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Outcomes and reoperation rates after tibial tubercle transfer and medial patellofemoral ligament reconstruction: higher revision stabilization in patients with trochlear dysplasia and patella alta

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To determine the reoperation rate, risk factors for reoperation, and patient-reported outcomes after isolated or combined tibial tubercle transfer and medial patellofemoral ligament reconstruction, for patellofemoral instability surgery.

Methods

Patient’s records who underwent medial patellofemoral ligament reconstruction and/or tibial tubercle transfer for patellar instability by 35 surgeons from 2002 to 2018 at a single academic institution were retrospectively reviewed using CPT codes. Four-hundred-and-eighty-six patients were identified. Radiographic measurements, demographic parameters, and subsequent revision procedures and their indications were identified. A modified anterior knee pain survey was conducted by mail and with follow-up phone survey.

Results

The overall rate of reoperation was 120/486 (24.7%). The most common cause for reoperation was removal of hardware 42/486 (8.6%). The rate of reoperation for isolated medial patellofemoral ligament reconstruction 43/226 (19%) was lower than that of isolated tibial tubercle transfer 45/133 (33.8%) or a combined procedure 32/127 (25.2%) (P = 0.007). Woman had a higher rate of reoperation (29.4%) compared to men (15.9%) (P = 0.002). Patients at risk for a revision stabilization procedure included those with severe trochlear morphology (C or D) (6.1%) and those with Caton–Deschamps index > 1.3 (7.3%). Patients who underwent reoperation of any kind had poorer patient-reported outcomes.

Conclusion

The overall reoperation rate after patellofemoral instability surgery remains high, and any reoperation portends worse patient-reported outcomes. Re-operations for instability are more likely in patients with trochlear dysplasia and patella alta and may benefit from more aggressive initial treatment, such as medial patellofemoral ligament reconstruction and tibial tubercle transfer in combination. Using the results of this study, surgeons will be able to engage in meaningful discussion with patients to counsel patients on expectations postoperatively.

Level of evidence

IV.

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Funding

No funding was received for this study.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Atrium Health, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC, 28207, USA

    Jacob D. Gorbaty

  2. OrthoCarolina Sports Medicine Center, 1915 Randolph Road, Charlotte, NC, 28207, USA

    Dax T. Varkey, Ian S. Hong, Dana P. Piasecki, Bryan M. Saltzman & James E. Fleischli

  3. Musculoskeletal Institute, Atrium Health, 1320 Scott Ave, Charlotte, NC, 28203, USA

    Ian S. Hong, Susan M. Odum, Dana P. Piasecki, Bryan M. Saltzman & James E. Fleischli

  4. Department of Orthopaedics, New York Presbyterian, Columbia University Medical Center, 622 West 168th St, PH 11-1130, New York, NY, 10032, USA

    David P. Trofa

  5. OrthoCarolina Research Institute, 2001 Vail Ave Suite #300, Charlotte, NC, 28207, USA

    Susan M. Odum

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  1. Jacob D. Gorbaty
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Corresponding author

Correspondence to Bryan M. Saltzman.

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Conflict of interest

The authors declare no direct conflict of interest related to the study. However, author S.M.O. has received consulting fees from American Joint Replacement Registry. D.P.P. is a paid presenter for Zimmer. B.M.S. received publishing royalties, financial or material support from Nova Science Publishers. J.E.F. received research support from Arthrix and Smith & Nephew.

Ethical approval

This study was IRB approved, Pro00024253.

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Gorbaty, J.D., Varkey, D.T., Hong, I.S. et al. Outcomes and reoperation rates after tibial tubercle transfer and medial patellofemoral ligament reconstruction: higher revision stabilization in patients with trochlear dysplasia and patella alta. Knee Surg Sports Traumatol Arthrosc 30, 2227–2234 (2022). https://doi.org/10.1007/s00167-021-06784-5

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  • DOI: https://doi.org/10.1007/s00167-021-06784-5

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