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

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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.

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Most cited references 46

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Radiographic landmarks for femoral tunnel placement in medial patellofemoral ligament reconstruction.

Philip Schöttle, Arno Schmeling, Nikolaus Rosenstiel … (2007)

Reconstruction of the medial patellofemoral ligament has recently become popular for restoring patellofemoral stability. Femoral insertion site anatomy of the medial patellofemoral ligament has been described. This anatomical insertion has been inferred to be the isometric point in medial patellofemoral ligament reconstruction, but data about radiographic landmarks for a postoperative or intraoperative control are missing. To determine the radiographic landmarks for control of postoperative and intraoperative femoral medial patellofemoral ligament insertion. Descriptive laboratory study. Eight fresh-frozen human knees were dissected, and the medial patellofemoral ligament was exposed. After identification of the femoral medial patellofemoral ligament insertion site, the insertion center was marked with a lead ball of 2-mm diameter. Straight lateral radiographs were taken, and posterior-anterior as well as proximal-distal position were evaluated. Six of 8 insertion points were anterior to a line representing an extension of the posterior cortex, 1 point was touching this line, and 1 point was posterior to it. All points were situated distal to the posterior origin of the medial femoral condyle and proximal to the most posterior point of the Blumensaat line. A reproducible anatomical and radiographic point, 1 mm anterior to the posterior cortex extension line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to the level of the posterior point of the Blumensaat line on a lateral radiograph with both posterior condyles projected in the same plane, shows the mean femoral medial patellofemoral ligament center. This radiographic point may be useful both intraoperatively and postoperatively.

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Scoring of patellofemoral disorders

Urho M Kujala, Laura H. Jaakkola, Seppo K Koskinen … (1993)

A new questionnaire was used to evaluate subjective symptoms and functional limitations in patellofemoral disorders. The questionnaire was completed independently by four groups of female subjects: controls (N = 17), and subjects with anterior knee pain (N = 16), patellar subluxation (N = 16), and patellar dislocation (N = 19). The questionnaire mean scores for the groups were 100, 83, 68, and 62 points, respectively (p < 0.0001). The items dealing with abnormal painful patellar movements (subluxations) (p < 0.0001), limp (p < 0.0001), pain (p < 0.0001), running (p < 0.0001), climbing stairs (p < 0.0001), and prolonged sitting with the knees flexed (p < 0.0001) differentiated the study groups most clearly. We recommend that these questions be asked when taking a standardized clinical history of an anterior knee pain patient. We also analyzed lateral patellar tilt and displacement by magnetic resonance imaging (MRI) in 28 subjects with patellar subluxation or dislocation. Low questionnaire sum score correlated best with increased lateral patellar tilt measured during quadriceps contraction in 0 degree knee flexion. It seems that a tendency to lateral patellar tilt during quadriceps contraction causes anterior knee pain and can be imaged in knee extension when the patella is not fully supported by femoral condyles.

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Outcomes After Isolated Medial Patellofemoral Ligament Reconstruction for the Treatment of Recurrent Lateral Patellar Dislocations: A Systematic Review and Meta-analysis.

Daniel Schneider, Brian Grawe, Robert Magnussen … (2016)

A patellar dislocation is a common knee injury in the young, athletic patient population. Recent trends indicate that the use of long-term nonoperative treatment is decreasing, and surgical intervention is more commonly recommended for those patients who fail initial nonoperative management with recurrent patellar dislocations. Medial patellofemoral ligament (MPFL) reconstruction has become increasingly utilized in this regard.

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Author and article information

Contributors

Yusuke Hashimoto:

ORCID: https://orcid.org/0000-0001-8138-5341

hussyyomu@omu.ac.jp

Journal

Journal ID (nlm-ta): BMC Musculoskelet Disord

Journal ID (iso-abbrev): BMC Musculoskelet Disord

Title: BMC Musculoskeletal Disorders

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2474

Publication date (Electronic): 23 January 2023

Publication date PMC-release: 23 January 2023

Publication date Collection: 2023

Volume: 24

Electronic Location Identifier: 56

Affiliations

[1 ]GRID grid.258799.8, ISNI 0000 0004 0372 2033, Department of Orthopaedic Surgery, , Osaka Metropolitan University Graduate School of Medicine, ; Osaka, Japan

[2 ]GRID grid.415744.7, ISNI 0000 0004 0377 9726, Department of Orthopaedic Surgery, , Shimada Hospital, ; Habikino, Japan

Author information

Yusuke Hashimoto https://orcid.org/0000-0001-8138-5341

Article

Publisher ID: 6100

DOI: 10.1186/s12891-022-06100-3

PMC ID: 9869604

PubMed ID: 36683021

SO-VID: 8bdd13f0-0a64-44df-84de-70c97e027836

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 27 August 2022

Date accepted : 19 December 2022

Custom metadata

ScienceOpen disciplines: Orthopedics

Keywords: medial patellofemoral ligament reconstruction,postoperative osteoarthritis,anteromedialization,tibial tubercle osteotomy

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ScienceOpen disciplines: Orthopedics

Keywords: medial patellofemoral ligament reconstruction, postoperative osteoarthritis, anteromedialization, tibial tubercle osteotomy

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

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Most cited references 46

Radiographic landmarks for femoral tunnel placement in medial patellofemoral ligament reconstruction.

Scoring of patellofemoral disorders

Outcomes After Isolated Medial Patellofemoral Ligament Reconstruction for the Treatment of Recurrent Lateral Patellar Dislocations: A Systematic Review and Meta-analysis.

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