and Mann–Whitney U tests were used to analyze the differences. Categorical variables were compared by chi-square or Fisher’s exact test. Results All of the QoL (EQ-5D-5L and EQ-5D VAS), clinical results and radiological outcomes significantly improved in both groups at the final follow-up, with no significant differences between groups. There was no significant difference in five dimensions of EQ-5D at the final follow-up, although percentages of people with problems of mobility and pain/discomfort were higher in the MPFLr + TTT group. Female patients had lower EQ-5D index and EQ-5D VAS compared with male patients in both groups at the final follow-up, but there was only a significant difference in the EQ-5D VAS. Conclusions Both MPFLr + TTT and iMPFLr groups obtained similar and satisfactory improvements in the QoL, clinical results and radiological outcomes, indicating that MPFLr combined with TTT is a safe and effective procedure, which can significantly improve the QoL for patients with recurrent patellar dislocation in cases of pathologically lateralized TT. However, female patients obtained lower QoL than males.

Derotational distal femur osteotomy with medial patellofemoral ligament reconstruction can get good outcomes in the treatment of recurrent patellar dislocation with excessive TT-TG and increased femoral anteversion

“…The patellofemoral joint stability depends on both bone morphology and soft tissue restraints, and it has a role of fundamental importance for proper functioning of the knee extensor mechanism (4). Abnormal pathology and anatomy of soft tissues and bones are present in PD, including disruption of medial soft tissue, trochlear dysplasia, patella alta, torsional deformity, and excessive tibial tubercle-trochlear groove (TT-TG) distance (6,7). Among them, excessive TT-TG and increased femoral anteversion (FA), as important risk factors for PD, have attracted more and more attention in recent years (6,(8)(9)(10).…”

“…Abnormal pathology and anatomy of soft tissues and bones are present in PD, including disruption of medial soft tissue, trochlear dysplasia, patella alta, torsional deformity, and excessive tibial tubercle-trochlear groove (TT-TG) distance ( 6 , 7 ). Among them, excessive TT-TG and increased femoral anteversion (FA), as important risk factors for PD, have attracted more and more attention in recent years ( 6 , 8 – 10 ).…”

Distal femoral torsion is correlated with higher‐grade trochlear dysplasia and shorter anterior condyles in patients with patellar dislocation and increased femoral torsion

“…Recurrent patellar dislocation is a common and debilitating condition with multifactorial aetiologies associated with various pathoanatomical factors, which usually affects young active children and adolescents [6,20,26]. Of all the anatomical variants, increased femoral torsion is a potential risk factor for recurrent patellar dislocation, which may exert a persistent lateralizing force vector on the patella and lead to increased tension of the reconstructed medial patellofemoral ligament (MPFL), thus causing anterior knee pain, patellar maltracking, early cartilage degeneration, graft failure and patellar redislocation [8,10,19,21,24,28,30].…”

Medial patellofemoral ligament reconstruction combined with derotational distal femoral osteotomy yields better outcomes than isolated procedures in patellar dislocation with increased femoral anteversion

“…Lateral patellar dislocation (LPD) is a common and debilitating condition in children and adolescents, causing pain, functional impairment, and potential patellofemoral arthritis [19,30,34]. Abnormal pathology and anatomy of soft tissues and bones are present in LPD, including disruption of medial soft tissue, trochlear dysplasia, patella alta, torsional deformity, and increased tibial tubercle-trochlear groove (TT-TG) distance [12,40].…”