Paper 19: Outcomes for Primary versus Revision Medial Patellofemoral Ligament Reconstruction with Concomitant Tibial Tubercle Osteotomy

• Published in: Orthopaedic journal of sports medicine 2022-05, Vol.10 (5_suppl3)
• Main Authors: Marmor, William, Gruber, Simone, Nguyen, Joseph, Shubin Stein, Beth, Dennis, Elizabeth
• Format: Article
• Language: English
• Subjects: Orthopedics; Patients; Sports medicine; Surgery
• ISSN: 2325-9671; 2325-9671
• DOI: 10.1177/2325967121S00557

Objectives: It is not currently understood which subset of patients with recurrent patellofemoral instability require concomitant bony realignment procedures in addition to a soft tissue stabilization. Additionally, the optimal timing of surgical intervention is not well defined by current literature and can be dictated by the skeletal maturity of a patient. If the patient’s complete pathology is not addressed at their primary procedure, there can be a high risk of recurrent instability necessitating revision surgery. It is not known if the outcomes of medial patellofemoral reconstruction with concomitant tibial tubercle osteotomy (MPFL+TTO) performed as a revision procedure equate the outcomes of MPFL+TTO performed in the primary setting. This study compares patients who underwent primary MPFL+TTO versus those who underwent the same procedure in the revision setting. Methods: Patients who underwent a MPFL+TTO from March 2014 to December 2018 were identified from an institutional patellofemoral registry. Patients were separated into two groups, those undergoing a primary MPFL+TTO and those undergoing a MPFL+TTO after a previously failed surgical attempt for patellar stabilization. Baseline demographic, radiographic, and knee-specific patient reported outcome measures (PROMs) including KOOS QOL, Pedi-Fabs, IKDC, KOOS-PS, and Kujala were collected prior to surgery and at 1- and 2-years following surgical intervention. Return to sport (RTS) rates and recurrent instability events were also collected. Results: 92 knees (84 patients) were included; 59 in the primary group and 33 in the revision group. No differences were identified between the groups with respect to sex (85% vs. 82%, p=0.715), age (23.7 vs. 22.5, p=0.468), BMI (26.3 vs 24.5, p=0.144), TT-TG (20.3 vs 19.3, p=0.238), or patella alta (33% vs 19%, p=0.354). Previous procedures in the revision cohort included 12 MPFL reconstructions, 3 tibial tubercle transfers, 16 lateral releases, 9 imbrications/reefings/plications, 7 loose body removals and 9 chondroplasties. 53 (90%) patients in the primary group and 29 (88%) patients in the revision group had a minimum of 2-year follow-up. There was no difference between the groups for recurrent dislocation (4% vs 0%, p=0.547), recurrent subluxation (9% vs 0%, p=0.162) and RTS (88% vs 83%, p=0.713). In regard to RTS, 79% of the primary surgery group and 71% of the revision group returned at an equal or higher level (p=0.461). At baseline, the primary group had a