Skip to main content
Log in

Clinical outcome in MPFL reconstruction with and without tuberositas transposition

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

There are several surgical options for recurrent patella dislocations. As the reconstruction of the medial patellofemoral ligament (MPFL) has been proven to restore stability, it has become more accepted. Aim of this study was to investigate the clinical outcome after MPFL reconstruction as an isolated procedure or in association with a transposition of the tibial tubercle (in case of patella alta or an excessive TT–TG) in a large prospective cohort study. Additionally, the effect on patellar height was analysed radiographically using the Caton–Deschamps index.

Methods

In a large prospective cohort study of 129 knees in 124 patients (81 females, 48 males, mean age 22.8 ± 7.7 years), 91 knees received primary MPFL reconstruction (group 1) and 38 were a combination with a transposition of the tibial tubercle (group 2). The clinical follow-up was evaluated using KOOS and Kujala scores preoperatively and 1 year postoperatively. Patient satisfaction, complications and revision surgery were recorded.

Results

Overall, Kujala improved significantly from 53.5 (SD 22.7) preoperatively to 74.7 (SD 20.5) postoperatively (p < 0.01). All KOOS subdomains improved significantly (p < 0.01). No significant difference for Kujala score between groups was noticed. Revision rate was (5/129) 3.9 %. Reconstruction was supplemented with a transfer of the tibial tuberosity in (38/129) 29.4 % of the cases and shows a comparable outcome.

Conclusion

MPFL reconstruction is a viable treatment option for episodic patellar dislocation. A concomitant tuberositas transposition is useful in selected patients.

Level of evidence

I.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Bellemans J, Witvrouw E, Brys P, Victor J (1997) Anteromedial tibial tubercle transfer in patients with chronic anterior knee pain and a subluxation-type patellar malalignment. Am J Sports Med 25(3):375–381

    Article  CAS  PubMed  Google Scholar 

  2. Buckens CF (2010) Reconstruction of the medial patellofemoral ligament for treatment of patellofemoral instability: a systematic review. Am J Sports Med 38:181–188

    Article  PubMed  Google Scholar 

  3. Caton J, Walch G, Levigne C, Michel CR (1990) Idiopathic high patella in adolescents. Apropos of 61 surgical cases. Rev Chir Orthop Reparatrice Appar Mot 76(4):253–260

    CAS  PubMed  Google Scholar 

  4. Deie M, Sumen Y, Adachi N, Kobayashi K, Yasumoto M (2005) A long-term follow-up study after medial patellofemoral ligament reconstruction using the transferred semitendinosus tendon for patellar dislocation. Knee Surg Sports Traumatol Arthrosc 13:522–528

    Article  PubMed  Google Scholar 

  5. Dejour H, Nove-Josserand L, Guier C (1994) Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 2(1):19–26

    Article  CAS  PubMed  Google Scholar 

  6. Desio SM, Bachus KN (1998) Soft tissue restraints to lateral patellar translation in the human knee. Am J Sports Med 26(1):59–65

    Article  CAS  PubMed  Google Scholar 

  7. Drez D, Williams CS (2001) Results of medial patellofemoral ligament reconstruction in the treatment of patellar dislocation. Arthroscopy 17:298–306

    Article  PubMed  Google Scholar 

  8. Earhart C, White EA, Gottsegen CJ, Forrester DM, Matcuk GR Jr (2013) Transient lateral patellar dislocation: review of imaging findings, patellofemoral anatomy, and treatment options. Emerg Radiol 20(1):1073–1079

    Article  Google Scholar 

  9. Enderlein D, Christiansen SE, Faunø P, Lind M (2014) Clinical outcome after reconstruction of the medial patellofemoral ligament in patients with recurrent patella instability. Knee Surg Sports Traumatol Arthrosc 22(10):2458–2464

    Article  PubMed  Google Scholar 

  10. Howells NR, Ahearn N, Ansari A, Eldridge JD (2012) Medial patellofemoral ligament reconstruction: a prospective outcome assessment of a large single centre series. J Bone Joint Surg Br 94(9):1202–1208

    Article  CAS  PubMed  Google Scholar 

  11. Fulkerson JP (1983) Anteromedialization of the tibial tuberosity for patellofemoral malalignment. Clin Orthop Relat Res 177:176–181

    Google Scholar 

  12. Kita K, Toritsuka Y, Nakamura N, Tanaka Y, Yonetani Y, Mae T, Nakata K, Yoshikawa H, Shino K (2012) Effects of medial patellofemoral ligament reconstruction on patellar tracking. Knee Surg Sports Traumatol Arthrosc 20(5):829–837

    Article  PubMed  Google Scholar 

  13. Kujala UM, Koskinen SK, Taimela S, Hurme M, Nelimarkka O (1993) Scoring of patellofemoral disorders. Arthroscopy 9(2):159–163

    Article  CAS  PubMed  Google Scholar 

  14. Li J, Wei J, Wang J, Gao S, Shen Y (2014) A simple technique for reconstruction of medial patellofemoral ligament with bone-fascia tunnel fixation at the medial margin of the patella: a 6-year-minimum follow-up study. J Orthop Surg Res 9(1):66

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Lippacher S, Williams SR, Reichel H, Nelitz M (2014) Reconstruction of the medial patellofemoral ligament: clinical outcomes and return to sports. Am J Sports Med 42(7):1661–1668

    Article  PubMed  Google Scholar 

  16. Matsushita T, Kuroda R, Oka S, Matsumoto T, Takayama K, Kurosaka M (2014) Clinical outcomes of medial patellofemoral ligament reconstruction in patients with an increased tibial tuberosity–trochlear groove distance. Knee Surg Sports Traumatol Arthrosc 22(10):2438–2444

    Article  PubMed  Google Scholar 

  17. McCarthy M, Bollier M, Wolf B, Albright J, Amendola A (2013) Femoral tunnel placement in medial patellofemoral ligament reconstruction. Iowa Orthop J 33:58–63

    PubMed  PubMed Central  Google Scholar 

  18. Nelitz M, Lippacher S, Reichel H, Dornacher D (2014) Analysis of failure and clinical outcome after unsuccessful medial patellofemoral ligament reconstruction in young patients. Int Orthop 38(11):2265–2272

    Article  PubMed  Google Scholar 

  19. Nomura E, Kihara M (2000) Medial patellofemoral ligament restraint in lateral patellar translation and reconstruction. Knee 7:121–127

    Article  CAS  PubMed  Google Scholar 

  20. Sillanpää P, Visuri T, Mäenpää H, Pihlajamäki H (2008) Ligament reconstruction versus distal realignment for patellar dislocation. Clin Orthop Relat Res 466:1475–1484

    Article  PubMed  PubMed Central  Google Scholar 

  21. Panni AS, Cerciello S, Vasso M, Maffulli N (2011) Medial patellofemoral ligament reconstruction with a divergent patellar transverse 2-tunnel technique. Am J Sports Med 39(12):2647–2655

    Article  PubMed  Google Scholar 

  22. Schöttle PBFS, Romero J (2005) Clinical and radiological outcome of medial patellofemoral ligament reconstruction with a semitendinosis autograft for patella instability. Knee Surg Sports Traumatol Arthrosc 13:516–521

    Article  PubMed  Google Scholar 

  23. Schottle PBSA, Rosenstiel N, Weiler A (2007) Radiographic landmarks for femoral tunnel placement in medial patellofemoral ligament reconstruction. Am J Sports Med 35:801–804

    Article  PubMed  Google Scholar 

  24. Senavongse W (2005) The effects of articular, retinacular, or muscular deficiencies on patellofemoral joint stability: a biomechanical study in vitro. J Bone Joint Surg Br 87(4):577–582

    Article  CAS  PubMed  Google Scholar 

  25. Servien E, Neyret P (2007) Tibial tuberosity transfer for episodic patellar dislocation. Sports Med Arthrosc 15(2):61–67

    Article  PubMed  Google Scholar 

  26. Shah JN, Flanigan DC, Brophy RH, Carey JL, Lattermann C (2012) A systematic review of complications and failures associated with medial patellofemoral ligament reconstruction for recurrent patellar dislocation. Am J Sports Med 40(8):1916–1923

    Article  PubMed  PubMed Central  Google Scholar 

  27. Sherman SL, Cvetanovich GL, Chalmers PN, Farr J 2nd, Bach BR Jr, Cole BJ (2013) Tibial tuberosity osteotomy: indications, techniques, and outcomes. Am J Sports Med 42(8):2006–2017

    Article  PubMed  Google Scholar 

  28. Siebold R, Fernandez F (2014) Clinical outcome after medial patellofemoral ligament reconstruction and autologous chondrocyte implantation following recurrent patella dislocation. Knee Surg Sports Traumatol Arthrosc 22(10):2477–2483

    Article  PubMed  Google Scholar 

  29. Singhal R, Charalambous CP (2013) Double-bundle medial patellofemoral ligament reconstruction with hamstring tendon autograft and mediolateral patellar tunnel fixation: a meta-analysis of outcomes and complications. Bone Joint J 95-B(7):900–905

    Article  CAS  PubMed  Google Scholar 

  30. Slenker NR, Pepe MD, Marchetto PA, Cohen SB (2013) Short-/intermediate-term outcomes after medial patellofemoral ligament reconstruction in the treatment of chronic lateral patellofemoral instability. Phys Sportsmed 41(2):26–33

    Article  PubMed  Google Scholar 

  31. Song SY, Kim IS, Chang HG, Shin JH, Kim HJ, Seo YJ (2014) Anatomic medial patellofemoral ligament reconstruction using patellar suture anchor fixation for recurrent patellar instability. Knee Surg Sports Traumatol Arthrosc 22(10):2431–2437

    Article  PubMed  Google Scholar 

  32. Steiner TM, Teitge RA (2006) Medial patellofemoral ligament reconstruction in patients with lateral patellar instability and trochlear dysplasia. Am J Sports Med 34:1254–1261

    Article  PubMed  Google Scholar 

  33. Verdonk P, Selmi T (2007) Chirurgie du genou: my knee practice. Masson, Paris

    Google Scholar 

  34. Wagner D, Hingelbaum S, Huth J, Mauch F, Bauer G (2013) The influence of risk factors on clinical outcomes following anatomical medial patellofemoral ligament (MPFL) reconstruction using the gracilis tendon. Knee Surg Sports Traumatol Arthrosc 21(2):318–324

    Article  PubMed  Google Scholar 

  35. Witoński D, Synder M, Sibiński M (2013) An isolated medial patellofemoral ligament reconstruction with patellar tendon autograft. Biomed Res Int 637–678

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to D. Lambrecht.

Additional information

A. Mulliez and D. Lambrecht have contributed equally to this article.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mulliez, A., Lambrecht, D., Verbruggen, D. et al. Clinical outcome in MPFL reconstruction with and without tuberositas transposition. Knee Surg Sports Traumatol Arthrosc 25, 2708–2714 (2017). https://doi.org/10.1007/s00167-015-3654-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-015-3654-0

Keywords

Navigation