Patients undergoing medial patellofemoral ligament reconstruction return to sport sooner and at a higher level than those undergoing concomitant tibial tubercle osteotomy.
Academic Article
Overview
abstract
PURPOSE: The purpose of the study was to compare time to return to sport between patients undergoing isolated medial patellofemoral ligament reconstruction (MPFL-R) and patients undergoing MPFL-R and concomitant TTO (MPFL-TTO) for recurrent patellofemoral instability. METHODS: A retrospective chart review of prospectively collected data was conducted to identify consecutive patients who underwent primary isolated MPFL-R or MPFL-TTO. Exclusion criteria included concomitant cruciate ligament surgery, multi-ligament surgery, failed previous surgery and <1 year follow-up. Patient demographic information, surgical data, radiographic data, return to sport, and re-dislocation rates were recorded. Pre-operative and post-operative functional outcome scores (Kujala, IKDC), activity level (Pedi-FABS), and health-related quality of life (KOOS-PS, KOOS-QOL) were compared. RESULTS: One hundred and seventy-eight patients were included in the study. One hundred and nineteen patients (74% female) underwent isolated MPFL-R, and 59 patients (85% female) underwent MPFL-TTO. Patients who underwent MPFL-R returned to sport at 9.5 ± 3.9 months, and patients who underwent MPFL-TTO returned to sport at 12.9 ± 11.0 months (p = 0.011). Patients who underwent isolated MPFL-R had a significantly higher return to the same or higher level of sport compared to MPFL-TTO (85% vs. 66%, p = 0.018). Both cohorts showed significant improvement in KOOS, IKDC, and Kujala scores at all follow-ups (p < 0.001). CONCLUSION: Patients who underwent both isolated MPFL-R and MPFL-TTO had excellent return to sport rates, with isolated MPFL-R patients reporting significantly higher rates of return to the same or higher level of sport. The MPFL-R group returned to sport faster than those who had a concomitant TTO, with no difference in rates of recurrent instability. Patient-reported outcomes for both groups were significantly improved at 5 years postoperatively. The results of this study contribute to the growing body of literature supporting excellent long-term functional recovery with low rates of recurrent instability after isolated MPFL-R or MPFL-TTO. LEVEL OF EVIDENCE: Level III, cohort study.
