The remaining parameters of patellar instability could be affected for osteoarthritic change after medial patellofemoral ligament reconstruction with or without anteromedialization of the tibial tubercle osteotomy for patellar instability: a retrospective cohort study

Abstract

Background In literature, studies evaluating the factors associated the postoperative progression of patellofemoral (PF) osteoarthritis (OA) following patellar stabilization surgery are limited. This study aimed to compare the clinical outcomes after medial patellofemoral ligament reconstruction (MPFLR) as an isolated procedure (iMPFLR) and in combination with anteromedialization (AMZ) of the tibial tubercle osteotomy (TTO) and investigate the factors related to the postoperative progression of PFOA after patellar stabilization surgery. Methods Between 2009 and 2020, 30 knees of 23 consecutive patients underwent MPFLR with or without AMZ, using an autologous semitendinosus tendon graft; they were followed up for more than 2 years in the retrospective nature of the study. iMPFLR was performed in cases of recurrent patellar dislocation with normal tibial tubercle-trochlear groove (TT-TG) distance and no PFOA, and MPFLR+AMZ was performed for cases of excessive TT-TG distance, preoperative PFOA of recurrent patellar dislocation, or habitual patellar dislocation. Clinical findings and radiographs of the PF joint were evaluated pre- and postoperatively with PF alignment parameters and PFOA and were compared between surgical procedures. Factors for the postoperative progression of PFOA were compared between the OA progression and non-progression groups. Results Postoperative clinical score, radiographic parameters except for sulcus angle, TT-TG distance, and progression of PFOA were not significantly different between the iMPFLR and MPFLR+AMZ groups. Postoperative lateral patellar displacement (p = 0.001) and congruence angle (p = 0.017) were significantly different between the OA progression and non-progression groups. Conclusion Similar to MPFLR for recurrent cases, MPFLR with AMZ can improve the clinical and radiographic outcomes in severe cases. The remaining parameters of patellar instability could be affected in the postoperative progression of PFOA after MPFL reconstruction with or without AMZ of TTO for patellar instability.

Patellar motion and dysfunction of its stabilizers in a biomechanical model of the knee joint

“…Lateral dislocation of the patella can also lead to cartilage degeneration or damage to the medial facet of the patella [8,9]. Lateral displacement can overload the lateral surface of the patella [10,11] and cause degradation of the articular cartilage [2]. Cartilage damage increases pressure on the subchondral bone and activates nociceptive fi bers in the bone, causing pain [8].…”

Rehabilitation after surgery for patellar instability

“…The disorder is associated with a substantial reduction in knee function [ 9 , 27 , 61 ], persistent pain [ 3 , 61 ], kinesiophobia [ 53 ], activity limitations [ 4 , 26 , 38 , 57 , 58 , 61 ] and diminished health‐related quality‐of‐life [ 4 , 6 , 28 , 38 , 47 , 61 ]. Moreover, recurrent dislocations frequently result in early osteoarthritic changes in the patellofemoral joint, leaving patients dealing with both knee instability and pain [ 2 , 22 ]. While PI has traditionally been seen as a traumatic incident, there has been a change in focus on the internal risk factors that predispose patients to recurrent episodes of instability.…”

Early Postoperative Rapid Rehabilitation Yields More Favorable Short-term Outcomes in Patients Undergoing Patellar Realignment Surgery for Recurrent Patellar Dislocation: A Prospective Randomized Controlled Study

“…17 Conservative rehabilitation often involves postoperative fixation in a 0°extended position, with relatively prolonged restrictions on weightbearing and functional exercises. 1,9,12,17,27,39 This approach may lead to adhesions in the surgical site and patellar ligament contracture, resulting in the development of patella baja and quadriceps atrophy as well as pain and restricted movement. 2,8,20 For some patients, the return to physical activity is delayed.…”