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Surgical treatment of patellar instability: clinical and radiological outcome after medial patellofemoral ligament reconstruction and tibial tuberosity medialisation

  • Arthroscopy and Sports Medicine
  • Published:
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Abstract

Introduction

The aim of this retrospective study was to analyse clinical and radiological outcome after medial patellofemoral ligament reconstruction (MPFLR) and tibial tuberosity medialisation (TTM) in patients with recurrent patellar instability.

Materials and methods

Thirty-five patients were included between 2008 and 2012. According to defined criteria such as tibial tuberosity-trochlear groove (TTTG) distance, hyperpression on the lateral patella facet and lateral retropatellar cartilage damage either MPFLR (group A) or TTM (group B) was performed: 18 patients underwent TTM, the other 17 patients underwent MPFLR. At a mean of 25.4 ± 9.7 (group A) and 35.2 ± 17.6 months (group B) patients were clinically and radiologically reviewed. Validated knee scores such as Kujala, Lysholm and Tegner score were evaluated.

Results

In both groups one patient reported of a non-traumatic patellar redislocation. Patients who underwent MPFLR (group A) had less pain postoperatively during activity according to the Visual Analogue Scale (group A: 2.0 ± 2.1 points, group B: 3.9 ± 2.3 points). Retropatellar cartilage damage increased in group B from grade 1 (range: 1–3) preoperatively to grade 2 (range 1–3) postoperatively (p > 0.05). All other clinically evaluated items, as well as the applied knee scoring systems, indicated no significant difference (p > 0.05) and displayed good to excellent results.

Conclusions

MPFLR and TTM leed to good clinical results despite its own indications. For this reason—in selected cases—TTM may still be a suitable procedure for surgical treatment of patellar instability. However, patients treated by TTM (group B) revealed an increased retropatellar cartilage damage as well as significantly more pain during activity.

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Authors and Affiliations

  1. Department of Orthopaedics, Trauma Surgery and Sports Medicine, Johanna-Etienne Hospital Neuss, Neuss, Germany

    Stefan Lobner

  2. Sports Clinic of Stuttgart, Stuttgart, Germany

    Christine Krauss

  3. Department of Rheumatology and Arthroscopy, Marienkrankenhaus Duesseldorf-Kaiserswerth, Duesseldorf, Germany

    Stefan Lobner, Christine Krauss, Frank Reichwein, Wolfgang Nebelung & Arne J. Venjakob

  4. Department of Orthopaedics, University Hospital of Duesseldorf, Duesseldorf, Germany

    Thilo Patzer

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  1. Stefan Lobner
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Correspondence to Stefan Lobner.

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Author Stefan Lobner, Author Christine Krauss, Author Frank Reichwein, Author Thilo Patzer, Author Wolfgang Nebelung, and Author Arne J. Venjakob declare that they have no conflict of interest.

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Lobner, S., Krauss, C., Reichwein, F. et al. Surgical treatment of patellar instability: clinical and radiological outcome after medial patellofemoral ligament reconstruction and tibial tuberosity medialisation. Arch Orthop Trauma Surg 137, 1087–1095 (2017). https://doi.org/10.1007/s00402-017-2705-z

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  • DOI: https://doi.org/10.1007/s00402-017-2705-z

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